16. Treatment of Cardiac Arrhythmias

The treatment of arrhythmias involves consideration of patient symptoms, the clinical situation in which the arrhythmia arises, the natural history of a given arrhythmia, and the relative likelihood of success of different pharmacologic and invasive options such as device implantation, catheter ablation, or surgery. With advances in implantable cardiac devices and catheter ablation, the options for arrhythmia treatment have expanded significantly, and a basic understanding of these procedures is necessary to properly counsel patients on arrhythmia management. It is also important to understand the basic pharmacology of antiarrhythmic drugs, their indications, and their potential side effects and relative contraindications. An algorithmic approach to decision making while also taking into account individual patient preference and clinician experience is key. Thus, a structured approach to considering the different treatment modalities available for arrhythmias, when certain therapies may be reasonable, and how they may be implemented must be taken in the context of constantly evolving epidemiologic understanding and technological advances.