A Comprehensive Guide to Treating Arrhythmia

Heart arrhythmias are usually harmless, but some can be life threatening. Treatments help correct your heart rate to prevent serious health issues.

When the electrical impulses that affect your heartbeat don’t function properly, it results in a condition called arrhythmia.

The typical resting heart rate for adults is 60 to 100 beats per minute. With arrhythmia, your heart may beat faster ( tachycardia ) or slower ( bradycardia ) than this range, or it may beat irregularly.

Some common arrhythmias include:

• atrial fibrillation (AFib)
• atrial flutter
• ventricular tachycardia (VT)
• supraventricular tachycardia (SVT)
• ventricular fibrillation (VF)
• premature ventricular contractions (PVCs)

Some arrhythmias, like AFib and SVT, start in the atria, the upper chambers of your heart. Others that start in the ventricles (the lower chambers) may be more life threatening.

Among the common treatments for arrhythmia are medications, implants, procedures, and lifestyle changes.

When to get help for arrhythmia

Although most arrhythmias are harmless and may have no symptoms, seek immediate medical treatment if you experience any of these symptoms:

• chest pain
• shortness of breath
• lightheadedness

If you experience frequent or persistent heart palpitations, talk with a doctor, especially if you have a risk factor such as high blood pressure , coronary artery disease , or diabetes .

Medications to treat anemia

The medications a doctor may prescribe to treat your arrhythmia depend on factors such as the type of arrhythmia and whether you have other health conditions.

Most of these medications come in pill form, and you can use them long term.

The following medications are commonly prescribed for arrhythmia:

Medication	Use	Examples
antiarrhythmics	change your heart’s electrical current to treat tachycardia and premature or extra heartbeats	• amiodarone (Pacerone, Nexterone) • flecainide (Tambocor) • propafenone (Rythmol SR) • dofetilide ( Tikosyn )
calcium channel blockers	dilate your blood vessels to treat arrhythmia as well as chest pain and high or low blood pressure	• diltiazem (Cardizem CD, Taztia XT) • verapamil (Calan, Verelan)
beta-blockers	block the effects of stress hormones like adrenaline to slow your heart rate and lower your blood pressure	• acebutolol (Sectral) • bisoprolol (Zebeta) • metoprolol (Lopressor, Toprol-XL) • propranolol (Inderal LA, InnoPran XL)
anticoagulants	treat AFib by preventing blood from pooling in your heart and creating blood clots	• rivaroxaban (Xarelto) • apixaban (Eliquis)

The side effects of these medications vary. For example, antiarrhythmic drugs may cause arrhythmias to reoccur . Other drugs may affect your digestive system or cause dizziness or headaches.

Cardioversion for arrhythmia

If medications don’t effectively treat your arrhythmia and symptoms are severe, cardioversion may help. It’s a procedure that uses electrical or chemical impulses to shock your heart into beating normally.

Healthcare professionals perform electrical cardioversion, the most common type, while you’re under general anesthesia, so you’ll be asleep and won’t feel any pain or discomfort. They place electrodes attached to a cardioversion machine on your chest. The machine then releases electrical impulses that shock your heart into a regular rhythm.

Chemical or pharmacologic cardioversion is also an option for AFib or SVT. Healthcare professionals administer medications that help restore your heart rhythm either through an intravenous (IV) line or orally. Sedation is not necessary.

Although cardioversion is a relatively safe procedure, in rare cases, it may create a new arrhythmia. Electrical cardioversion may increase the risk of blood clots and stroke for a short time after the procedure. Current guidelines recommend anticoagulation to help reduce this risk.

According to a small 2020 study involving 396 Canadians with severe AFib, chemical cardioversion followed by electrical cardioversion was a more effective treatment than electrical cardioversion alone. However, this combination treatment is not common.

Catheter ablation for arrhythmia

Catheter ablation uses radiofrequency energy to ablate (kill) the heart tissue causing your arrhythmia. It does not destroy healthy tissue.

Doctors most frequently use catheter ablation to treat SVT. A 2024 study found that it helped nearly 82% of 2,470 people with AFib.

Catheter ablation takes place in an electrophysiology laboratory. It takes about 3 to 6 hours. While you’re under general or local anesthesia, a doctor makes a needle puncture through skin on your groin, arm, neck, or upper thigh, then inserts a small, thin tube called a sheath in the blood vessel.

Next, the doctor places a catheter inside the sheath, followed by electrode catheters that they guide to your heart. To locate the irregular tissue causing your arrhythmia, the doctor sends a small electrical impulse through the electrode catheters.

Once they’ve found the irregular tissue, the doctor sends mild radiofrequency energy, similar to heat in a microwave oven, to the tissue. The energy only destroys the irregular cells.

Implantable devices for arrhythmia

Depending on the type of arrhythmia, a doctor may recommend one of the following implantable devices that shocks your heart so it beats regularly:

• Implantable cardioverter defibrillator (ICD): This small device contains a battery and computer that monitors your heart rate and delivers an electric shock if necessary. A doctor may recommend it if you have a VT or other serious arrhythmia.
• Pacemaker: A surgeon can implant a pacemaker under your skin, most commonly near your collarbone. The device contains a generator, wires (some are wireless), and electrodes. It releases an electrical pulse that is not as strong as an ICD’s.
• Cardiac resynchronization therapy (CRT): Doctors can insert a cardiac resynchronization device or biventricular pacemaker, usually near your collarbone. The device delivers electrical impulses that enable your heart’s ventricles to contract at the same time.
• Implantable loop recorder: This electrocardiogram (EKG) monitoring device implanted in your chest can monitor your heart’s electrical activity for 3 years or longer. The device may transmit information to a medical facility or monitoring company.

Doctors can implant these devices while you’re either awake and sedated or under general anesthesia in an electrophysiology laboratory.

The procedure may take 1 to 3 hours. After the procedure, you’ll stay in the hospital for 24 hours for recovery and monitoring.

Maneuvers to help manage arrhythmia

If you have an SVT, as an alternative to medications or other arrhythmia treatments, you may be able to temporarily slow your heart rate by performing a simple exercise called a vagal maneuver .

This technique tones the vagus nerve , located between your brain and abdomen, which affects your heart rate.

The following are common vagal maneuvers:

• Standard Valsalva maneuver: While sitting or lying on your back, inhale and then pinch your nose, close your mouth, and then exhale forcefully against your closed mouth for 15 to 20 seconds while bearing down like you’re having a bowel movement.
• Modified Valsalva maneuver: Lean back about 30 to 45 degrees and perform the same steps as for a standard Valsalva maneuver. A healthcare professional then raises your legs 45 degrees for about 45 seconds.
• Carotid sinus massage: As you lie on your back with your head turned to one side, a healthcare professional applies gentle pressure to your carotid artery, located on the side of your neck.

In a 2019 clinical trial involving 98 people with SVT, the success rate for those performing the modified Valsalva maneuver was 43%. It was 24.2% for the standard Valsalva maneuver and 9.1% for carotid sinus massage.

Experts recommend you only perform vagal maneuvers if you have no symptoms of a stroke or heart attack , such as chest pain, shortness of breath, or a sudden headache.

Lifestyle changes

Certain lifestyle changes and strategies may help prevent arrhythmia . They include the following:

• Eat heart-healthy foods and avoid caffeine .
• Exercise regularly.
• Reduce stress.
• Avoid smoking. Quit smoking if you do smoke.
• Drink alcohol only in moderation.
• Maintain a moderate weight and healthy blood pressure and cholesterol levels.
• Avoid some over-the-counter medications and recreational drugs that may increase your heart rate.

You may also want to consider consulting a healthcare professional about a sleep study . If you have obstructive sleep apnea , using a CPAP machine can reduce arrhythmias, according to some research .

Takeaway

Arrhythmias are usually mild with no symptoms, so treatment may not be necessary. However, arrhythmias that originate in your heart’s ventricles may become life threatening. Contact a doctor if you experience the feeling that your heart rate isn’t typical.

Depending on the type of arrhythmia you have, treatment may involve lifestyle changes, medications, or implants that correct your heart rate.

Treatment may prevent arrhythmias from developing into more serious issues like stroke, cardiac arrest, or even death.