Arrhythmia

Medically Reviewed by Dr. K on 12 April 2021

Arrhythmia

What Is an Arrhythmia?

An arrhythmia is a condition in which the heartbeat is irregular. It means your heart isn't beating at its normal rate.

Your heart may sound as though it has skipped a beat, added a beat, or is “fluttering." It may feel as if it is beating too quickly (a condition known as tachycardia) or too slowly (called bradycardia). It's also possible that you won't notice anything.

Arrhythmias can be life-threatening or completely harmless. If you notice something irregular about your pulse, seek immediate treatment so that doctors can determine what's happening and what you can do about it.

 

Symptoms of Arrhythmias

You might not have any signs if you have an arrhythmia. During a physical exam, your doctor may notice an irregular heartbeat.

If you have symptoms, they could be as follows:

  • Palpitations (a feeling of skipped heartbeats, fluttering, or “flip-flops")
  • Pounding in your chest
  • Dizziness or feeling lightheaded
  • Fainting
  • Shortness of breath
  • Chest pain or tightness
  • Weakness or fatigue (feeling very tired)
  • Anxiety
  • Blurry vision
  • Sweating

Arrhythmia Causes

Even if your heart is in good shape, you might have an arrhythmia. It may also occur as a result of:

  • Heart disease
  • Electrolyte imbalance (for example, sodium or potassium) in your blood
  • Injury to the heart or changes in the heart, such as decreased blood flow or rigid heart tissue
  • Healing process after heart surgery
  • Certain medications
  • Problems with the electrical signals in your heart
  • Strong emotions, stress, or shock
  • Things like alcohol, cigarettes, caffeine or exercise in your everyday life

 

Arrhythmia Risk Factors

The following factors may increase your chances of developing an arrhythmia:

  • Age. As you age, your risks increase.
  • Genes. If a close relative has had an arrhythmia, the chances are likely to be higher. Heart disease can run in families in some cases.
  • Lifestyle. Tobacco, alcohol, and recreational drugs can all increase the risk.
  • Medical problems. High blood pressure, diabetes, hypoglycemia, obesity, sleep apnea, and autoimmune disorders are just a few of the conditions that can result in abnormal heart rhythms.
  • Environment. Things in your environment, such as air pollution, can increase your chances of developing an arrhythmia.

 

Types of Arrhythmias

Arrhythmias are classified based on where they occur.  They are classified as ventricular if they begin in the ventricles or lower chambers of the heart. Supraventricular arrhythmias occur when they originate in the atria or upper chambers.

Additionally, doctors classify them according to their effect on your resting heart rate. Bradycardia is characterised by a heart rate of less than 60 beats per minute. Tachycardia is defined as a heart rate greater than 100 beats per minute.

Supraventricular arrhythmias include:

  • Premature atrial contractions. These are the first extra beats. They are generally harmless and do not require treatment.
  • Atrial fibrillation (AFib). Your heart's upper chambers contract in an unusual way. Your heart may beat at a rate of more than 400 beats per minute.
  • Atrial flutter. This is typically more organised and consistent than atrial fibrillation. It occurs most frequently in people with heart disease and in the first week following heart surgery. It frequently progresses to atrial fibrillation.
  • Paroxysmal supraventricular tachycardia (PSVT). This is a fast heart rate with a regular rhythm. It starts and ends abruptly.
  • Accessory pathway tachycardias. A rapid heart rate can occur as a result of an additional pathway connecting the upper and lower chambers of the heart. Consider it an additional road on your way home in addition to your usual route. When this occurs in your heart, it can result in a fast rhythm.
  • AV nodal reentrant tachycardia (AVNRT). This is due to the presence of an additional pathway through a section of your heart called the AV node. It may result in palpitations, fainting, or heart failure.

Ventricular arrhythmias include:

  • Premature ventricular contractions (PVCs). These are the most frequently occurring arrhythmias. They are the “missed heartbeats" that many of us experience on occasion.
  • Ventricular tachycardia (V-tach). This is a rapid heartbeat that begins in the lower chambers of the heart. Due to your heart beating too quickly, it is unable to fill with enough blood. This is a potentially dangerous arrhythmia, particularly in people with heart disease, and it may be associated with other symptoms.
  • Ventricular fibrillation (V-fib). This occurs when the lower chambers of your heart quiver and are unable to contract or pump blood to the rest of your body. This is a medical emergency that requires immediate CPR and defibrillation.
  • Long QT syndrome. Lower chambers of the heart contract and release at an abnormally slow rate. This can result in life-threatening rhythm problems and death.

Bradyarrhythmia is another type of arrhythmia. It is a slow rhythm caused by disease in the electrical system of the heart or by medication. It may cause you to pass out or make you feel as if you will.

There are several types of bradyarrhythmia:

  • Sinus node dysfunction. This is due to an issue with your heart's sinus node, which serves as its natural pacemaker.
  • Heart block. The electrical impulse is delayed or blocked as it travels from the sinus node of your heart to the lower chambers.

Diagnosis of Arrhythmias

Doctors use a variety of tests to diagnose and determine the cause of an arrhythmia:

  • ECG. An electrocardiogram records the electrical activity of your heart. For the quick, painless test, which is performed in your doctor's office, you wear small electrode patches on your chest, arms, and legs.
  • Holter monitor. This is a portable ECG (also called an “ambulatory electrocardiogram" or an EKG) about the size of a postcard or digital camera that you'll use for 1 to 2 days or up to 2 weeks. The test determines how electrical signals or waves travel through your heart. These electrical signals instruct your heart to contract (squeeze) and pump blood. Electrodes will be taped to your skin. It is completely painless, though some people experience mild skin irritation as a result of the tape used to secure the electrodes to the chest. While wearing the electrodes, you can do everything except shower or bathe. Following the test period, you'll return to your doctor. They will download the data.
  • Event monitor. If your symptoms are not frequent, your doctor may recommend that you wear one of these for approximately a month. When you press a button, it records and stores for a few minutes the electrical activity of your heart. Take the reading as soon as you notice symptoms. Your doctor will analyse the results.
  • Implantable loop recorder. This is implanted beneath the skin, where it continuously records the electrical activity of your heart. It is capable of transmitting data to your doctor's office.
  • Stress test. There are various types of stress tests. The objective is to determine how much stress your heart can withstand without developing a rhythm problem or not receiving enough blood. The most common type of stress test involves walking on a treadmill or pedaling a stationary bike while you get an ECG and your heart rate and blood pressure are monitored. The technicians gradually increase the intensity of your exercise.
  • Echocardiogram. This test uses ultrasound to check your heart muscle and valves.
  • Cardiac catheterization. A long, thin tube called a catheter will be inserted into a blood vessel in your arm or leg by your doctor. They'll direct it to your heart using a specialized X-ray machine. They will then inject dye into the catheter to aid in the creation of X-ray videos of your heart valves, coronary arteries, and chambers.
  • Electrophysiology study. This test records the electrical activity and pathways of your heart. It can assist in determining the reason for your heart rhythm problems and determining the most appropriate treatment for you. Your doctor will safely induce an abnormal heart rhythm during the test. Then, they may prescribe medication to determine which one best controls it or to determine which procedure or device is necessary to treat it.
  • Head-up tilt table test. This test is used by doctors to determine the cause of fainting spells. It determines the difference between standing and lying down in terms of heart rate and blood pressure. This test will be administered in a laboratory. You'll lie on a stretcher at various angles while an ECG is performed and specialists check your blood pressure and oxygen saturation level. This determines whether your passing out symptoms are caused by your electrical system, nervous system, or cardiovascular system.

Treatment of Arrhythmias

The treatment will vary according to the type of arrhythmia you have. One or more of these may be recommended by your physician.

Medications

Among the medications used to treat irregular heart rhythms are the following:

  • Adenosine (Adenocard)
  • Atropine (Atropen)
  • Beta-blockers
  • Calcium channel blockers
  • Digoxin (Digitek, Digox, Lanoxin)
  • Potassium channel blockers
  • Sodium channel blockers

Vagal maneuvers

These techniques induce relaxation in your body by affecting your vagus nerve, which is responsible for controlling your heart rate. Your doctor may advise you to:

  • Cough or gag
  • Hold your breath and bear down (Valsalva maneuver)
  • Lie down
  • Put a cold, wet towel over your face

Electrical cardioversion

If medications are unable to control an irregular heart rhythm (such as atrial fibrillation), cardioversion may be required. This is accomplished by placing you under anaesthesia and then administering an electrical shock to your chest wall to re-establish your heart's normal rhythm.

Pacemaker

This device stimulates your heart muscle with small electrical impulses to maintain a safe heart rate. It consists of a pulse generator housing the battery and a small computer, as well as wires that transmit impulses to the heart muscle.

Implantable cardioverter defibrillator (ICD)

ICDs are primarily used to treat ventricular tachycardia and ventricular fibrillation, which are two potentially fatal heart rhythms.

Your heart rhythm is constantly monitored by the ICD. When it detects an extremely fast, irregular rhythm, it shocks the heart muscle to restore normal rhythm. The ICD is composed of two components: leads and a pulse generator. The leads are composed of wires and sensors that are used to monitor the heart rhythm and deliver energy for pacing or defibrillation. The generator is equipped with a battery and a miniature computer. The battery stores energy until it is required. The computer utilizes information from the leads to determine the rate at which the heartbeats.

Your doctor customizes the ICD to perform one or more of the following functions:

  • Anti-tachycardia pacing (ATP). A series of brief electrical impulses delivered to the heart muscle restores the heart's normal rate and rhythm.
  • Cardioversion. You may receive a low-energy shock concurrently with your heartbeat to restore normal rhythm.
  • Defibrillation. When your heartbeat becomes dangerously fast or uneven, a higher-energy shock is delivered to your heart muscle to restore a normal rhythm.
  • Anti-bradycardia pacing. Numerous ICDs provide backup pacing to maintain the heart rhythm if it becomes too slow.

There are numerous types of ICDs, including the following::

  • Single-chamber ICD. In the right ventricle, a lead is attached. If necessary, energy is transmitted to the ventricle to restore the normal rhythm of the heart.
  • Dual-chamber ICD. In the right atrium are the plumes and the right ventricle attached. Energy can be supplied to the right atrium and to the right ventricle to help your heart paced normally.
  • Biventricular ICD. Leads in the right atrium and the ventricle are attached to the left coronary sinus. This technique helps cardiovascular beats more effectively and is used specifically for heart failure patients.

Your doctor will find out which type of ICD is best for you. Always ask your doctor what medications you can take before you have your ICD implanted. Before the procedure, your doctor may request you to stop taking certain medications. Specific instructions are received.

You may not notice a low-energy shock after it is implanted. Alternatively, you may experience a flutter in your chest. The energy-efficient shock only lasts a second, but it could hurt. According to some, it feels like being hit by a baseball bat or kicked by a horse. It feels much more in the back of most people than in the chest. If you experience a shock, sit or lie down immediately to avoid passing out.

Consult with your doctor regarding what to do if you are ever shocked. If you are shocked, contact your doctor immediately.

Catheter ablation

Consider this procedure as rewiring your heart to correct an electrical problem.

A catheter will be inserted into your leg by your doctor. It delivers high-frequency electrical energy to a small area of your heart that causes the irregular rhythm. This energy “detaches" the unusual rhythm's pathway.

Ablation is used to treat the majority of PSVTs, atrial flutter, atrial fibrillation, and certain types of atrial and ventricular tachycardias.

Heart surgery for arrhythmias

The maze procedure is a surgical procedure used to treat atrial fibrillation. Your surgeon makes a series of cuts in the upper chambers of your heart, called a “maze." The objective is to confine your heart's electrical impulses to specific pathways. Following the procedure, some patients require a pacemaker.

Other procedures, such as a coronary bypass, may be recommended by your doctor to treat other types of heart disease.

 

Complications of Arrhythmias

An irregular heart rhythm, if left untreated, can lead to serious complications such as:

  • Alzheimer’s disease and dementia. These cognitive disorders may occur as a result of your brain not receiving enough blood over time.
  • Heart failure. After repeated arrhythmias, your heart may not pump as efficiently as it should.
  • Stroke. Blood that remains in your atria has the potential to clot. If a clot makes its way to the brain, it may result in a stroke.
  • Cardiac arrest. V-fib could cause your heart to stop functioning.

 

Safe Driving Concerns

You could pass out behind the wheel if you have an arrhythmia. This may endanger you, other motorists, pedestrians, and property.

Your doctor will consider several factors when determining your ability to drive safely:

  • What type of arrhythmia you have
  • How severe your condition is
  • What medications or treatments you have received
  • Frequency of your symptoms
  • Severity of your symptoms

If you are not experiencing any symptoms and have never had any serious heart rhythm problems, you should be able to drive normally. If your arrhythmia is under control with medication, your doctor may also give you the green light to drive.

Along with medications to help manage your heart rhythm, you may be eligible for two additional treatments. Both of these options would keep you out of the driver's seat for an extended period of time.:

Ablation: Usually, this treatment will prevent you driving for approximately a week. It may keep you there for an extended period of time, depending on your medical history.

Implantable cardioverter defibrillator: Normally, after receiving an ICD, you will be asked to abstain from driving for a week. If you received an ICD as a result of fainting or surviving cardiac arrest, you may have to wait several months before resuming driving.

If you have an ICD, you are not permitted to drive commercially (e.g., in a delivery truck or a taxi).

 

Arrhythmia Prevention

Arrhythmias are not always preventable. Regular checkups with your doctor can help prevent the development of new heart rhythm problems. Ascertain that they are aware of all medications you are taking. Certain cold and cough medications may cause an arrhythmia; therefore, consult your physician before using them.

Additionally, they may suggest some lifestyle modifications.:

  • Consume a balanced diet. Consume an abundance of fruits and vegetables, as well as fish and plant-based proteins. Steer clear of saturated and trans fats.
  • Maintain healthy cholesterol and blood pressure levels.
  • Stop smoking.
  • Maintain a healthy weight.
  • Exercise on a regular basis.
  • Control your stress.
  • Limit your intake of alcohol and caffeine.

Sources

Referenced on 2.3.2021

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  2. FDA.
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  4. American Academy of Family Physicians: “Arrhythmia.”
  5. Cleveland Clinic: “Arrhythmia,” “Dos and Don'ts: Life with an ICD," “Don't Let Heart Disease Derail Your Travel Plans."
  6. Harvard Health Publishing: “Cardiac Arrhythmias.”
  7. American Heart Association: “Arrhythmia”  “Holter Monitor," “Electrocardiogram (ECG or EKG)," “FAQs About Atrial Fibrillation," “Prevention and Treatment of Arrhythmia," “FAQs of Atrial Fibrillation (AFib or AF)," “About Arrhythmia," “Warning Signs of a Heart Attack,"  “Living with Your Implantable Cardioverter Defibrillator,” “Electrophysiology Studies (EPS)."
  8. Merck Manual Consumer Version: “Sinus Node Dysfunction.”
  9. Johns Hopkins University: “Holter Monitor."
  10. NIH: “Who Needs a Holter or Event Monitor?"
  11. Zimetbaum, P. Circulation, Oct. 19, 2010.
  12. University of Michigan Frankel Cardiovascular Center: “Frequently Asked Questions: Implantable Cardiac Defibrillator (ICD)."
  13. Texas Heart Institute: “Implantable Cardioverter Defibrillator (ICD)."
  14. International Society for Sexual Medicine: “Can a Person with an Implantable Cardioverter Defibrillator (ICD) Have Sex Regularly?" “How Might an Implantable Cardioverter Defibrillator (ICD) Affect a Person's Sex Life?"
  15. Transportation Security Administration: “TSA Travel Tips Tuesday: Traveling With Personal Medical Electronic Devices."
  16. Up-to-Date: “Patient education: Implantable cardioverter-defibrillators (Beyond the Basics)."
  17. European Heart Journal: “Driving and arrhythmia: a review of scientific basis for international guidelines.”
  18. Maine Department of Motor Vehicles: “Cardiovascular Disorders.”
  19. American College of Cardiology: “When Is It Safe to Resume Driving After ICD Implantation.”
  20. National Highway Traffic Safety Administration: “Physician’s Guide to Assessing and Counseling Older Drivers.”
  21. The BMJ: “Driving and arrhythmias.”
  22. Mayo Clinic: “Brugada syndrome."
  23. NHS Choices: “Brugada syndrome."
  24. U.S. National Library of Medicine: “Brugada syndrome."

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