Heart Arrhythmias

There are several options available for the treatment of heart arrhythmias. These can range from drug treatments to nonsurgical, implant, or surgical treatments. Some of these arrhythmia treatments may be recommended in combination with one another.

Many people are able to have their heart rhythm controlled using medication. Examples of antiarrhythmic drugs include:

• Amiodarone (Cordarone, Pacerone). This drug is used to treat many different arrhythmias. It works by modifying the electrical signals in the heart. Patients may be monitored during use to assess the effectiveness of the drug and the appropriateness of the dose.
• Tikosyn (Dofetilide), which modifies certain electrical signals in the heart. Patients are usually monitored for at least three days when starting use or modifying the dosage.
• Multaq (Dronedarone). This drug is used to treat symptoms of atrial fibrillation. It can be prescribed on its own or with other medications.
• Flecainide (Tambocor). Flecainide works by slowing the signals in the heart in order to regulate and stabilize the rhythm of an individual's heart.
• Procainamide (Procan, Procanbid) works to combat arrhythmias by slowing certain signals and reducing the sensitivity of the heart's tissues, which then makes the heart more resistant to irregular rhythms. Procainamide is only available intravenously in the US.
• Sotalol (Betapace) is a beta blocker and potassium channel blocker. This can help the heart beat more slowly and regularly.

Catheter ablation

Our doctors at NewYork-Presbyterian are experienced in curing arrhythmias by disrupting the electrical impulses that cause them. This technique is called catheter ablation. This is a nonsurgical percutaneous approach that can often treat supraventricular arrhythmias (including atrial fibrillation ) and ventricular arrhythmias.

• These are very effective procedures with high success rates depending on the arrhythmia, and a low risk of complications. NewYork-Presbyterian discharges most patients in less than 24 hours following this procedure.
• During catheter ablation , electrode catheters are guided through your veins to various positions in the heart where radiofrequency energy or freezing temperatures (cryoablation ) are applied. We are also offering new advanced forms of energy to treat arrhythmias. This new form of energy interrupts the electrical impulses causing your arrhythmia.
• Our electrophysiologists (or heart rhythm specialists) combine information gained from previous CT or MRI scans taken before your procedure with advanced mapping systems to help guide the procedure to maximize effectiveness and minimize complications.

Implanted devices

Some arrhythmias are treated with medication or ablation, but others are treated with surgically implanted devices that correct abnormalities in your heart's rhythm. We also have specialized expertise in the removal of leads in individuals with damaged or infected devices. You may benefit from one of the technologies below.

Pacemaker

If your heartbeat is too slow, you may benefit from a permanent pacemaker. This is a small device implanted near your chest under the skin. The device has leads going into your heart, usually through a venous system, that keeps your heart beating at a normal rate. These can be used alone or in combination with other devices to treat arrhythmias. We can also place pacemakers without leads that are directly implanted in the heart without a generator under the skin or leads. 

Implantable cardioverter defibrillators (ICDs)

ICDs can be implanted under the skin in the chest, of patients who have or are at risk of arrhythmias. ICDs can be entirely subcutaneous (without leads in the heart) or transvenous  (with leads traveling into the heart). They protect against life-threatening fast heartbeat irregularities and sudden cardiac death. These devices monitor your heartbeat and can sense potentially dangerous abnormalities in your heart rhythm. The ICD can deliver electrical impulses to stop the arrhythmia and allow your normal heartbeat to continue.

Biventricular pacemakers

These implantable devices have a pacemaker wire that directly paces the beating of the left ventricle and a standard pacemaker wire in the right ventricle. They are designed to resynchronize the beating of the heart in people with congestive heart failure whose heart contractions have fallen out of sync. They are often combined with ICDs for people at risk of life-threatening arrhythmias.

LAAO devices

Left Atrial Appendage Occlusion (LAAO) devices can be implanted in the heart using a catheter. These mechanical devices are intended to help prevent stroke in patients with non-valvular atrial fibrillation. 

Surgical treatments

Our heart surgeons offer surgical procedures for people with atrial fibrillation that cannot be adequately controlled with medications, ablation, or implanted devices.

Maze procedure

This open-heart procedure interrupts the electrical impulses that cause abnormal heart rhythm. The surgeon will make incisions in both atria, which heal into scar tissue. This acts as a roadblock that prevents abnormal electrical impulses from passing through the heart. The Maze procedure is commonly performed with mitral valve repair, replacement, and coronary artery bypass graft. 

Surgery for Ventricular Tachycardia 

Surgery can be performed for some patients to remove scar tissue from under the heart's lining to treat ventricular tachycardia. 

Robotic heart surgery

This is a minimally invasive, robotically assisted version of surgical atrial fibrillation ablation. This can be done without stopping your heart or using a heart-lung machine.