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Treatment options

The recommended treatment for heart racing depends on the type of arrhythmia, the severity of symptoms, and whether other heart problems are present. For the heart rhythm problems discussed here, the most widespread treatments for arrhythmias are antiarrhythmic medications, and catheter ablation.

Medications

Heart rhythm medications can sometimes be given only when the arrhythmia occurs. This so-called “pill in the pocket” approach involves the patient taking a large single dose of a heart rhythm medication and then waiting for a few hours to see if their arrhythmia goes away. Flecainide or propafenone are the most common medications used. This approach is generally only safe for people who have strong hearts and tolerate their arrhythmia well with minimal symptoms.

Daily heart rhythm medication is a better option if the arrhythmia is not as well tolerated by the person. The doctor starts a medication and asks the person to notify them if any side effects occur. If none occurs, the dose of the medication is increased until there is a good chance that it might work for the person. Then the person takes the medicine daily. If the arrhythmia never recurs, the medication is taken the rest of his or her life. If it recurs, the doctor has the option of increasing the dose or trying another medication. The milder medications (digitalis, beta blockers, and calcium-channel blockers) are the safest and the least expensive, but they tend to be less effective and have more side effects. Some people, however, need to be on such medications for other reasons, such as high blood pressure or migraine headaches. In these cases, such medications should generally be tried before considering other medications or ablation.

There are stronger medications – including flecainide, propafenone, and sotalol – for people who don’t respond to milder medications. Flecainide and propafenone cannot be given if there is any weakness of the left ventricle or any degree of blockage in the heart arteries. Sotalol, however, is safe if such abnormalities exist. These three medications are less likely to cause side effects and more likely to prevent the arrhythmia. However, rarely such medications may cause cardiac arrest. Estimates of this risk are in the 2-3% range, but many physicians consider this to be too high an estimate and believe that 1% is a more reasonable estimate.

Implantable cardioverter defibrillator

An implantable cardioverter defibrillator (ICD) is a small electronic device placed under the skin near one of the collar bones where it monitors heart rhythm. When the ICD detects a potentially dangerous arrhythmia from the bottom part of the heart, it sends a shock to the heart to restore a normal heart rhythm and save the person’s life. This is an effective way of dealing with dangerous arrhythmias such as ventricular tachycardia. Surgery is required to place the ICD inside the body.

Catheter ablation

Catheter ablation is a treatment option selected by many people. To a large extent, the chance of success and risk of ablation depends on the arrhythmia being treated. The most common reasons given by people for choosing ablation are: (1) wanting to get the heart rhythm problem fixed; (2) not wanting to take medications for the rest of their lives; (3) not wanting to go to the emergency room any more; (4) not wanting to have to worry about their arrhythmia occurring where they cannot easily get to a hospital (for example, traveling overseas and camping in the wilderness).