Medical Center Tower I 7950 Floyd Curl Drive Suite 803 San Antonio, TX 78229 tel: 210-615-9500 fax: 210-615-9600 email: office at cecst.com |
Specializing in the compassionate care of people who suffer from abnormalities of the electrical system of the heart |
Current Insurance Plans:
We accept most major commercial insurance plans. Please call for details. Medicare: We have opted out of Medicare, and are happy to care for Medicare beneficiaries on an affordable cash basis. Note: Federal law prohibits signing the Federally-mandated opt-out contract with a Medicare beneficiary who is in an emergency situation. No insurance? No problem! Consider our affordable Fee for service (direct pay). Home of the Original Personalized Medical Office SystemTM released April 5, 2013 |
The Arrhythmias Section Contents |
Treatments for the Arrhythmias | |||||||||||||||||||||
What to do if you have an arrhythmia | |||||||||||||||||||||
The symptoms of a fast heart beat (tachycardia) usually are a combination of palpitations, faintness, and/or shortness of breath. In some cases, the person will notice only "pounding" of the heart. In other cases, the person may pass out with very little warning. The symptoms of a slow heart beat (bradycardia) are similar except that people usually do not notice palpitations or "pounding". If you are having any these symptoms and you do not know why, you should go to a medical facility while you are experiencing the abnormal rhythm so that an electrocardiogram ("12-lead ECG") can be obtained. The 12-lead ECG of the fast heart rhythm is the best way to find out just what kind of fast heart rhythm you are having. The general rule for arrhythmias is to act according to the severity of the symptoms. If you feel bad, seek medical help. If you feel really bad, call your local Emergency Medical Service (usually by dialing 911 on the telephone). This advice sounds trite, but in an emergency the simplest strategies are best. Below is some information that may help you but may hurt you instead. Please ask your doctor whether you can and/or should use any of the information below (or anywhere elsewhere on this or other Internet sites as well). If your heart is going so slowly that you feel faint, you can lie down with your feet elevated (for example, on a chair or bed). This will increase the amount of blood returning to your heart due to gravity, and may help maintain your blood pressure. If this does not help, you can cough hard about once a minute. The pressure of the cough on the heart will force some blood out. This is a measure of last resort, so make sure someone is calling for help. If your heart is going so fast that you feel faint, you can lie down with your feet elevated (for example, on a chair or bed). This will increase the amount of blood returning to your heart due to gravity, and may help maintain your blood pressure. You can also try the Valsalva maneuver or carotid sinus massage, which are often effective for certain types of fast heart rhythms ( AV nodal reentrant tachycardia and AV reentrant tachycardia). It is best to review this maneuver with your doctor before you may actually need it. Finally, your doctor may have given you pills to take in case your heart went too fast. Remember that these pills will usually take 30-45 minutes to take full effect because the medicine has to be absorbed from your stomach and intestines into the blood stream. | |||||||||||||||||||||
Drug Therapies | |||||||||||||||||||||
Drugs are often effective for the treatment of tachycardias.
Unfortunately, all of the effective antiarrhythmic drugs have
side effects, are expensive, and require the person to remember
to take them on at least a daily basis. The topic of drug
therapies of tachycardias is vast, but there are several general
principles that can be stated.
The generally used classification of antiarrhythmic drugs is that
of Vaughn-Williams, who categorized drugs by their major effects
on the heart.
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Catheter-mediated Radiofrequency Ablation | |||||||||||||||||||||
Radiofrequency ablation is a technique for
treating tachycardias. It has been used widely since about
1990, and is now the treatment of first choice for many of the
supraventricular tachycardias and several types of ventricular
tachycardia. Its use for the cure of atrial fibrillation is
becoming routine for some types of cases, and
its use for ventricular tachcardias related to
myocardial infarction is routine but not very successful
because of the nature of the disease process (so an ICD is usually
implanted in patients with this problem).
In this technique, a long, thin, solid tube (catheter) with
wires inside
and electrodes near its tip is inserted into the body through a
vein in the thigh, shoulder, or neck. The tip is positioned
inside the heart next to the abnormal heart tissue that is
responsible for the tachycardia. Then, a small amount (about 50
watts) of energy is applied to the heart between the tip
electrode and a skin patch that is usually placed behind the left
shoulder. This energy heats up and thus dries out the heart
tissue that is within about 5 millimeters of the tip. After
about 30 to 60 seconds of heating, this tissue is no longer alive
and cannot cause tachycardia any more.
Although the actual ablation takes only a minute, the procedure
often takes 4 to 10 hours. The reason is that it is
time-consuming to identify the exact tissue in the heart that is
responsible for a tachycardia and to make sure that all of this
tissue has been ablated completely.
Ablation is performed by specialists known as clinical cardiac
electrophysiologists.
The cardiac rhythms that can often be cured by radiofrequency
ablation include atrioventricular nodal reentrant tachycardia (AVNRT),
atrioventricular tachycardia (AVRT) that uses an accessory bypass
tract for retrograde conduction, atrial tachycardias that occur in
otherwise-normal hearts and also in hearts that have had prior
surgery, atrial flutter, and some kinds of ventricular tachycardia
that occur in otherwise-normal hearts. The first three rhythms
are often grouped together with the term "supraventricular
tachycardia", although this term can also be used to include
atrial flutter and atrial fibrillation.
As noted above, two kinds
of rhythms can sometimes be cured by radiofrequency
ablation but often cannot be. Ventricular tachycardia occuring in
hearts that have suffered myocardial infarction can be cured in
about 25% of cases in which radiofrequency ablation is tried.
Most electrophysiologists implant cardioverter-defibrillators in
all of these patients because recurrence of the rhythm weeks or
months after the ablation effort can prove fatal. Ablation for
cure of atrial fibrillation is a very active research topic in the
field of clinical cardiac electrophysiology, and in recent years
has been in routine clinical use with reported long-term success
rates of 50-80%.
The cardiac rhythms that cannot be cured but whose symptoms
can be improved by radiofrequency
ablation include any of the supraventricular tachycardias,
including atrial flutter and atrial fibrillation. The improvement
comes at a price, however. When the tachycardia cannot be
controlled with medication and cannot be cured by ablation, the
symptoms due to the rhythm (but not the rhythm itself) can often
be controlled by one of two procedures.
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Implantable Cardioverter-Defibrillators | |||||||||||||||||||||
Implantable cardioverter-defibrillators are devices that are placed under the skin (as are pacemakers) to treat ventricular tachycardia and ventricular fibrillation. They have been in general use since 1985, and have proven safe and effective for treating patients who have suffered or are likely to suffer sudden cardiac death due to those rhythms. The difference between pacemakers and implantable cardioverter-defibrillators is that pacemakers prevent the heart from beating too slowly, while implantable cardioverter-defibrillators prevent the heart from beating too fast due to certain abnormal fast heart rhythms. In recent years, the devices have been getting smaller and more capable. The original devices required open chest surgery for implantation. The most recent devices can almost always be placed under the skin of the shoulder, as are pacemakers. The batteries in the original device lasted about 18 months. The batteries implanted in the 2000s up 2010 were predicted to last 6 to 8 years, and starting in about 2010, battery service durations up to 10-12 years are predicted by the manufacturers. |
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