Arrhythmia Treatment

Arrhythmias are abnormal heart rhythms caused by problems with the heart’s conduction or electrical system, genetics, underlying heart disease, aging, and other conditions like diabetes or high blood pressure. A rhythm that is too slow is called bradycardia, and a rhythm that is too fast is called tachycardia. Other times, normal heart rhythms can be interrupted by early or extra heartbeats. 

Abnormal heart rhythms may make your heart feel like it is fluttering, pounding, or skipping beats. These are called heart palpitations. Other symptoms include chest discomfort, shortness of breath, dizziness, fainting, fatigue, weakness, limited exercise tolerance, and more. When left untreated, some arrhythmias can lead to life-threatening complications like sudden cardiac death, heart muscle damage, heart failure, and stroke.

Your doctor will conduct an evaluation and physical exam. Additional tests may be ordered to accurately diagnose an arrhythmia.

Blood Tests
Blood tests measure substances in your blood, like electrolytes, hormones, and medications. They can also look for genetic causes of arrhythmias.

Electrocardiogram (EKG)
Small adhesive electrodes placed on the skin record your heart’s electrical activity over a short period of time.

Imaging Scans

• An echocardiogram (also called an echo) is an ultrasound of the heart that assesses its size, shape, and function. 
• A cardiac MRI scan uses magnets to capture images of your heart. 
• A CT scan uses X-rays to take images of your heart in layers. 

Heart Monitors
Wearable monitors can record your heart rhythm continuously for at least 24 hours, and for up to two weeks. Some only record abnormal heart rhythms when they occur and can be worn for up to 30 days. Wearable heart monitors use electrodes placed on the surface of your skin with an adhesive patch. Insertable loop monitors are surgically implanted under your skin.

Stress Test
Your heart rhythm is evaluated while you exercise on a treadmill or stationary bicycle.

Tilt Table Test
Your heart’s pulse and rhythm and your blood pressure are measured while you lie on a table that is tilted to an upright (near standing) position. This can help diagnose arrhythmias that may cause fainting.

Electrophysiology (EP) Study and Catheter Mapping
In a special EP lab, thin and flexible tubes called catheters are inserted through a small incision into a large blood vessel (usually in the groin), and carefully guided to your heart. Specialized electrophysiologists use catheters or medications to stimulate your heart’s abnormal rhythm and pinpoint its origin. 

It’s important to seek care at a center like Duke, where our electrophysiologists specialize in treating different types of arrhythmias based on their causes, severity, and symptoms. Your treatment plan may include medications, procedures, implanted devices, and/or other therapies to maintain your heart’s normal rhythm. You may need one or more of the following treatments.

Noninvasive Treatments

Lifestyle Changes: Your doctor may recommend making changes to your daily lifestyle, like eating healthier, exercising more, lowering blood pressure, and managing sleep apnea. You may also need to avoid alcohol, certain medications, and activities that can trigger arrhythmia episodes.

Medications: Medications can regulate your heart rate and reduce risks associated with arrhythmias. Some medications suppress heart rhythm disturbances, and others shorten their duration. Some medications may require you to be hospitalized for a few days to ensure that you can tolerate them.

Procedures and Surgery

Cardioversion: Carefully applied electrical shocks or medications quickly restore a normal heart rhythm. 

Cardiac Ablation: This minimally invasive procedure -- also called catheter ablation -- is usually performed following an EP study and catheter mapping. Using a thin, flexible tube inserted in a blood vessel, an electrophysiologist applies heat, cold, or electricity to destroy the area(s) of the heart where abnormal heartbeats originate. Cardiac ablation may cure an arrhythmia or dramatically reduce how often it occurs. We offer the full range of advanced ablation techniques in our specialized EP labs.

Surgical Ablation: Like catheter ablation, this technique uses heat or cold to destroy the area(s) of the heart where irregular heartbeats originate. However, this approach requires surgeons to operate on your heart through an incision in your muscle or chest. Surgical ablation is usually reserved for people who are already undergoing open heart surgery or who have not benefited enough from other ablation procedures. You may undergo hybrid ablation, during which a minimally invasive surgical approach is paired with catheter ablation. 

Left Atrial Appendage Closure: Atrial fibrillation can lead to blood clots and strokes. Left atrial appendage closure devices are an alternative to blood thinners, which may be prescribed to help prevent these complications. The devices close or seal off part of the top chamber of the heart, known as the left atrial appendage, where blood clots tend to form. Duke was the first hospital in North Carolina to offer left atrial appendage closure after its FDA approval. 

Surgically Implanted Devices

These battery-powered devices are placed during minimally invasive surgical procedures, usually in an EP lab. Wires or “leads” connect the device to the heart. Following device implantation, we provide comprehensive, long-term care to ensure your device functions properly.

Pacemaker: When the heart beats too slowly, this device is implanted in the chest and delivers electrical impulses that maintain a normal heart rhythm. Duke was one of the first centers in the country to offer leadless pacemakers, which provide important advantages to the right candidates.

Cardiac Resynchronization Therapy (CRT): Abnormalities in the “conduction cables” of the heart can lead to uncoordinated heartbeats. Cardiac resynchronization therapy (CRT) paces your upper and lower heart chambers to restore normal timing and can be beneficial if you have heart failure and an arrhythmia.

Implantable Cardioverter Defibrillator (ICD): This electrical device monitors your heart rhythm continuously and delivers an electrical shock to restore a normal heartbeat if it detects a life-threatening arrhythmia. ICDs can prevent sudden cardiac death caused by abnormal heart rhythms. 

Lead Extraction for Implanted Cardiac Devices
If leads from an implanted device malfunction, fracture, or become infected, our electrophysiologists and surgeons work together to remove the leads without the need for open heart surgery. 

Experienced Team of Electrophysiologists
Our board-certified electrophysiologists treat thousands of people with arrhythmias each year. Our expertise ranges from the most common arrhythmias to the most complex and rare conditions. Our program has received awards and distinctions for leadership in treating heart rhythm disorders and delivering high-quality care. Our doctors, nurses, and other providers have advanced training; many of them are members of heart rhythm organizations and have completed special certification programs. We are continually developing and evaluating innovative treatment strategies and technologies. Our research and expertise help set standards for arrhythmia treatment nationwide.

Leading Research Efforts in New Arrhythmia Treatments 
Our electrophysiologists are part of research efforts to develop and evaluate innovative treatment strategies. Our research has been published in prominent medical journals, and our program is visited by professional peers from all over the world.

Sophisticated Mapping Techniques
Cardiac ablation procedures are performed by electrophysiologists who are trained in the most advanced mapping and ablation techniques available. These include high-density substrate mapping and activation mapping using advanced electromagnetic mapping systems, irrigated contact force-sensing catheters, cryothermal ablation, and other emerging technologies. These methods reduce the need for repeat procedures. 

Recognized Leaders in Lead Extraction 
Duke is a regional and national referral center for the safe removal of leads in people with complicated conditions and is well known for achieving positive outcomes. Our experience and excellent results have been featured in major medical journals and presented at international cardiology meetings. Providers come from all over the world to train with our program. 

Options for High-Risk Patients
We assess and care for people who have undergone catheter or surgical ablation without success. We provide hope to those with complex heart rhythm conditions who have been turned away elsewhere.

Skilled Geneticists
Our genetic heart disease program is staffed by experts who administer and interpret the complex tests to identify inherited heart rhythm disorders such as long QT and Brugada syndromes. Pinpointing the cause of your arrhythmia helps us take a proactive approach to treatment, prevents the possibility of sudden cardiac death, and ensures your family is well-informed of any increased risk.