Management of Arrhythmia
Management of cardiac arrhythmias depends on the type of abnormality and its origin. The goals of treatment are:
- Prevent sudden cardiac death
- Eliminate risk of other dangers, such as stroke (e.g., atrial fibrillation or flutter)
- Eliminate discomforting symptoms
- Prevent the compromise that results from the heart being an ineffective pump
Sudden Cardiac Death
Sudden cardiac death is preventable in most cases by the appropriate identification and management (treatment) of risk factors and suspicious symptomatology. Treatment is via proactive anti-arrhythmic drugs and precautionary withdrawal/exchange of pro-arrhythmic drugs.Some arrhythmias from ectopic pacemakers can be treated with catheter-driven radio-frequency ablation of the ectopic sites.
Managing the Risk of Other Dangers
When arrhythmia has been identified, therapeutic management includes the use of anti-arrhythmic drugs and close surveillance with long-term monitoring. Some arrhythmias are fraught with traditional consequences, such as atrial fibrillation and subsequent emboli, and preventing them is prudent to avoid serious untoward events. Prevention may require a cardiac pacemaker.
Elimination of Unpleasant Symptoms
Palpitations are unpleasant perceptions of the heart beating which can be associated with syncope, near syncope, and/or a disturbing psychological premonition of doom. Medical management (beta blockers) is used in certain patients to mitigate their frequency or severity. These drugs may not eliminate the arrhythmia altogether but will lessen the symptoms from it. When valve damage is the cause, valve replacement may be necessary.
Prevention of Dysfunction of Cardiac Output
When the heart is an ineffective pump, all of the end-organs are not perfused optimally, from the internal organs to the heart itself (from its coronary artery supply). Such partial disruptions of flow are prevented or remedied by superseding the electrical conduction abnormalities responsible for arrhythmias via pacing with continuous or on-demand pacemakers.
Anyone with heart disease or cardiac arrhythmia lives under the relentless burden of on-going risk to life. Part of the treatment is to implant devices to intervene automatically upon demand, such as pacemakers and even cardioverters-defibrillators.