The term “arrhythmia” refers to any kind of abnormal heartbeat, and it’s an incredibly common phenomenon. Caused by a disruption of the heart’s normal electrical impulses, most people have experienced an arrhythmia at least once – you may recognize it as an unexpected heart race or flutter. But while there is often no cause for concern, certain arrhythmias can suggest serious underlying issues.
Understanding Arrhythmia
“The heart has specialized cells that send electrical signals through the heart to produce each heartbeat.
“These specialized cells work together in an organized way to produce the heart rhythm,” explains Dr. Newton Wiggins, a cardiologist with The Chattanooga Heart Institute at CHI Memorial. “An arrhythmia is an abnormality in the heart rhythm; it is an electrical problem of the heart.”
While some forms of arrhythmia make your heart beat too fast, others cause it to beat too slowly. Some arrhythmias even result in an irregular heartbeat. Experiencing one may feel like skipped heartbeats, fluttering, thumping, or racing. But the difference between an arrhythmia and a natural change in heart rate is arrhythmia’s abnormality. For instance, it’s normal, even expected, for your heart rate to increase during exercise, but it shouldn’t happen at rest.
The three most common forms of arrhythmia are bradycardia, tachycardia, and atrial fibrillation. The first, bradycardia, means your heart rate is too slow. It occurs when the electrical signals in your heart slow down or become blocked. Several factors, such as damaged heart tissue, imbalanced chemicals in your blood, and certain medications, can cause bradycardia, and you may experience dizziness, confusion, fatigue, and other symptoms.
Tachycardia is when your heart beats faster than normal while you’re at rest. A typical adult heart rate at rest is somewhere between 60 to 100 beats per minute. With tachycardia, rapid electrical signals take your heart rate much higher. When your heart rate is too high, the heart doesn’t pump blood throughout your body effectively. Your organs can become oxygen deprived, and you could develop shortness of breath, chest pain, or even lose consciousness. It can be caused by a congenital defect, anemia, smoking, and more.
“Atrial fibrillation, a subtype of tachycardia, is the most common arrhythmia,” says Dr. Harish Manyam, director of cardiovascular research and head of the Atrial Fibrillation Center at Erlanger Heart and Lung Institute. “It’s characterized by a rapid, erratic heartbeat.” It occurs when the atria, or upper chambers of your heart, begin to quiver or spasm instead of fully contracting to pump blood into the ventricles, or lower chambers.
How It’s Diagnosed
While arrhythmias can occur in healthy hearts from time to time, they may also indicate a serious problem that can lead to heart disease, stroke, or sudden cardiac arrest. A prompt and accurate diagnosis is key to avoiding these potential issues. “Some arrhythmias occur in normal hearts, while others may be the first sign of heart disease,” explains Dr. Wiggins. “Therefore, it is really important to work with your medical team to ensure your heart is healthy.”
After the doctor takes a full medical history, the most common way to diagnose arrhythmia is through an in-office electrocardiogram, also known as EKG or ECG. In other cases, your doctor may fit you with a portable, wearable outpatient monitor. Both tests connect electrodes to your chest to monitor and record your heart’s electrical impulses over a period of time.
If the results are inconclusive, you may also require an echocardiogram, or your doctor may try to trigger an arrhythmia with a stress test or tilt table test. The results can determine whether or not there’s an underlying cardiac disorder.
An echocardiogram is a noninvasive ultrasound of your heart. Your doctor can review the results to determine if your heart is structurally sound and functioning properly. Echocardiograms can be taken at rest or during exercise.
A stress test is helpful in determining if your arrhythmia is brought on by physical activity. This involves recording your heart rate while you exercise on a stationary bike or a treadmill. If for some reason you’re unable to work out, your doctor may choose to give you a stimulant to simulate the cardiac effect of exercise.
If fainting episodes are a recurring symptom, a tilt table test is meant to replicate the effect standing up has on your blood pressure. You begin lying horizontally on a special table, and your doctor records your heart rate and blood pressure. Then, the table is tilted into a vertical position while they monitor any changes to your vital signs.
Treating Arrhythmia
Most arrhythmias are considered harmless and don’t require treatment. However, if your arrhythmia is abnormal and potentially risky, your doctor will create a treatment plan, which will likely fall into one of three main categories:
Medication
Your doctor could prescribe several types of medications for treatment. “An arrhythmia is not always life-threatening, and often with good medications it can be managed,” explains Dr. Manyam. Antiarrhythmic medications interact with your hormones and block impulses that can trigger irregular heartbeats. These medications also have the potential to exacerbate the problem, though, so they may not be suitable for everyone. Other drugs can slow your heart rate to help regulate an arrhythmia, minimize risk of blood clots, and help decrease the risk of abrupt cardiac arrest. Your doctor will talk to you about the risks and side effects, should medication be the most appropriate treatment option.
An arrhythmia is not always life-threatening, and often with good medications it can be managed.”
Ablation
“An alternative to medications is a procedure called an ablation, which can be used to eliminate, or ablate, the symptoms of arrhythmias,” says Dr. Manyam. With this procedure, a catheter with electrodes at the end is placed at specific points inside your heart. If your doctor discovers an abnormal area causing your arrhythmia, they can destroy the faulty tissue with the catheter using radiofrequency energy. The newly created scar tissue blocks the electrical pathway responsible for causing your arrhythmia.
Implantable Cardiac Devices
There are two types of implantable cardiac devices, pacemakers and defibrillators, that can be used to treat certain arrhythmias. Like its name suggests, a pacemaker helps your heart keep the correct pace. This device is implanted in your chest and connected to your heart with a wire. It sends electrical signals through your heart to keep it beating consistently.
Defibrillators, on the other hand, only activate when they detect an abnormality in your heart activity. Implanted under the skin, wires with electrode tips are attached to your heart to give it a corrective electrical shock to fix an abnormal rhythm. These devices are often used hand in hand with medication because they don’t prevent arrhythmia.
If these methods don’t work for you, surgery may be recommended. The overall goals of treatment are to prevent blood clots, reduce the risk of stroke, return heart rate into a relatively normal range, restore normal rhythm if possible, and treat any underlying condition that could be causing the arrhythmia.
Prevention
Arrhythmia prevention isn’t just up to your doctor – you can play an active role. By making a few lifestyle changes, you can minimize and prevent the onset of cardiac arrhythmias.
First and foremost, try to keep your stress levels low. Practices like yoga or meditation can be natural, calming stress-relievers. You should also avoid substances that could induce irregular heartbeats, such as caffeine, alcohol, tobacco, certain medications, and illicit drugs. Beyond that, Dr. Wiggins recommends Life’s Simple 7, created by the American Heart Association. “To improve heart health, you should manage blood pressure, control cholesterol, reduce blood sugar, get active, eat better, lose weight, and stop smoking.”
Lastly, and perhaps most important, be sure you keep all your medical appointments. Even if treatment helps you feel better, it is imperative to continue appointments with your doctor so that they can watch your heart and help you maintain your health.
Dr. Newton Wiggins
Cardiologist, The Chattanooga Heart Institute at CHI Memorial
Dr. Harish Manyam
Director of Cardiovascular Research and Head of Atrial Fibrillation Center
