Alternative treatments to having a pacemaker fitted include:
- medication,
- cardiac catheter ablation, and
- an implantable cardioverter-defibrillator (ICD).
Medication
Medicines called anti-arrhythmics can control heart rhythm disorders by:
- restoring a normal heart rhythm, and/or
- controlling the rate at which the heart beats.
Examples are calcium channel blockers (such as verapamil), which slow your heart rate, and beta-blockers (such as sotalol), which restore a normal heart rhythm.
The most common side effects of beta-blockers are coldness of hands and feet, low blood pressure and impotence. Possible side effects of calcium channel blockers are low blood pressure, ankle swelling and heart failure.
For more information, see Treating atrial fibrillation and Treating heart failure.
Cardiac catheter ablation
Catheter ablation is a procedure that very carefully destroys the diseased area of your heart and interrupts abnormal electrical circuits. It is an option if medication has not been effective or tolerated.
Catheters (thin, soft wires) are guided through one of your veins into your heart, where they record electrical activity. When the source of the abnormality is found, an energy source (such as high-frequency radio waves that generate heat) is transmitted through one of the catheters to destroy the tissue.
This can be quite a long procedure and commonly takes two to three hours, so it may be done under general anaesthetic (where you are put to sleep).
For more detailed information on catheter ablation for atrial fibrillation, go to the Arrhythmia Alliance website
Implantable cardioverter-defibrillator (ICD)
An ICD is a device slightly bigger than a matchbox that is implanted under your collarbone, with wires leading to your heart. Like a pacemaker, it can be used to pace your heart.
An ICD is often inserted under local anaesthetic (which numbs the area), but a general anaesthetic (which puts you to sleep) may be used if you are at high risk of having a cardiac arrest (when your heart stops).
You may need an ICD if:
- you have had a previous cardiac arrest and are at risk of another one, or
- you have never had a cardiac arrest but tests show you have high risk of having one at some point in the future because of abnormal heart rhythms.
How is an ICD different from a pacemaker?
If the ICD detects an abnormal heart rhythm, it tries to correct this by pacing your heart and, if this fails, delivering a small, controlled electric shock. If this fails, it delivers a larger shock, known as defibrillation. A pacemaker does not give you any electric shocks.
