Medical

Treatments for abnormal heart rhythms

X-ray of pacemaker and heart pump

Dr Ben Brown, Consultant Cardiologist at the University Hospital of South Manchester, explains pacemakers, ICDs, and ablations, which are used to treat heart rhythm problems. Find out what the treatments involve and how long they last.

Abnormal heart rhythms (often called arrhythmias) are when your heart beats very slowly, very quickly or irregularly. They can cause symptoms like dizziness and palpitations. The most common arrhythmia in the UK is atrial fibrillation (AF).

While medications play a vital role in helping to treat arrhythmias, sometimes a procedure is necessary. This could be an ablation for AF, a pacemaker or an implantable cardioverter defibrillator (ICD).

Ablation for atrial fibrillation

What happens during the procedure?

During a cardiac ablation, a thin, hollow catheter is passed into your heart through an artery in your groin or wrist. Your doctor pinpoints the tissue where the abnormal signal originates and destroys it with radiofrequency waves (radiofrequency ablation) or by freezing (cryoablation). Hopefully this will resolve your AF.

How quickly will it start to work?

Immediately afterwards, you may still have symptoms, usually palpitations, but these should stop. It will be clearer whether the ablation has worked eight to 10 weeks later. Some people experience short-term chest pain because of inflammation, but this usually settles after seven to 10 days.

It will be clearer whether the ablation has worked eight to 10 weeks later

If the ablation is successful, your doctor will discuss stopping some of your medications. You’ll be monitored for a year and if your symptoms stay under control, you won’t require further follow-up.

Some people with AF will only have one ablation; others may have multiple ablations, which may or may not work but may help improve their symptoms. “This is unusual, but if AF gives you symptoms and affects your quality of life, we can repeat the procedure,” says Dr Ben Brown.

What if it doesn’t work?

For other people, where an ablation has not been effective, medications can help to alleviate the symptoms.

Pacemakers

Most pacemaker recipients have either a very slow heart rate, long pauses between heartbeats or AF. In heart failure patients, a special ‘biventricular pacemaker’ can help your heart pump more efficiently.

How quickly will it start to work?

Your pacemaker starts functioning as soon as it is inserted. Some people feel the benefit straight away as their heart rate is increased to a normal rate.

How long does it last?

Pacemaker batteries last for eight to 10 years and sometimes longer

All pacemakers have an internal battery, connected to the heart by one or more leads. It is not unusual to need new batteries, known as a ‘box change’, as leads remain in place but the box is swapped.

Batteries last for eight to 10 years and sometimes longer, depending on how often the device is used. Your pacemaker clinic closely monitors your battery. When it starts to run low, they arrange for you to have a new pacemaker box implanted. This is a routine procedure.

If the insulation on the leads is wearing, you will need a lead change too. This is also easily detected during pacemaker clinic checks. Pacemaker leads last for 20 to 30 years.

When your battery is low, the pacemaker functions just as effectively. However, it’s important to let your GP or pacemaker clinic know if you experience symptoms that concern you.

What can go wrong?

Overall, little can go wrong, as long as you attend your regular pacemaker clinic appointments. Your underlying abnormal heart rhythm or condition will always be there, but your pacemaker will aim to help improve any symptoms.

Implantable cardioverter defibrillator (ICD)

What does it involve?

The main aim of an ICD is to treat rapid abnormal heart rhythms that can lead to cardiac arrest. This is achieved by rapid pacing or by the device giving your heart a direct shock via a special lead.

How quickly will it start to work?

If you have an ICD to treat only rapid, life-threatening heart rhythms, you won’t feel any difference in your overall condition. However, if your ICD also uses pacing functions to bring a very slow heart rate into the normal range, you should immediately feel better.

An ICD will not cure your underlying heart condition, but it does give immediate treatment if you ever have a life-threatening abnormal rhythm.

How long will it last?

ICD batteries run down over time but usually last six to eight years, depending on how much pacing or how many shocks you receive. ICD leads are more complicated and less durable than pacemaker leads. After five years, around one in 10 people will need to have their lead replaced.

Dr Ben Brown, Consultant Cardiologist of the University Hospital of South ManchesterDr Ben Brown

  • Consultant Cardiologist, University Hospital of South Manchester
  • Expert in cardiac electrophysiology and treatment of heart rhythm disorders
  • Performs ablation procedures; implants pacemakers and ICDs

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