“Can you fix heart arrhythmia without medications?”

Thats a very generalized question. The short answer is yes.. Most arrhythmias originate in the upper chambers of the heart , known as the atria. These arrhythmias are also called supraventricular or above the ventricles. Ventricular arrhythmias originate in either the right or left ventricles. Ventricular arrhythmias are more rare and more dangerous. Arrhythmias that originate in either the right or left atria are not life threatening, with few exceptions. One such situation is when an AV node blocking drug is given to a patient in atrial fibrillation with an underlying electrical bypass pathway ( pre-excitation, such as WPW). The pathway connects the atrium directly to the ventricle, avoiding the physiologic pause in the AV node. The pre-excitation comes from the early depolarization of the ventricle, as the electrical conduction travels through the bypass pathway. This wave is followed shortly after by the slower conduction down the normal pathway of the AV node, bundle of his, and the right and left bundle branches. So the ECG shows a widened QRS with a delta wave, due to the fusion of the double depolarizations of the ventricles superimposed on each other. So if a medication is given that slows the AV node, the conduction down the bypass pathway is unabated. The atrial fibrillation becomes ventricular fibrillation , and cardiac arrest is likely. This is treated by emergent, electrical cardioversion, with successive shocks provided by the automated defibrillator. Ventricular fibrillation requires electrical cardioversion in every case, because it is the ultimate life-threatening arrhythmia. Fibrillation prevents ventricular contractions , and the complete loss of cardiac output, followed by imminent death. Most ventricular arrhythmias are the result of re-entry electrical pathways around scarred ventricular tissue , during or after a myocardial infarction (or heart attack). Antiarrhythmic drugs, such as amiodarone, help maintain sinus rhythm following direct-current cardioversion (shocks). AV nodal blocking agents ( beta-blockers and calcium channel blockers) are largely ineffective, because these arrhythmias originate below the AV node (in the ventricular tissue). There are several varieties of ventricular tachycardia, including inherited channelopathies ( Brugada, Long QT), those related to birth defects causing abnormalities in the ventricles (arrhythmogenic right ventricular dysplasia) , non-compaction syndromes of ventricular tissue , etc. These potentially life threatening arrhythmias are treated with antiarrhythmic drugs and often, implantation of a cardiodefibrillator or AICD. Some of these arrhythmias can be eliminated using ablation therapies by Electrophysiologists. Ablations are certainly a way to avoid long-standing medications. Atrial ,or Supraventricular, arrhythmias come in many forms. Sinus tachycardia is included, but is not considered a true arrhythmia. sinus tachycardia originates in the sinus node and follows the normal electrical conduction pathway. Sinus tach is secondary to increased sympathetic tone from the autonomic nervous system, mediated by the neurotransmitter norepinephrine, or adrenaline. This is triggered by pain, anemia, fever, thyroid hormone, infections etc. The treatment is to correct the underlying cause and slow down the sinus node depolarization and heart rate with the same meds that block the AV node. The true atrial arrhythmias are supraventricular re-entry electrical pathways, ( with or without inclusion of the AV node). Those that do involve the AV node (AVNRT, ectopic atrial tach,or EAT) are converted by maneuvers that increase vagal nerve tone and block the AV node ( valsalva, face submersion in ice water or carotid massage). Also the usual AV blocking meds are effective. The the re-entry arrhythmias that do not involve the AV node (AVRT, WPW), use a bypass pathway as part of the circuit. Since these arrhythmias do not involve the AV node , maneuvers and nodal blocking meds are ineffective. True anti-arrhythmic meds,or electrical shocks, are used to treat these. The most common atrial arrhythmias are atrial fibrillation and atrial flutter. Flutter tends to be unstable long term. Atrial flutter either converts to normal sinus rhythm or degrades into a -fib. The nodal blockers will slow the rates of these tachyarrhythmias, but will not convert them to sinus rhythm. That is done with true anti-arrhythmic drugs ( flecainide, amiodarone, sotalol, dofetillide, dronederone ) and/ or electrical cardioversion. As it pertains to your question, to avoid long term , potentially toxic, anti arrhythmic meds, then the best option is an ablation procedure. The success rate of ablation in AV nodal re-entry tachycardia, or AVNRT, is at 90%. Ablation of bypass pathways , like WPW or AVRT, has about the same efficacy. Ablation of atrial fib is now above 80% , since the pathways of re-entry are around the entry of the pulmonary veins into the left atrium. Ablation of atrial flutter is slightly more effective. the pathway involves the isthmus of the Inferior vena cava and annulus of the tricuspid valve, in the right atrium. In summary, ablation therapy has come a long way in the last decade, with better equipment, better techniques (radio frequency waves vs cryotherapy or freezing the tissue) and less adverse events. To completely avoid long-term medication, ablation procedures are the best option, whether the arrhythmias originate in or above the ventricles. Scar re-entry arrhythmias can usually be ablated, as can some inherited ventricular conduction pathways. However, avoiding long-term medication when treating ventricular arrhythmias might not be an option, regardless of the success of an ablation procedure. The potential for future adverse outcomes can be prohibitive.