What are the symptoms of an arrhythmia?

An arrhythmia may be “silent” and not cause any symptoms. A doctor can detect an irregular heartbeat during an examination by taking your pulse, listening to your heart or by performing diagnostic tests.

If symptoms occur, they may include:

• Palpitations: A feeling of skipped heartbeats, fluttering, “flip-flops” or feeling that the heart is “running away”
• Pounding in the chest
• Dizziness or feeling lightheaded
• Shortness of breath
• Chest discomfort
• Weakness or fatigue (feeling very tired)

How is an arrhythmia diagnosed?

If you have symptoms of an arrhythmia, you should make an appointment with a cardiologist. You may want to see an electrophysiologist — a cardiologist who has additional specialized training in the diagnosis and treatment of heart rhythm disorders.

After evaluating your symptoms and performing a physical examination, the cardiologist may perform a variety of diagnostic tests to help confirm the presence of an arrhythmia and indicate its causes.

Some tests that may be done to confirm the presence of an irregular heart rhythm include:

• 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.
• Ambulatory monitors, such as:
  
• Holter monitor: A small portable recorder that is attached to electrodes on your chest. It continuously records your heart’s rhythm for 24 hours.
• Transtelephonic monitor: A small monitor is attached to electrode leads, usually on your finger or wrist. With the help of this device, your heart’s rhythm is transmitted over the phone line to your doctor’s office.
• Transtelephonic monitor with a memory loop: A small, portable recorder that is worn continuously for an extended period of time to record and save information about your heart’s rhythm around the time you experience an arrhythmia. The recording is triggered by pushing a button (event button). The rhythm is recorded, saved and transmitted over the phone line.

• Stress test: A test used to record arrhythmias that start or get worse when you exercise. This test can also help detect heart disease that causes 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.

What treatments are available for patients with an arrhythmia?

Treatment depends on the type and severity of your arrhythmia. Sometimes, no treatment is needed. Treatments include medications, lifestyle changes, invasive therapies, electrical devices and surgery.

Medications

Antiarrhythmic drugs are medications used to convert the arrhythmia to a normal sinus rhythm or to prevent an arrhythmia. Other medications may include heart-rate-control drugs and “blood thinners”, which reduce your risk of stroke or developing blood clots.

It is important that you know the names of your medications, why they are prescribed, how often and at what times to take them, what side effects may occur, and what medications you have previously taken for your arrhythmia.

Lifestyle changes

Arrhythmias may be related to certain lifestyle factors. The following tips can help reduce your risk:

• If you smoke, stop.
• 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.
• Avoid using stimulants. Beware of stimulants used in cough and cold medications and herbal or nutritional supplements. Some of these substances contain ingredients that cause irregular heart rhythms. Read the label and ask your doctor or pharmacist which medication is best for you.
• Your family may want to be involved in your care by learning to recognize your symptoms and how to start CPR if needed, for example, in the case of a life-threatening arrhythmia.
• If your irregular heart rhythm occurs more often with certain activities, you should avoid them.

Invasive therapies

Electrical cardioversion and catheter ablation are invasive therapies used to treat or eliminate irregular heart rhythms. Your doctor will determine the best treatment for you and discuss the benefits and risks of these therapies with you.

• Electrical cardioversion: Patients with persistent arrhythmias, such as atrial fibrillation, may not be able to achieve a normal heart rhythm with drug therapy alone. Electrical cardioversion delivers an electrical shock to your chest wall, which synchronizes the heart and allows the normal rhythm to restart. This procedure is done after you receive short-acting anesthesia.
• Catheter ablation: During ablation, energy is delivered through a catheter to tiny areas of the heart muscle. This energy can either “disconnect” the pathway of the abnormal rhythm, block the abnormal pulses and promote normal conduction of impulses, or disconnect the electrical pathway between the atria and the ventricles. Ablation is most often used to treat paroxysmal supraventricular tachycardia (PSVT), atrial fibrillation, atrial flutter, AV nodal re-entrant tachycardia and ventricular tachycardia. Ablation may be combined with other procedures to achieve optimal treatment.

Electrical devices

• Permanent pacemaker: A device that sends small electrical impulses to the heart muscle to maintain a normal heart rate. The pacemaker has a pulse generator (which contains a battery and a tiny computer) and leads (wires) that send impulses from the pulse generator to your heart muscle and sense the heart’s electrical activity. Pacemakers are mostly used to prevent the heart from beating too slowly. Newer pacemakers have features designed to help manage arrhythmias, optimize heart rate- related functions, improve synchronization, and eliminate the need for leads.
• Implantable cardioverter-defibrillator (ICD): A sophisticated electronic device used primarily to treat ventricular tachycardia and ventricular fibrillation — two life-threatening abnormal heart rhythms. The ICD constantly monitors the heart rhythm. When it detects a very fast, abnormal heart rhythm, it delivers energy to the heart muscle to cause the heart to beat in a normal rhythm again.

There are several ways an ICD can restore a normal heart rhythm:

• Antitachycardia pacing (ATP): When the heart beats too fast, a series of small electrical impulses are delivered to the heart muscle to restore a normal heart rate and rhythm.
• Cardioversion: A low-energy shock is delivered at the same time as the heartbeat to restore a normal heart rhythm.
• Defibrillation: When the heart is beating dangerously fast or irregularly, a higher energy shock is delivered to the heart muscle to restore a normal rhythm.
• Antibrachycardia pacing: Many ICDs provide backup pacing to prevent heart rhythms that are too slow.

Heart surgery

Surgery may be needed to correct arrhythmias that can’t be controlled with medications or nonsurgical treatment methods. Arrhythmia surgery may also be recommended if you need surgery, such as valve or bypass surgery, to correct other forms of heart disease. The Maze and modified Maze procedures are two surgeries used to treat patients with atrial fibrillation.

Your doctor will determine the best treatment for you and discuss these options with you, including more information about surgical treatment if it is an appropriate treatment option.

Regular follow-up visits

You will need to visit your doctor for regular follow-up visits to:

• Make sure your arrhythmia is controlled
• Properly adjust your medications
• Evaluate the function of any implanted devices
• Make sure you are staying healthy and not having other medical problems

Your doctor will tell you how often you should visit. Call your doctor in between visits if your symptoms become more frequent or severe.