Arrhythmia

An arrhythmia is an irregular heartbeat. If you have an arrhythmia, your heart may beat faster or slower than others without arrhythmia. There are several different conditions might cause your heart to beat abnormally, and treatment depends on the cause.

Causes #

• Coronary artery disease.

• Irritable tissue in the heart (due to genetic or acquired causes).

• High blood pressure.

• Changes in the heart muscle (cardiomyopathy).

• Valve disorders.

• Electrolyte imbalances in your blood, such as sodium or potassium imbalances.

• Injury from a heart attack.

• The healing process after heart surgery.

• Other medical conditions.

Types #

Supraventricular arrhythmias #

Arrhythmias that begin in the atria (the heart’s upper chambers). Supra means above. Ventricular refers to the lower chambers of the heart or ventricles.

Ventricular arrhythmias #

Arrhythmias that begin in the ventricles (the heart’s lower chambers).

Bradyarrhythmias #

Slow heart rhythms that may be caused by disease in the heart’s conduction system, such as the sinoatrial (SA) node, atrioventricular (AV) node or HIS-Purkinje network.

Symptoms #

• Palpitations: A feeling of skipped heartbeat or that your heart is “running away,” fluttering or doing “flip-flops.”

• Pounding in your chest.

• Dizziness or feeling lightheaded.

• Shortness of breath.

• Chest discomfort.

• Weakness or fatigue (feeling very tired).

• Weakening of the heart muscle or low ejection fraction.

Diagnosis #

Electrocardiogram (ECG or EKG) #

A picture of the electrical impulses traveling through the heart muscle. An ECG is recorded on graph paper, through the use of electrodes (small, sticky patches) that are attached to your skin on the chest, arms and legs.

Stress test #

A test used to record arrhythmias that start or are worsened with exercise. This test also may be helpful to determine if there is underlying heart disease or coronary artery disease associated with an arrhythmia.

Echocardiogram #

A type of ultrasound used to provide a view of the heart to determine if there is heart muscle or valve disease that may be causing an arrhythmia. This test may be performed at rest or with activity.

Cardiac catheterization #

Using a local anesthetic, a catheter (small, hollow, flexible tube) is inserted into a blood vessel and guided to the heart with the help of an X-ray machine. A contrast dye is injected through the catheter so X-ray movies of your coronary arteries, heart chambers and valves may be taken.

This test helps your doctor determine if the cause of an arrhythmia is coronary artery disease. This test also provides information about how well your heart muscle and valves are working.

Electrophysiology study (EPS) #

A special heart catheterization that evaluates your heart’s electrical system. Catheters are inserted into your heart to record the electrical activity. The EPS is used to find the cause of the abnormal rhythm and determine the best treatment for you. During the test, the arrhythmia can be safely reproduced and terminated.

Tilt table test (also called a passive head-up tilt test or head upright tilt test) #

Records your blood pressure and heart rate on a minute-by-minute basis while the table is tilted in a head-up position at different levels. The test results may be used to evaluate heart rhythm, blood pressure and sometimes other measurements as you change position.

Risk factors #

• If you smoke or use tobacco products, quit.

• Limit your intake of alcohol.

• Limit or stop using caffeine. Some people are sensitive to caffeine and may notice more symptoms when using caffeinated products (such as tea, coffee, colas and some over-the-counter medications).

• Don’t take stimulants. Beware of stimulants used in cough and cold medications and herbal or nutritional supplements. Some of these medications contain ingredients that promote irregular heart rhythms. Read the label and ask your doctor or pharmacist what medication would be best for you.

• Control high blood pressure.

• If you have obesity, working toward a weight that’s healthy for you can lower your risk for arrhythmia.

• Control blood sugar levels.

Treatment #

Medication #

• Anti-arrhythmic drugs are drugs used to convert the arrhythmia to sinus rhythm (normal rhythm) or to prevent an arrhythmia.

• Heart-rate control drugs are drugs used to control the heart rate.

• Anticoagulant or antiplatelet therapy are drugs, such as warfarin (a blood thinner) or aspirin, that reduce the risk of clots forming or having strokes.

• Medications used to treat related conditions that may be causing an abnormal heart rhythm.

Electrical cardioversion #

• In people with persistent past or irregular arrhythmias (such as atrial fibrillation), a normal rhythm may not be achieved with drug therapy alone.

• Cardioversion is performed by the doctor in a special procedure room.

• After administration of a short-acting anesthesia, an electrical impulse is delivered through your chest wall that synchronizes the heart and allows the normal rhythm to restart.

Catheter ablation #

• During a catheter ablation, high-frequency electrical energy is delivered through a catheter to a small area of tissue inside of the heart that causes the abnormal heart rhythm. This energy disconnects the pathway of the abnormal rhythm.

• Ablation can be used to treat most SVTs, atrial flutter, and some atrial and ventricular tachycardias.

• It can also be used to disconnect the electrical pathway between the atria and the ventricles, which may be useful in people with atrial fibrillation.

• Ablation may be combined with other procedures to achieve optimal treatment.

Pulmonary vein isolation #

• In people with frequent, paroxysmal or persistent atrial fibrillation, isolation of the pulmonary veins (pulmonary vein isolation) is a type of ablation that targets areas thought to cause atrial fibrillation.

• The goal is to create rings of scar that isolate the foci responsible for triggering atrial fibrillation.