Question: I am 67 years old and as far back as I am able to remember have always had an irregular heartbeat. But I have never had any pains in the chest area and have never been treated. Should I be on medication?
Dr. Hibberd's answer:
Irregular heartbeats are very common. But not all irregular heartbeats increase your risk of stroke or death, and not all need to be treated.
So which irregular beats are worrisome? If you have extra beats from the upper heart chambers (called the atria), you should be OK without treatment — as long as they remain isolated and do not accelerate beats from the large heart chambers (called ventricles) or cause heart rates to accelerate uncontrollably.
But some irregular heartbeats should be treated with ablation therapy, by an interventional cardiologist. In cases of atrial fibrillation (AF) or atrial flutter — where the atria are quivering and not fully contracting — sufferers are at increased risk for clots and emboli that can cause adverse events such as strokes. The aim here is to regulate the rate of ventricular response to the AF using medication and/or ablation treatment.
In patients at risk for stroke from AF, permanent clot-busting treatment is recommended, especially in people over the age of 60. Other irregular beats from the ventricles are treated more aggressively because of the total loss of heart function that occurs when ventricular arrhythmias occur, raising the risk of sudden death. Irregular ventricular beats are usually treated with medication and/or automated defibrillator pacemakers. Most recurrent arrhythmias can be controlled, and sometimes an ablation treatment is done through a heart catheterization device to cure them permanently.
Chest pain is not usually experienced with arrhythmias unless circulation to the coronary arteries is impaired.
But you need to have your irregular beat problems evaluated to see if regular medication use or a procedure such as an ablation is advisable. The decision about the best course of action for you will depend on the rhythm and its rate, its frequency, and its risk of degenerating into more dangerous conditions, strokes, or heart failure.
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