Your doctor will try available medications to control your arrhythmia before resorting to an invasive therapy option or inserting a rhythm-stabilizing device. If your arrhythmia doesn’t respond to medication, the medications produce too many side effects, or your doctor determines that you’re at risk for serious complications that require more than medication, then they will discuss your options. Which option is right for you will depend on your medical history and type of arrhythmia. If none of the anti-arrhythmic medications have effectively controlled your arrhythmia, then you may be a candidate for electrical cardioversion. Atrial fibrillation and atrial flutter are the most common forms of arrhythmia that respond to electrical cardioversion. The procedure involves delivering a small electrical signal to your heart to stabilize the rhythm. An electrophysiologist can use catheter ablation to correct a variety of arrhythmias, including AFib, atrial flutter, and ventricular tachycardia, which is potentially life threatening. For this procedure, your doctor will insert a small catheter into your heart and deliver high-frequency currents to the tissue causing the arrhythmia. This essentially “disconnects” the faulty pathway, resulting in a normal heartbeat.  Because this procedure is more invasive than electrical cardioversion, your doctor may try the latter option first, followed by ablation if necessary. This is a short procedure (two to four hours), and you can typically resume normal activities within a few days with a low risk of any complication. If your arrhythmia causes your heart to beat too slowly, then your doctor will likely discuss the option of a pacemaker. Unfortunately, no medications are available to treat a slow heart rate (bradycardia). A pacemaker includes a very small set of wires that measure the electrical activity in your heart. They connect to a small pulse generator that delivers a signal to normalize your heart’s rate whenever it detects an abnormality.  Though it sounds very invasive, the procedure is considered very safe and requires only one night in a hospital while the team monitors your heart rate and rhythm to ensure proper functioning of the device.  Because of their ability to interfere with your pacemaker, you should avoid strong magnetic fields and power-generating equipment (getting an MRI or using arc welding equipment, for instance). You should also avoid storing an electronic device such as your cell phone in your chest pocket next to your pacemaker. An ICD is similar to a pacemaker (leads inserted into the heart connected to a pulse generator), but they are used to treat a wider range of arrhythmias, especially ventricular tachycardia and ventricular fibrillation, both of which can be life threatening.  Before you consider an ICD, your arrhythmia must be life-threatening and originate from an uncorrectable cause such as: acute myocardial infarction (heart attack), myocardial ischemia (inadequate blood flow to the heart muscle), or electrolyte imbalance and drug toxicity. If you choose an ICD, you can maintain a normal lifestyle, including taking part in sports and exercise. Your ICD may need to get checked several times a year, although their batteries last between five and seven years. To help protect the ICD’s pulse generator, you will need to avoid large magnetic fields and energy-generating equipment (such as MRIs and arc welding equipment, for example). You should also avoid placing your cell phone or headphones within six inches of the device. If nothing else has controlled your atrial fibrillation, then your doctor may discuss the option of a heart Maze procedure, which can be minimally invasive cardiac surgery or is an open heart surgery. In the surgery, the doctor creates small cuts that are stitched together and scar tissue forms, which interferes with abnormal impulses.

Summary:
Consult your doctor. Discuss electrical cardioversion. Ask about catheter ablation. Choose a pacemaker if your heart beats too slowly. Ask your doctor about an implantable cardioverter-defibrillator (ICD). Discuss a heart Maze procedure.