Treating arrhythmia: how can an abnormal heart rate be corrected?

Written by: Dr Boon Lim
Edited by: Top Doctors®

Arrhythmia: causes and types

The term arrhythmia describes a heart rhythm abnormality. This can either be due to the fact that the heart is beating too slowly, which is called a bradycardia, or too quickly, which is called a tachycardia. The most common cause of bradycardia is intrinsic disease within the conducting tissue of the heart. This is normally treated with a pacemaker. If your heart beats too quickly, this called a tachycardia and the most common reason for a tachycardia is atrial fibrillation.

This diagnosis is prevalent in more than 5% of the population above 60 years of age and the most common risks that predispose patients to atrial fibrillation include hypertension, diabetes or a previous history of a heart attack.

If the arrhythmia is due to a slow heart rate or bradycardia, this is usually only resolved with a permanent pacemaker implantation. If the arrhythmia is due to a tachycardia, the most common of which is a diagnosis of atrial fibrillation, then there are several strategies in a stepwise manner that can be applied to treat the arrhythmia.

Treatment approaches for arrhythmia

The first is to try and modify risk factors that provoke arrhythmia. This may be to do with lifestyle changes treating obesity, treating diabetes, and hypertension. In patients who continue to have frequent arrhythmic episodes, then drugs could be tried and in the case where the drugs fail, then the option of catheter ablation, which is a specialised keyhole cardiac surgical procedure, can be performed on selected individuals who fulfil the criteria. These procedures are normally performed by a cardiac electrophysiologist in a specialised catheter laboratory.

A catheter ablation approach utilises a catheter with a handle that allows very precise deflection of the tip of the catheter, and this is passed up through the femoral vein in your groin up to the heart. We can navigate the catheter very precisely around regions of the heart flexing onto the areas of the heart that are causing the arrhythmia to start up or fire off from. We can then use radiofrequency energy which generates heat to destroy areas of tissue that are causing the arrhythmia thus providing a cure for your arrhythmia. These procedures are usually done in a catheter laboratory which has complex mapping equipment. These procedures are usually done by a cardiac electrophysiologist.

The latest developments in treatment

Here at Imperial College London, we have a very active research program which looks into the mechanisms of arrhythmia that underscore atrial fibrillation. We have developed with our industry partners and charitable funders novel treatment strategies for atrial fibrillation, which includes an understanding of the heart rhythm abnormalities that are due to the nervous supply of the heart or the autonomic nervous system.

There are other recent strategies that we focus on which includes the understanding of the substrate or the tissue characteristics of the atria which promote atrial fibrillation and this is done with 3D mapping technology in collaboration with our industry partners to try and refine the ablation protocol to improve the cure and success rates for atrial fibrillation for our patients

By Dr Boon Lim

Dr Boon Lim is one of London's leading cardiologists and electrophysiologists. He specialises in heart rhythm disturbances, pacing and syncope at Imperial College and at his Harley Street clinic. He leads the established Imperial Syncope Diagnostic Service at Hammersmith Hospital and is frequently invited to national and international meetings to share his experience. He has a special interest in the mapping and ablation of atrial fibrillation (AF) and is highly-skilled at using modern 3-D mapping technologies.

Dr Lim has been awarded the prestigious Top Doctors Award in each of it's editions in 2017, 2018, and 2019-20. The Top Doctors Awards are peer-nominated by other medical specialists of the doctors that they would recommend to friends and family in times of medical need.

Dr Lim was awarded several distinguished prizes during his medical training at Cambridge University where he obtained a double First Class Honours Degree. He has continued his passion for education and research serving as an Honorary Senior Lecturer at Imperial College where he supervises several PhD students. He is very actively engaged in all aspects of research with a particular interest in developing the best techniques for treating atrial fibrillation. He is invited to speak both nationally and internationally to discuss his findings and to teach other physicians about the best techniques for complex mapping and ablation of atrial fibrillation and other complex arrhythmias.

He leads a very active syncope research team based at the Imperial Syncope Diagnostic Unit and is looking to improve healthcare delivery for patients through use of effective online education to help improve the quality of life for patients across the UK. 

Dr Lim is the author of the Penguin Life Experts book 'Keeping Your Heart Healthy' published in September 2021.

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