Treatment
Common tests for heart rhythm disorders include an electrocardiogram (ECG or EKG), an exercise electrocardiogram (stress test) and a Holter or event monitor. These tests are non-invasive: information is gathered about your heart by attaching electrodes onto the skin.
In some cases, your physician may also order an electrophysiology study. This invasive diagnostic test, performed under local anesthesia in a hospital setting, helps determine the type of arrhythmia and the best treatment options, including catheter ablation. Both electrophysiology study and catheter ablation procedures are coordinated provincially by Cardiac Services BC.
If doctors suspect a genetic cause for an arrhythmia, further medical and genetic testing may be done. In this case, testing is also offered to family members. See the BC Inherited Arrhythmia Program for more information.
Treatment will depend upon the type and severity of the arrhythmia. Many arrhythmias are treatable with lifestyle changes, medications, and non-surgical techniques. For some people, invasive or surgical procedures offer the best option to restore a normal heart rhythm.
In BC, there are specialized programs and clinics for certain heart rhythm conditions. They provide patients with comprehensive services, including specialist consultation, individualized treatment plans, and patient education and counselling.
- Patients with atrial fibrillation may be referred to one of BC's atrial fibrillation clinics, where a specialist team (cardiologist, nurse and pharmacist) will work with them and their primary care provider to manage and treat their condition.
- The BC Inherited Arrhythmia Program is a provincial program of Cardiac Services BC that brings together specialist expertise in adult and pediatric cardiology with medical genetics to identify, screen and manage patients and families affected by an inherited heart rhythm condition.
A number of procedures are used to treat heart rhythm problems. These procedures are performed in hospital and may involve either surgical or minimally-invasive techniques (e.g. catheterization).
An implantable cardiac rhythm device is used to regulate an irregular heartbeat by sending electrical signals to the heart to alter its rhythm.
These devices are surgically implanted under the skin, typically just below the collarbone. A small, battery-operated computer generates the electrical signal (pulse generator), which is transmitted to the heart via one or more electric wires (leads).
There are three main categories of implantable cardiac rhythm device.
These deliver specifically timed, low-energy electrical impulses to the heart. Pacemakers help maintain adequate heart rate when the heart rate is not fast enough (bradycardia) or there is a block in the heart's electrical conduction system (heart block).
Also called biventricular pacemakers, these have at least two leads implanted in the heart to simultaneously stimulate both the left and right lower chambers (ventricles) to make them contract at the same time. A third lead may be implanted to coordinate the upper (atria) and lower chamber contractions.
These act as a permanent safeguard that corrects sudden, life-threatening arrhythmias with high-energy pulses (cardioversion or defibrillation). ICDs are used in people who are at high risk for having a potentially life-threatening heart rhythm (ventricular tachycardia or ventricular fibrillation) or who have survived such an event. Some CRT pacemakers have additional ICD capacity to provide additional protection if required.
Catheter ablation is an invasive procedure that targets faulty electrical tissue in the heart. It is used primarily to treat people with atrial fibrillation or rapid heartbeat. In most cases, the diagnostic test (electrophysiology study) and the treatment (cardiac ablation) are performed as part of the same procedure.
During the diagnostic electrophysiology study, special catheters (thin flexible tubes) are inserted through a vein in your arm, groin or neck and guided to your heart. The procedure involves triggering certain heart rhythms and mapping the electrical activity of the heart cells. This helps pinpoint the abnormal tissue causing the arrhythmia. Based on this information, doctors will decide whether catheter ablation would be useful to treat the arrhythmia. If so, the treatment will proceed immediately.
During catheter ablation treatment, a special catheter is placed in the dysfunctional area identified by the electrophysiology study. The catheter then uses heat or cold to damage the tissue. The resulting scar (ablation) creates a barrier that isolates the faulty electrical section from healthy heart tissue. This prevents abnormal electrical signals from traveling to the rest of the heart and causing arrhythmias.
