Tachyarrhythmia is an abnormally fast heart rate (usually 100 to 400 beats) in either the upper heart chambers or lower heart chambers. Treatment for these rhythm disorders depends on whether the fast heart rhythm is in the upper heart chambers (atrial tachyarrhythmia) or lower heart chambers (ventricular tachyarrhythmia).

• Too fast lower heart chambers
• Too fast upper hart chambers

Too fast lower heart chambers; Ventricular Tachyarrhythmia
Treatment depends on the type of tachyarrhythmia:

• Ventricular Tachycardia (VT) is when the heart beats too quickly at rest and the electrical signals start in the lower chambers (ventricles).
  
  
  
• Ventricular Fibrillation (VF) is a very fast, irregular heart rhythm in the lower chambers (ventricles) of the heart. VF is more serious than VT because the heart's electrical system and pumping cycle are completely disorganized. The ventricles quiver and little or no blood is pumped to the body. When the heart does not pump blood, the body is quickly starved of oxygen and Sudden Cardiac Arrest occurs. If left untreated, death will occur in minutes.

Treatment Options for Ventricular Tachycardia
Your heart specialist will determine the treatment that is best for your medical condition. Treatments for a ventricular tachycardia include the following options.

• Medications to reduce the heart rate
  Many antiarrhythmic medications are available for people with ventricular tachycardias. Medications do not cure the arrhythmia. Instead, they suppress the beginning of a tachyarrhythmia episode.
  
  
  
• Implantable defibrillator to reset the heart rhythm
  The defibrillator is a small metal case that contains electronics and a battery. It is similar to a pacemaker in that it is designed to correct arrhythmias. But while a pacemaker increases a slow heart rate, a defibrillator detects and corrects fast heart rates. Some defibrillation systems can also detect and treat a slow heart rhythm (bradycardia).
  
  
  
• Ablation to eliminate the small area of heart tissue causing the arrhythmia
  Ablation is a procedure that destroys the specific area of the heart that begins the abnormally fast signals. First, the specific area of the heart that is causing the abnormal signals is located (endocardial mapping). Then, either radiofrequency waves or small incisions are used to destroy or stop that heart tissue from sending any signals.

Treatment Options for Ventricular Fibrillation
There are two phases to treatment after ventricular fibrillation has suddenly stopped the heart from pumping blood to the body (sudden cardiac arrest). The first phase, or emergency phase, keeps blood flowing through the body until the electrical system of the heart is restarted.

• Emergency:
  Cardiopulmonary resuscitation is the mechanical pushing of the heart (hands pushing on rib cage) and breathing (through the mouth) done in a rhythmic pattern. These actions keep blood and oxygen circulating through the body until emergency help arrives.
  
  
  
• Emergency:
  External defibrillation is an electric shock given to the heart through paddles placed on the chest. External defibrillation may be done using a manual external defibrillator or an automated external defibrillator (AED).

After a person is revived from sudden cardiac arrest, the second phase of treatment begins at the hospital. Diagnostic tests may provide details about the medical condition that caused the sudden cardiac arrest. A heart rhythm specialist will use results from diagnostic tests and a person's medical history to determine treatment options.

• Medication may be used to prevent an abnormal heart rhythm (antiarrhythmic drugs).
• If testing reveals rapid, irregular heartbeats in the lower heart chambers (ventricular fibrillation), an implantable defibrillator may be prescribed to treat the fibrillation when it occurs and return the heart to a more normal rhythm.

top

Too fast upper heart chambers; Atrial Tachyarrhythmia

When the heart beats too quickly and the signals start in the upper heart chambers (atria), the tachyarrhythmia is called an atrial tachyarrhythmia. Atrial flutter and atrial fibrillation are specific types of atrial tachyarrhythmias.

• Atrial Flutter
  is a rapid, regular heartbeat in which the atria pump very rapidly. Although the atria beat at a rate of 250 to 350 beats per minute, the ventricles beat at about half that rate. With atrial flutter, the ventricular rate (your pulse) would be about 125 to 175 beats per minute. When the ventricles beat this fast, blood is not pumped as efficiently as it is during normal sinus rhythm. Symptoms may be a pounding of the heart or heart palpitations. Atrial flutter is generally not life threatening.
  
  
  
• Atrial Fibrillation (AF)
  is an irregular and sometimes rapid heart rhythm found in over 2 million Americans. In AF, the atria quiver instead of pumping effectively. Blood in the atria may pool and clot. If the clot breaks loose and travels to the brain, a stroke can result. About 15 percent of strokes occur in people with atrial fibrillation.

Sinus Rhythm	Atrial Fibrillation

Treatment Options for Atrial Flutter
Diagnostic tests may provide details about the medical condition that caused atrial flutter. A heart rhythm specialist will use results from diagnostic tests and a person's medical history to determine treatment options.

• Medication may be used to prevent an abnormal heart rhythm (antiarrhythmic drugs).
• If testing reveals rapid, irregular heartbeats in the lower heart chambers (ventricular fibrillation), an implantable defibrillator may be prescribed to treat the fibrillation when it occurs and return the heart to a more normal rhythm.

Treatment Options for Atrial Fibrillation
Treatment for atria that pump too fast and irregularly (atrial fibrillation) is intended to:

• Regain and maintain a normal heart rhythm
• Control the heart rate (pulse)
• Prevent a stroke

What heart medication do I need?
Atrial fibrillation is mostly treated with medication, aimed towards restoring the normal heart rate -sinus rhythm, and/or relieving the symptoms and to control the blood clotting; anti coagulation also known as 'blood thinner'.

Some patients may not need medication or need it only for a limited time. Sometimes it can be correct via a procedure in the hospital, known as cardioversion, than atrial fibrillation may not come back. Most individuals will, however, need medication on a regular basis and usually permanently.

There are three categories of medication:

1. Medication to restore the heart rhythm
   These medications are aimed at restoring and maintaining the normal heart rhythm (sinus rhythm) by stabilizing the electrical activity of the heart cells. Examples include quinidine, procainamide, flecainide, disopyramide, propafenone, amiodarone and sotalol. Some of these medications will also help to slow the heart rate (amiodarone, sotalol).
   
   
   
2. Medication to control and slow down the heart rate
   These medications are aimed towards relieving the symptoms of (conducted) atrial fibrillation. They will not prevent or stop the fibrillation but will slow the pulse to a more normal level. All of these medications work by impeding the flow of electrical impulses through the AV node.
   Examples include digoxin, beta blockers such as propranolol, and calcium channel blockers such as verapamil and diltiazem.
   
   
   
3. Medication to "thin" the blood
   These medications are intended to prevent blood clotting and strokes The medical term is anticoagulation. Your doctor will generally choose warfarin or acetylsalicylic acid (ASA) if you require a blood thinner. Use of warfarin will require regular blood tests to assess the amount of blood thinning (anticoagulation). The increased tendency to bleed with these medications may require limiting of certain activities such as contact sports.
   

Medication is tailored to a specific patient situation, and most people will need occasional adjustments or changes in medication. Whether a given medication will succeed in a given person is impossible to predict. All have possible side-effects and cautionary notes which you will want to discuss with your doctor and/or pharmacist.

If the medications don't work appropriately?
Some individuals will try many medications only to find that none are satisfactory and symptoms from the atrial fibrillation remain intolerable. Other options are available, such as pacemakers that are designed to prevent atrial fibrillation and to relieve the symptoms via special pacemaker functions.
As a last resort to relieve symptoms your physician may consider AV node ablation.

How may a pacemaker help?
Modern pacemaker systems. Such as the Vitatron Selection series (not available in the US), are designed to prevent the occurrence of atrial Fibrillation by reacting to specific triggers which may start an period of AF.
These novel pacemaker functions are variations on a theme; triggered overdrive pacing or permanent overdrive pacing.

Triggered overdrive pacing
By applying triggered overdrive pacing, the pacemaker starts to pulse at a slightly higher ra
te than the normal -underlying- heart rate, in order to suppress the start of an episode of atrial fibrillation. A 'trigger' can be a fast extra beat (also called a premature beat) or a sudden drop in the heart rate due to physical or emotional stress.

Permanent overdrive pacing
Permanent overdrive pacing is designed to continously pulse at a rate slightly higher than the normal -underlying- heart rate. This function is permanently active and is aimed to suppress the various triggers of atrial fibrillation episodes.

Symptom relief by a pacemaker
Recent clinical studies demonstrate that relieving the symptoms of (conducted) atrial fibrillation is possible using specific pacemaker functions. These functions stabilize the ventricular rate and are aimed to reduce ventricular rate irregularity. These functions will not prevent or stop the fibrillation but will slow the pulse down to a more normal level.

AV node ablation
The normal electrical conducting system is interrupted or blocked by a small burn made by the wire at the AV node. This prevents the many electrical impulses in the atria from reaching the ventricles and effectively slows the heart. A permanent pacemaker is then implanted to allow the heart to have an adequate heart rate for daily activity. The atrial fibrillation is not cured but is prevented from making the heart race. Blood thinners may still be necessary, since the root cause of blood clotting, atrial fibrillation, is not cured.

Is atrial fibrillation a "serious problem"?
Living a normal life with atrial fibrillation. Atrial fibrillation can be very frustrating and may require several adjustments in medication or other treatment before the problem is under control. With proper attention, it is not generally a life-threatening condition. Most patients can live a normal life without restriction of activity unless there are other serious medical conditions present.

top | glossary