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Treatments and drugs

By Mayo Clinic staff

The treatments goals for tachycardias are to slow a fast heart rate when it occurs, prevent future episodes and minimize complications.

Stopping a fast heart rate
A fast heartbeat may correct itself, and you may be able to slow your heart rate using simple physical movements. However, you may need medication or other medical treatment to slow down your heartbeat. Ways to slow your heartbeat include:

  • Vagal maneuvers. Your doctor may ask you to perform an action, called a vagal maneuver, during an episode of a fast heartbeat. Vagal maneuvers affect the vagus nerve, which helps regulate your heartbeat. The maneuvers include coughing, bearing down as if you're having a bowel movement, and putting an icepack on your face.
  • Medications. If vagal maneuvers don't stop the fast heartbeat, you may need an injection of an anti-arrhythmic medication to restore a normal heart rate. An injection of this drug is administered at a hospital. Your doctor may also prescribe a pill version of an anti-arrhythmic drug, such as flecainide (Tambocor) or propafenone (Rythmol), to take if you have an episode of a fast heartbeat that doesn't respond to vagal maneuvers.
  • Cardioversion. In this procedure, a shock is delivered to your heart through paddles or patches on your chest. The current affects the electrical impulses in your heart and restores a normal rhythm. It's typically used when emergency care is needed or when maneuvers and medications aren't effective.

Preventing episodes of a fast heart rate
With the following treatments, it may be possible to prevent or manage episodes of tachycardia.

  • Radiofrequency catheter ablation. This procedure is used most often when an extra electrical pathway is responsible for an increased heart rate. In this procedure, catheters are threaded through the blood vessels to your heart. Electrodes at the catheter tips are heated to damage (ablate) the extra electrical pathway and prevent it from sending electrical signals. This procedure is highly effective, especially for supraventricular tachycardia. Radiofrequency ablation can also be used to treat atrial fibrillation and atrial flutter.
  • Medications. Anti-arrhythmic medications may prevent a fast heart rate when taken regularly. Other medications that may be prescribed either as an alternative or in combination with anti-arrhythmic medications are calcium channel blockers, such as diltiazem (Cardizem) and verapamil (Calan), or beta blockers, such as propranolol (Inderal) and esmolol (Brevibloc).
  • Implantable cardioverter-defibrillator. If you're at risk of having a life-threatening tachycardia episode, your doctor may recommend an implantable cardioverter-defibrillator (ICD). The device, about the size of a cell phone, is surgically implanted in your chest. The ICD continuously monitors your heartbeat, detects an increase in heart rate and delivers precisely calibrated electrical shocks to restore a normal heart rhythm.
  • Surgery. Open-heart surgery may be needed in some cases to destroy an extra electrical pathway. In another type of surgery, called the maze procedure, a surgeon makes small incisions in heart tissue to create a pattern or maze of scar tissue. Because scar tissue doesn't conduct electricity, it interferes with stray electrical impulses that cause some types of tachycardia. Surgery is usually used only when other treatment options don't work or surgery is needed to treat another heart disorder.

Preventing blood clots
Some people with tachycardias have an increased risk of developing a blood clot that could cause a stroke or heart attack. Your doctor may prescribe a drug-thinning medication to help lower your risk.

Treating underlying disease
If another medical condition is contributing to tachycardia — for example, some form of heart disease or hyperthyroidism — treating the underlying problem may prevent or minimize tachycardia episodes.

Coping and support Tests and diagnosis
References
  1. Mitchell LB. Arrhythmias and conduction disorders: Introduction. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec07/ch075/ch075a.html. Accessed April 19, 2009.
  2. Olgin JE, et al. Specific arrhythmias: Diagnosis and treatment. In: Libby P, et al., eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/book/player/book.do?method=display&type=aboutPage&decorator=header&eid=4-u1.0-B978-1-4160-4106-1..X5001-8--TOP&isbn=978-1-4160-4106-1&uniq=134565520#lpState=open&lpTab=contentsTab&content=4-u1.0-B978-1-4160-4106-1..50038-8%3Bfrom%3Dtoc%3Btype%3DbookPage%3Bisbn%3D978-1-4160-4106-1. Accessed April 19, 2009.
  3. Ventricular tachycardia. American Heart Association. http://americanheart.org/print_presenter.jhtml?identifier=3062877. Accessed April 22, 2009.
  4. Atrial or supraventricular tachycardia. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=3062868. Accessed April 18, 2009.
  5. Mitchell LB. Atrial fibrillation (AF). The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec07/ch075/ch075e.html. Accessed April 20, 2009.
  6. Mitchell LB. Ventricular tachycardia (VT). The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec07/ch075/ch075k.html. Accessed April 20, 2009.
  7. Mitchell LB. Reentrant supraventricular tachycardias (SVT, PSVT). The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec07/ch075/ch075g.html. Accessed April 20, 2009.
  8. Mitchell LB. Ventricular fibrillation. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec07/ch075/ch075m.html. Accessed April 20, 2009.
  9. Hebbar AK, et al. Management of common arrhythmias: Part I. Supraventricular arrhythmias. American Family Physician. 2002;65:2479.
  10. Hebbar AK, et al. Management of common arrhythmias: Part II. Ventricular arrhythmias and arrhythmias in special populations. American Family Physician. 2002;65:2491.
  11. Mitchell LB. Atrial flutter. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec07/ch075/ch075f.html. Accessed April 20, 2009.
  12. What are Holter, event and transtelephonic monitors? American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=3005149. Accessed Jan. 15, 2009.
  13. Calkins H. Supraventricular tachycardia: AV nodal reentry and Wolff-Parkinson-White syndrome. In: Fuster V, et al., eds. Hurst's The Heart. 12th ed. New York, N.Y.: McGraw-Hill; 2008. http://www.accessmedicine.com/content.aspx?aID=3050545. Accessed April 19, 2009.
  14. Prystowsky EN, et al. Approach to the patient with cardiac arrhythmias: Introduction. In: Fuster V, et al., eds. Hurst's The Heart. 12th ed. New York, N.Y.: McGraw-Hill; 2008. http://www.accessmedicine.com/content.aspx?aID=3048673. Accessed April 20, 2009.
  15. Delacretaz E. Supraventricular tachycardia. New England Journal of Medicine. 2006;354:1039.
  16. Prystowsky EN, et al. Atrial fibrillation, atrial flutter, and atrial tachycardia: Introduction. In: Fuster V, et al., eds. Hurst's The Heart. 12th ed. New York, N.Y.: McGraw-Hill; 2008. http://www.accessmedicine.com/content.aspx?aID=3048772. Accessed April 20, 2009.
  17. Grogan M (expert opinion). Mayo Clinic, Rochester, Minn. April 29, 2009.

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