Health Chats
Arrhythmias: Different Types and Available Treatment Options
Tuesday Jun 28, 2011, 01:00PM - 02:00PM (EST)
There are many different types of cardiac arrhythmias. Many arrhythmias are benign and do not require any specific treatment. However there are some arrhythmias that need to be controlled with the use of medications, electric cardioversion, implantable devices such as defibrillators or pacemakers and catheter ablation. Join us with Dr. Borek, a Cleveland Clinic electrophysiologist who will provide answers to your questions about the different types of arrhythmias and their available treatment options.<br><br> Peter Borek, MD is a Staff Cardiologist in the Section of Cardiac Electrophysiology and Pacing in the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at Cleveland Clinic. He is board-certified in cardiac electrophysiology, cardiovascular disease and internal medicine. Dr. Borek is trained in all aspects of clinical cardiac electrophysiology and pacing, including catheter ablation of various arrhythmias.
Peter Borek, MD:
Your father should definitely have an ablation.  Having all these shocks isn't good for him.  There are always risk to any procedure that we do, however, the benefits certainly outweigh them in this case.  If the procedure goes well there really aren't any long term effects of ablation.  Unfortunately, because of your dad's heart condition he will be at risk for developing other arrhythmias and may need additional ablation procedures in the future.  It is also not a very good idea for him to be getting high doses of amiodarone as this medication has been known to cause various, some potentially serious, side effects.  Again, if the ablation were successful he could be weaned off that as well.  
I'm a 35 y.o. male with a left ventricular aneurysm diagnosed six months ago. EF 48%, posterobasilar and basal lateral dyskinetic segment consistent with aneurysm and/or pseudoaneurysm, localized lateral hypokinesis, mild MR & TR, RVSP 29mm Hg, EKG showing SR with NSTTWA and possible prior inferior and lateral infarct, no ST depression over baseline with excercise, resting wall motion abnormality as described with posterior akinesis consistent with periinfarction ischemia. CT scan showed no blockages. Could I have had a recent infarction without clogged arteries? Could Cialis be a possible culprit? Why not? If it’s a congenital condition, why no symptoms until now despite a very active and athletic life? What’s my prognosis and what can I do to control palpitations and headaches that sometimes leave me feeling close to blacking out or have me waking up in the middle of the night gasping for air? Am I at risk for stroke? Should I be taking taurine, arginine, magnesium, aspirin daily?
Peter Borek, MD:
This is a very complicated question and we will be happy to send you additional information and resources after this health chat.
After my heart attack in 1998, I had issues with Ventricular arrhythmia and ended up with an ICD.  While I still have ventricular arrhythmias, I have now also developed atrial flutter, but my device is not set to recognize any atrial events.  Should it be set to look for both?  Is Atrial Flutter serious?  Are there treatments for atrial flutter?
Peter Borek, MD:
Yes, your device needs to be reprogrammed if possible. Sometimes, if only one lead is present (is, no atrial lead, only ventricluar lead was implanted), the device won't be programmable to detect atrial flutter.  Atrial flutter can cause whats known as inappropriate shocks which carry some risk.  More importantly, atrial flutter can also be associated with increased risk of stroke.  I typically recommend anticoagulation to prevent stroke.  Finaly, there are multiple medical and interventional means of treating atrial flutter.  We typically start with medications first and if they dont' control the flutter proceed with an ablation procedure.  
Do abnormal heart rhythms weaken the heart and make a person more at risk for a heart attack?
Peter Borek, MD:
There are some abnomral rhythms which can weaken the heart.  Atrial fibrillation which may cause the heart to beat very fast for long periods of time can be associated with weakening of the heart muscle.  Premature ventricular contraction can also cause weakening of heart muscle when present in high numbers, typically greater than 10 to 15% of all heart beats over a 24 hour period.  We typically are very aggressive about managing these rhythms and often recommend proceeding with an ablation which may be curative.  
Can you please give me the definition of rare pvc's and frequent pvc's?  
Peter Borek, MD:
Rare PVC' probably occur at a rate of a few per hour.  Frequent PVC's occur over a period of seconds to minutes.  
I am a 39 year old male who has what have been diagnosed as benign PVCs. They have increased in frequency over the past year to an everyday basis -sometimes a few, sometimes 100s or 1000s a day. I have tried to eliminate all known triggers and current take 25 mg of metoprolol a day. I still feel each and every one and they are so detrimental to quality of life. I would like to know if there is any research into new, more effective and safe treatments for PVCs or is ablation the only curative option? If so, will ablation success continue to improve for PVC elimination?
Peter Borek, MD:
PVC ablation is really your only option at this point.  Depending on the origin of these PVC's the rate of success may be as high as 90%.  Occasionally, they may originate from areas that are either difficult to reach or unsafe to ablate.  These are much less frequent.  
When heart palpitations are felt when a person has them when hyperthyroid, are those Arrhythmias?
Peter Borek, MD:
They may be.  I would recommend wearing a holter monitor or an event recorder.  Typically, with hyperthyroidism, these palpitations are likely to be caused by either PAC's or PVCs.
I have been told my cardio that most people get some sort of PVC's or PAC's every day.&nbsp;&nbsp;I have been holtered and they caught a short run of PVC's, they called it salvos, and a few other PVC's and PAC's. Is it true that if you were to holter 100% of the people of there that "most" of them would have some sort of arrythmia during the day?How many PVC's and PAC's is considered a "normal" amount to have?
Peter Borek, MD:
Most people do have extra heart beats.  Most of these beats aren't felt, however.  PAC's typically aren't concenring at all.  When PVC's reach close to 10 to 15% of all beats over a 24 hour period is when most of us would recommend proceeding with aggressive therapy including an ablation.  
What kind of data do 30-day heart monitors capture? What data would recommend taking a drug versus installing a pacemaker versus doing nothing versus other treatments?
Peter Borek, MD:
It depends on the requsting physician.  Typically we look for arrhythmia burden when a diagnosis is present or look for an arrhythmia which could explain one's symptoms when diagnosis insn't present.  Generally speaking for atrial fibrillaton for example, depending on arrhytmia burden, one would recommend medications first, followed by ablation.  Pacemaker therapy is last resort for AF managment.  For slow heart rates, if present and correlate with symptoms, pacemaker therapy may be indicated.  For ventricular rhythms, if present and depending on underlying heart disease, one might recommend medical therapy and/or an ICD.  
We only have time for one more question.
Is it very usally to have bradycardia, pvc's, pac's, accelerated idioventricular rhythm (AIVR)  and reentry nonsustained VT if you got RVOT-VT? If not, what can cause those arrhythmias? could it be a dysfunction of ANS?
Peter Borek, MD:
These arrhythms which you describe are typically associated with normal heart VT's such as RVOT VT.  The exception is the PAC's of course.  They come from the atria.  We typically, however, don't think of RVOT as an re-entrant rhythm.
Thank you Dr. Borek for taking the time to answer our members' questions today.  We hope to be able to bring you back in the future for another chat.
Peter Borek, MD:
Thanks again for having me today. If you would like to make an appointment with me or one of my colleagues please call us at 216-444-6697. At Cleveland Clinic we have a dedicated Center for Atrial Fibrilation and Ventricular Arryhthmia Treatment Center where we provide a tailored treatment plans for all of our patients. We would be happy to see anyone.