How to Choose a Treatment for Arrhythmia

Medically reviewed by Dale K. Mueller, MD

Last Updated: October 11, 2022 References

An arrhythmia is an abnormal heartbeat (too fast, too slow, or erratic). Although arrhythmia is often benign, it can ultimately decrease your heart's ability to effectively pump blood. An arrhythmia may feel like fluttering or a brief pause in your heartbeat, and it may make you feel lightheaded or dizzy.^{[1]
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National Heart, Lung, and Blood Institute
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Go to source} A variety of abnormalities can cause arrhythmias. Your doctor will ultimately choose the best treatment plan for you from a variety of medications and procedures available based on your specific arrhythmia and its response to other methods.

Method 1

Method 1 of 2:

Choosing Medications

1
Consult your doctor. Many arrhythmias are harmless or require minimal treatment plans. Your doctor will always prefer medication to a surgical procedure if medication is enough to treat your arrhythmia on its own. Your doctor will consider a variety of factors, including your age, medical history, and type of arrhythmia based on diagnostic testing.
- For example, medications cannot reliably speed up your heart to treat a slow heartbeat (bradycardia), but they can help with arrhythmias stemming from a heart that beats erratically or too fast (tachycardia).^{[2]
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  National Heart, Lung, and Blood Institute
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A medication can (when taken according to your prescription) help to slow a fast heartbeat or even reduce the potential for complications stemming from your arrhythmia. Some of the most serious—and potentially life-threatening—complications of arrhythmia include stroke, heart failure, and sudden cardiac arrest.^{[4]
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3
Treat any underlying condition. An arrhythmia is often a symptom itself of another underlying condition. Your doctor’s diagnostic testing may undercover that your condition has resulted from a thyroid problem or even heart disease.^{[5]
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National Heart, Lung, and Blood Institute
Research and education center within the National Institutes of Health

Go to source} In this instance, your doctor may prescribe a medication (such as one to treat hyperthyroidism^{[6]
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Research source}) as well as a medication to combat your arrhythmia during the process.
- As with any medications, take exactly as directed by your doctor.
4
Ask about antiplatelet and anticoagulant treatments. One of the most common forms of arrhythmia is known as atrial fibrillation (AFib). This arrhythmia allows your blood to pool, increasing the risk of clotting — and therefore stroke — as one of the chambers in your heart pumps ineffectively.^{[7]
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American Heart Association
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Go to source} Your doctor will likely prescribe a blood-thinning medication to reduce the potential for your blood to clot in these instances.^{[8]
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American Heart Association
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- Common drugs used for this purpose include aspirin and warfarin (Coumadin), which you should always take according to your doctor’s recommended schedule.^{[9]
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- Blood-thinning medications often come with the risk of excess bleeding, and you must inform your doctor of all other drugs you take before beginning this treatment plan.^{[10]
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  Go to source} You may also have to submit to regular blood testing to assure the medication is at the correct dosage, especially for warfarin.^{[11]
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5
Look into anti-arrhythmic drugs. These options can help with converting the heart rhythm to normal (cardioversion).^{[12]
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American Heart Association
Leading nonprofit that funds medical research and public education

Go to source} Your doctor will have a large assortment of these drugs to choose from, and you may have to try several before finding one that manages your arrhythmia without adverse side effects. During the trial-and-error process, you may experience a worsened arrhythmia from some of these drugs, so your doctor will likely prescribe a blood-thinning medication in association to reduce the risk of stroke. Common options include:^{[13]
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American Heart Association
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- Amiodarone (Cordarone, Pacerone)
- Bepridil hydrochloride (Vascor)
- Flecainide (Tambocor)
- Ibutilide (Corvert)
6
Ask about calcium channel blockers. Calcium channel blockers (calcium antagonists) prevent the movement of calcium into cardiac tissue, resulting in a slowed heart rate.^{[14]
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American Heart Association
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Go to source} This makes these a common choice for slowing a fast heart rate (tachycardia), especially in situations where antiarrhythmic drugs haven’t worked or are not recommended by your doctor. Options include felodipine (Plendil), isradipine (Dynacirc), and nicardipine (Cardene).^{[15]
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American Heart Association
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- They are usually taken daily.
- Don’t take these drugs if you are pregnant.
- Don’t drink grapefruit juice when taking calcium channel blockers because it may increase drug concentration and have a toxic effect.
7
Consult your doctor about beta blockers. Beta blockers reduce the effects of adrenaline, which can also treat arrhythmia caused by a fast heartbeat.^{[16]
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American Heart Association
Leading nonprofit that funds medical research and public education

Go to source} Your doctor is more likely to prescribe these drugs if heart disease is the underlying cause of your arrhythmia because they can also treat angina pains associated with heart disease.^{[17]
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American Heart Association
Leading nonprofit that funds medical research and public education

Go to source} Common options include acebutolol (Sectral), atenolol (Tenormin), and betaxolol (Kerlone).^{[18]
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American Heart Association
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- This drug is usually taken daily.
- You shouldn't use this drug if you are lactating or pregnant.
- Side effects can include hypotension, bradycardia, and difficulty breathing.
- There is increased risk of hypoglycemia if you combine this drug with insulin.
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Method 2

Method 2 of 2:

Choosing Invasive Therapies or Devices

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.^{[19]
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Cleveland Clinic
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Go to source} The procedure involves delivering a small electrical signal to your heart to stabilize the rhythm.^{[20]
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Cleveland Clinic
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3
Ask about catheter ablation. 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.^{[21]
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Mayo Clinic
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- 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.
4
Choose a pacemaker if your heart beats too slowly. If your arrhythmia causes your heart to beat too slowly, then your doctor will likely discuss the option of a pacemaker.^{[22]
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Cleveland Clinic
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Go to source} 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.^{[23]
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- 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.^{[24]
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- 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.
5
Ask your doctor about an implantable cardioverter-defibrillator (ICD). 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.^{[25]
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Mayo Clinic
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- 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.^{[26]
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Warnings

While this article offers information related to arrhythmias, you should not consider it medical advice. Always consult your physician to determine the best course of action to treat your arrhythmia.

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