Arrhythmia - Types, Treatment Options, Causes and Preventions
Health Education

Arrhythmia - Types and Treatment Options

Dr.Aslam Khan profile Authored by Dr.Aslam Khan on 2 Jul 2014 - 12:54.

Defibrillator

Heart arrhythmia is an abnormal beating of the heart (too fast, too slow, or irregular). It is due to improper working of electrical signals responsible for the heartbeat.  Normal heartbeats occur due to electrical signals which cause the heart to contract and relax. A healthy heart produces 60 to 100 beats per minute. A normal increase and decrease in this heart rate occurs during periods of stress (exercise) or relaxation (sleep), respectively.

Heart arrhythmias may not produce any symptoms or can produce symptoms ranging from a sensation of an irregular heartbeat, to pounding in the chest, to a sensation of a racing heartbeat, or can cause sudden loss of consciousness and even death. Arrhythmias can happen even if the heart is otherwise structurally normal.  

Types of arrhythmias:

Arrhythmias are broadly classified in accordance with the speed of the heart rate followed by the chamber of the heart in which they originate. The various types of arrhythmias are:

1.      Tachycardia – It is a condition indicated by faster heart beats (more than 100 beats per minute) at resting.

i.      Tachycardia’s in the atria: These are tachycardias originating in the atria, which includes:

a.      Atrial fibrillation: It is the most common arrhythmia, especially in older people. It is harmful as it may lead to severe conditions like stroke and is associated with an increased risk of death.

b.      Atrial flutter: Is also associated with increased chance of stroke.

c.       Supraventricular tachycardia (SVT): This is a generic term which incorporates three types of arrhythmias which originate above the ventricles (atrial tachycardia, AVNRT, and AVRT). Its duration varies and is usually associated with a sensation of a sudden rapid heartbeat.

ii.     Tachycardia’s in the ventricles: These are tachycardias originating in the ventricle, which includes:

a.      Ventricular tachycardia (VT) – It is a condition of fast but regular beating of the heart which is often caused due to scars formed due to a weakened heart. Sustained condition may be life threatening and thus needs prompt treatment.

b.      Ventricular fibrillation – In this condition, the ventricles beat so fast that they are effectively unable to pump blood, thus resulting in sudden death.  It is mainly seen in people with weakened hearts but may also occur in those who have structurally normal hearts but have genetic heart abnormalities such as long QT syndrome and Brugada Syndrome.

iii.    Premature heartbeats :  Premature heartbeats usually feel like a skipped or missed beat. They can be harmless but if they occur frequently enough they can cause weakening of the heart and /or they may be a nuisance due to frequent symptoms. 

2.      Bradycardia – It is the condition indicated by slow heart beat (less than 60 heart beats per minute) at resting condition.

i.       Sinus node dysfunction: In this condition the normal pacemaker of the heart, the sinus node, produces electrical current slowly resulting in a heartbeat less than 60 beats per minute. If this slow heartbeat causes symptoms such as fatigue, weakness, dizziness, or a loss of consciousness, then treatment would be required.

ii.      Conduction block :  It is a slow heart beat caused by a block in the conduction pathways of the heart usually near the atrioventricular node or in the ventricles. 

Causes / risk factors: There are literally hundreds of various factors that may account for the development of arrhythmias, but it is important to remember that they may also occur in overall healthy people with no other medical problems. Some of the common causes associated with arrhythmias are:

  • Hypertension
  • Diabetes
  • Smoking
  • Excess consumption of alcohol
  • Sleep apnea
  • Obesity
  • Valvular heart disease
  • Coronary artery disease / history of a heart attack
  • Concurrently with a heart attack
  • Any situation that causes the heart to become weak (cardiomyopathy)
  • It can also be associated with certain medications /drugs ie. stimulants caffeine/cocaine
  • Hyperthyroidism
  • Genetic causes

Complications:

Certain arrhythmias may increase your risk of developing some severe heart conditions, which may include:

  • Stroke: It is an impairment of cerebral circulation caused due to disturbed impulses causing the abnormal beating of the heart.
  • Heart failure: Severely reduced ability of the heart to pump the blood.
  • Death.

Sometimes arrhythmia can be silent and are diagnosed accidently during routine check-ups. However, often patients will experience noticeable symptoms, which are indicative of arrhythmia.  These symptoms include:

  • Pounding sensation in the head and neck or chest
  • Sensation of a rapid or irregular heartbeat
  • Fatigue (tiredness), chest pain
  • Difficulty in breathing
  • Dizziness
  • A loss of consciousness.

When to call a doctor?

Consult a doctor if you feel weakness, dizziness, lightheadedness, shortness of breath or wheezing, fainting or near fainting, and chest pain or discomfort.

Diagnosis of heart arrhythmias can include several tests to identify the presence and type of arrhythmia. These include:

  • Electrocardiogram (ECG): Detects the electrical activity of the heart- usually records up to 10 seconds worth of information.
  • Holter monitor – Similar to an ECG but records heart signals while on daily routine for up to 48 hrs.
  • Event monitor – Allows the physician to check the heart rhythm during symptoms/arrhythmias which are infrequent and can be worn up to 3 weeks.
  • Echocardiogram – Used to visualize the structure, size and shape of the heart.
  • Stress test – It includes monitoring the heart activity while exercising.
  • Tilt table test – It is usually performed if the patient is experiencing fainting spells. This test includes monitoring the heart parameters while lying flat on the table and on tilting the table and then comparing the heart parameters recorded in a different angle. 
  • Electrophysiological testing – This is a minimally invasive test which allows the physician to induce and diagnose rhythm abnormalities.  It is often performed in conjunction with an ablation procedure to cure the arrhythmia.  


 

Treatment is usually considered only if arrhythmia is causing symptoms or if associated with increased risk of bodily harm or death. Treatment options may include:

Acute or temporary treatment:

  • Drugs and medications – aimed at restoring the heart rate and rhythm.
  • Vagal maneuvers – To terminate certain arrhythmias mainly SVT.
  • Cardioversion or defibrillation – utilizes electrical shock to reset the heart rhythm to normal.

Permanent treatment options: 

For tachycardias

  • Ablation therapy – It is a minimally invasive procedure that corrects tachycardias by destroying the electrical source or circuit of the arrhythmia. Ablation therapy offers a safe and effective cure for most arrhythmias without the need for further medications.
  • Implantable cardioverter- defibrillator (ICD) – It is a small device similar to a pacemaker which has the ability to pace the heart just like a pacemaker, but can also treat fast life threatening arrhythmias such as VT and VF. The device detects and corrects the dangerous arrhythmias by sending high energy shocks. 
  • Antiarrhythmic drugs – Aimed at reducing the heart rate or reducing the frequency and symptoms associated with the arrhythmia.
  • Surgical treatments: not usually indicated for treatment of arrhythmias. If a patient needs to undergo cardiac surgery for another reason such as valve disease or coronary artery disease and suffers from atrial fibrillation, they may undergo a maze procedure at the time of surgery.

For bradycardias:

o   Pacemaker – It is a small device that is implanted below the skin in the chest area below the collarbone with an ability to increase slow heart beats. 

 

Certain positive interventions in lifestyle can help to prevent the heart arrhythmias. These lifestyle interventions may include:

  • Eating healthy
  • Exercising regularly
  • Avoiding smoking
  • Avoiding excess alcohol consumption.
*Disclaimer This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.