Arrhythmia Frequently Asked Questions

Many medications are available to treat cardiac arrhythmias, or abnormal heart rhythms, including:

• Amiodarone (Cordarone, Pacerone)
• Disopyramide (Norpace)
• Dofetilide (Tikosyn)
• Dronedarone (Multaq)
• Flecainide (Tambocor)
• Propafenone (Rythmol)
• Quinidine (many trade names)
• Sotalol (Betapace)

For patients with certain atrial arrhythmias (abnormal heart rhythm originating in the top two chambers of the heart), including atrial fibrillation and atrial flutter, a blood thinner (anticoagulant) may also be prescribed to reduce the risk of blood clots and stroke:

• Warfarin (Coumadin or Jantoven)
• Dabigatran (Pradaxa)
• Dalteparin (Fragmin)
• Danaparoid (Orgaran)
• Enoxaparin (Lovenox)
• Heparin (many trade names)
• Tinzaparin (Innohep)

Arrhythmia medications work by slowing conduction of electrical impulses.

Blood thinners (anticoagulants) work by decreasing the clogging ability (coagulating) of the blood. Although commonly referred to as “blood thinners,” the drugs do not actually thin the blood or dissolve existing blood clots.

During your appointment, tell your doctor about all medications you currently take (including over-the-counter drugs and vitamins), as well as any existing medical issues (allergies, pre-existing conditions). Your doctor will choose the best medication for you based on this information.

Listen carefully to your doctor’s instructions regarding how and when to take your medication. It is very important to take arrhythmia medications exactly as directed.

If you are prescribed blood thinners, your doctor will explain how your blood-clotting level must be regularly monitored to ensure you are taking the correct dosage. The INR (international normalized ratio) value will test how quickly your blood clots, and your blood thinner dosage may be adjusted to maintain your heart’s appropriate INR level. Your doctor may also ask you to have regular blood tests.

Arrhythmia medications may have side effects. Call your doctor immediately if you experience any of the following:

• Worsening arrhythmias
• Allergic reaction
• Chest pain
• Fainting
• Swelling of the feet or legs
• Blurred vision
• Shortness of breath
• Dizziness or lightheadedness
• Cough
• Loss of appetite
• Increased sensitivity to sunlight
• Diarrhea or constipation

During the first few weeks of taking arrhythmia medication, you may want to avoid driving or operating heavy machinery until you know how the medication will affect you.

Blood thinners may also have side effects. Call your doctor immediately if you experience any of the following:

• Severe bleeding, including heavier-than-normal menstrual bleeding
• Red or brown urine
• Black or bloody stool
• Severe headache or stomach pain
• Joint pain, discomfort, or swelling, especially after an injury
• Vomiting of blood or dark material that looks like ground coffee
• Bruising that develops without injury
• Dizziness or weakness

Catheter ablation is a procedure to treat cardiac arrhythmias, using radiofrequency or another energy source to destroy an area of tissue involved in the arrhythmia.

Patients who have recurrent episodes of cardiac arrhythmias that cause symptoms may be considered for a catheter ablation procedure. Your doctor will advise you whether catheter ablation is the right treatment for you.

Learn more about a patient who had an ablation procedure to restore a normal heartbeat.

During the procedure, you will be connected to monitoring equipment. In some cases, mild sedation is used, while general anesthesia is used for other types of ablation procedures.

Local anesthetic will be administered to the groin area, and catheters will be placed through the femoral (thigh) vessels to the heart with the use of fluoroscopy (X-ray). An electrophysiologic study may be conducted to determine the source of the arrhythmia. Once the source of the arrhythmia is identified, radiofrequency energy will be applied to the area of interest. At the end of the procedure, the catheters will be removed and you will be on bed rest for four to six hours.

Catheter ablation is performed in the CardioVascular Institute’s Electrophysiology (EP) Lab, located on the West Campus of BIDMC on the fourth floor of the Baker Building (Farr Complex) at 185 Pilgrim Road.

• BIDMC Campus Maps

Some ablation procedures require an overnight stay, while others are outpatient, one-day procedures. For more information call 617-667-8800 and ask to speak with the Electrophysiology (EP) Lab.

You may be asked to stop taking some medications, including blood thinners, prior to the procedure. Do not eat or drink anything after midnight the day before the procedure.

On the day of the procedure, you will need to have a family member or friend drive you to BIDMC. Bring a list of medications approved by your doctor (including prescription, over-the-counter medicines, vitamins, and supplements). Do not bring any valuables with you. You will be called one to two days before your procedure with the time you should arrive at the medical center.

After a catheter ablation, you should generally avoid strenuous activity and heavy exercise for 10 days. You should also avoid lifting more than 10 pounds during this time.

An implantable cardioverter defibrillator (ICD) is a battery-powered device placed under the skin that keeps track of your heart rate. Thin wires connect the ICD to your heart, and when an abnormally fast heartbeat is detected, the device delivers an electrical shock to normalize your heartbeat.

Newer ICDs may also include a pacemaker function that allows for the device to detect abnormally slow heart rhythms as well.

ICDs are appropriate for patients with chronic, life-threatening arrhythmias due to:

• Heart attack(s)
• Cardiac arrest survival
• Congenital heart disease
• Brugada syndrome
• Long QT syndrome
• Ventricular arrhythmia

Your doctor will determine if an ICD is the right treatment option for you.

ICDs use wires and electrodes to detect irregular heart activity. The wires connect directly to the heart, and in the case of an abnormally fast heartbeat, the device will send electric pulses to the heart to help regulate the heartbeat. There are two kinds of ICDs:

• Single-chamber ICDs have a wire that connects to either the right ventricle or the right atrium
• Dual-chamber ICDs have wires that connect to both an atrium and a ventricle

ICDs emit low-energy and high-energy pulses. Low-energy pulses are painless, and patients will not notice them. However, patients may feel a “thump” in the chest during a high-energy pulse. High-energy pulses only last for fractions of a second.

During the procedure, you will receive local anesthesia to the area beneath your collarbone and a small incision will be made. Most often, the incision is on the left side. The ICD wires will be inserted through this incision and into a vein that leads to the heart. Once the wire or wires are in place, they will be connected to the ICD, which sits below the skin where the incision is made. The incision will be closed with stitches and covered with a bandage.

The procedure will take about two hours. Patients typically spend one night in the hospital following ICD implantation. Before you leave the hospital, the ICD will be checked and your doctor will let you know what activities to avoid during the recovery period. 

ICD implantation is performed in the CardioVascular Institute’s Electrophysiology (EP) Lab, located on the West Campus of BIDMC on the fourth floor of the Baker Building (Farr Complex) at 185 Pilgrim Road.

• BIDMC Campus Maps

After an ICD implantation, some of your arm movements on the side where the ICD is will be restricted. Strenuous activity, especially involving the upper body, should be avoided for four to six weeks.

Typically, patients may resume driving one week after the procedure once the ICD function has been checked.

After an ICD is inserted, you will need to avoid:

• MRI scans
• Heat therapy (this may be part of physical therapy)
• High-voltage or radar machinery such as electric arc welders, high-tension wires, radar installations or smelting furnaces
• Airport security scanners: instead of passing through the metal detector, passengers with ICDs must ask to be screened by imaging technology or pat-down

Be sure to tell your dentist and other doctors about your ICD as well.

After your ICD is implanted, we recommend:

• Following activity instructions provided by your doctor.
• Taking medications exactly as instructed.
• Keeping check-up appointments. Your doctor will alert you if the battery is running low.
• Monitoring your mental health: in some cases, patients with ICD experience feelings of anxiety or depression. Be sure to talk to your doctor if you are experiencing changes in your mental health.
• Carrying an ICD identification card in case of emergencies (a free download is available from the American Heart Association)

You may be asked to stop taking some medications, including blood thinners, prior to your procedure. Do not eat or drink anything after midnight the day before your procedure.

On the day of the procedure, a family member or friend should drive you to BIDMC. Although you will be wearing a hospital gown during the procedure, you will want to wear comfortable clothes to change into afterwards. You may also want to bring any necessary toiletries and personal items.

You will be called one to two days before your procedure with the time you should arrive at the medical center. 

An ICD battery should last anywhere from five to 10 years. During your regular ICD check-ups (every three to six months), your doctor will test the device’s battery life. If the battery is running low, it will be replaced with a new one during a minor outpatient procedure.

The procedure to change the pacemaker’s battery is simple, does not involve an overnight stay in the hospital, and requires little recovery time.

A pacemaker is a small, battery-operated device that helps the heart maintain a normal heart rate. Pacemakers are implanted under the skin, just under the collarbone.

Pacemakers are appropriate for patients with heartbeats that are too slow as a result of abnormalities in the electrical conduction system. Your doctor will determine if a pacemaker is the right treatment option for you.

Pacemakers contain sensitive electrodes that monitor the heart’s activity. In the case of an excessively slow heart rate, the pacemaker will automatically send electrical pulses that pace the heart and regulate the heartbeat. Most patients are not aware of the pacemaker itself, or the activity of the pacemaker.

During the procedure, local anesthesia will be delivered to the area beneath your collarbone and a small incision will be made. Most often, the incision is on the left side. The pacemaker wires will be inserted through this incision and into a vein that leads to the heart. Once the wire or wires are in place, they will be connected to the pacemaker, which sits below the skin where the incision is made. The incision will be closed with stitches and covered with a bandage. 

The procedure will take about two hours. Patients typically spend one night in the hospital following pacemaker implantation. Before you leave the hospital, your pacemaker will be checked, and your doctor will let you know what activities to avoid during the recovery period.

Pacemaker implantation is performed in the CardioVascular Institute’s Electrophysiology (EP) Lab, located on the West Campus of BIDMC on the fourth floor of the Baker Building (Farr Complex) at 185 Pilgrim Road.

• BIDMC Campus Maps

After the procedure, some of your arm movements on the side where the pacemaker was implanted will be restricted. Strenuous activity, especially involving the upper body, should be avoided for four to six weeks. Typically, patients may resume driving one week after the procedure once their pacemaker function has been checked.

Once the pacemaker is inserted, patients need to avoid:

• MRI scans, if your pacemaker is not specifically approved for use with an MRI
• Heat therapy (often a part of physical therapy)
• High-voltage or radar machinery such as electric arc welders, high-tension wires, radar installations or smelting furnaces
• Airport security scanners: instead of passing through the metal detector, passengers with pacemakers should request to be screened by imaging technology or patdown.

Be sure to tell your dentist and other doctors about your pacemaker as well. 

After your pacemaker is implanted, you can expect to have a healthy, regular heartbeat. We recommend:

• Following activity instructions provided by your doctor.
• Taking medications exactly as instructed.
• Keeping regular check-up appointments. Your doctor will alert you if the battery is running low.
• Carrying a pacemaker ID card in case of emergencies (a free download is available from the American Heart Association).

You may be asked to stop taking some medications, including blood thinners, prior to the procedure. Do not eat or drink anything after midnight the day before the procedure.

On the day of the procedure, a family member or friend should drive you to BIDMC. Although you will be wearing a hospital gown during the procedure, you will want comfortable clothes to change into afterwards. You may also want to bring any necessary toiletries and personal items.

You will be called one to two days before your procedure with the time you should arrive at the medical center. 

A pacemaker battery should last anywhere from five to 10 years. Once the battery runs out, you will need to undergo another procedure to get replace the generator. The procedure to change the pacemaker’s battery is simpler, does not involve an overnight stay in the hospital and requires less recovery time.

The left atrial appendage (LAA) is a small sac located in the muscle wall of the heart’s left atrium (top chamber of the heart).

When a patient has atrial fibrillation, the electrical impulses that carefully control heartbeats fail to follow their normal orderly route through the heart. Instead, impulses may become rapid and chaotic, and prevent the heart’s atria from properly contracting —  as it usually does with each heartbeat. This means that blood is not effectively squeezed out to the heart’s bottom chamber and can collect in the pouch-like LAA.

Pooled blot can cause clots to form in the LAA. If clots become dislodged from the LAA, they can travel to the brain and cause a stroke. A majority of blood clots have been found to develop in the heart’s left atrial appendage, and people with atrial fibrillation are 5 to 7 times more likely to have a stroke than the general population.

A left atrial appendage occlusion is a procedure that seals off the left atrial appendage with a self-expanding device, thereby preventing blood from pooling and preventing blood clots from forming. As a result, patients’ risk of stroke is reduced, as is the need to take blood-thinning medication.

One of the devices approved by the U.S. Food and Drug Administration (FDA) to close the LAA is called the Watchman. This parachute-shaped device closes off the LAA and reduces the risk of blood clots forming in the left atrial appendage in patients with atrial fibrillation. Studies have shown that the Watchman device can be a good alternative treatment for patients with atrial fibrillation who cannot tolerate treatment with the blood thinner Warfarin.

The Watchman device is implanted percutaneously (through the skin) in the Electrophysiology Lab at BIDMC. The procedure does not require surgery, but patients will get general anesthesia. A catheter sheath is inserted in a vein near the groin and then guided across the heart’s septum (the muscular wall that divides the right and left sides of the heart) to the opening of the left atrial appendage. The Watchman device is placed at the opening, which seals off the LAA and prevents it from releasing blood clots.

Patients will need to be able to tolerate anti-coagulation (blood thinning) medication for a short period of time, which can be up to three weeks prior to their scheduled procedure. Then, patients stay in the hospital overnight following the procedure. Patients will continue to take anti-coagulation medication from the time of discharge until their post-procedure imaging test, called a transesophageal echo, 45 days after the procedure. If the imaging test is normal, then patients will be transitioned to dual anti-platelet medication. Approximately six months following the procedure, if the implant site is sealed, patients will be transitioned from anti-coagulation medication to aspirin.