Treatments for Arrhythmias


Treatments for Tachycardias Offered by Dr. Stefano Grossi.

Stopping Tachycardia

In the acute phase, the goal is to stop tachycardia as quickly as possible. 

After receiving proper instructions from their cardiologist, patients can attempt vagal maneuvers on their own. These maneuvers can sometimes successfully restore the normal sinus rhythm.

However, vagal maneuvers are often either ineffective or improperly performed by the patient. In such cases, the patient must go to the emergency department, where intravenous medications (adenosine, calcium channel blockers, beta-blockers) will almost always stop the tachycardia. In a very small number of cases, electrical cardioversion may be necessary.

Prevenire le recidive

The real challenge is not stopping the arrhythmia but ensuring it does not recur after being interrupted. For many years, continuous treatment with antiarrhythmic drugs was the standard approach. However, this often failed to prevent episodes, even when patients adhered to the prescribed therapy. Additionally, long-term medication use could lead to intolerance or side effects.

Since the 1990s, electrophysiologists have developed transcatheter ablation techniques that have shown excellent results for these types of arrhythmias. These methods achieve nearly 100% success in patients with reentrant nodal tachycardia and tachycardias involving an accessory pathway, and an 80-90% success rate in focal atrial tachycardias. This treatment is now the first choice for patients with these conditions.

In cases of reentrant nodal tachycardia, the target is the slow nodal pathway, which forms one arm of the circuit (reentry) sustaining the arrhythmia (Fig. 4). In cases of arrhythmias caused by accessory pathways, the target is the Kent bundle (Fig. 5).

By applying energy that heats (radiofrequency) or cools (cryoablation) the tissue locally, the slow nodal pathway can be eliminated, permanently preventing the occurrence of paroxysmal tachycardia.

Trattamenti per tachicardie
Fig. 4 – A: The lower extension of the atrioventricular node represents the slow pathway of the reentrant circuit underlying the arrhythmias and the target of the ablation. D: The ablation catheter positioned in the corresponding heart area; once the reentrant circuit is eliminated, it will no longer occur.
Trattamenti per tachicardie
Fig. 5 – A: The presence of a connection between the left atrium and ventricle (accessory or anomalous pathway) represents one of the two limbs of the reentrant circuit sustaining the arrhythmia. B: The ablation catheter positioned in the corresponding heart area; once the reentrant circuit is eliminated, it will no longer occur.
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