Arrhythmia

An arrhythmia is a problem with your heart’s rhythm. It happens when electric signals that tell your heart to beat don’t work the way they should. As a result, your heart may beat too fast, too slow or just irregularly. You may feel like your heart is racing, fluttering, pounding, skipping beats or adding extra beats.

Normally, your heart beats in a steady, organized rhythm. Issues with various parts of your heart or abnormal blood flow to your heart can affect your heart’s normal rhythm. Having a normal heart rhythm matters because your heart supplies your whole body with nutrients and oxygen through the blood it pumps. Having an abnormal rhythm may hinder this.

Up to 5 out of 100 people may have arrhythmias. Some don’t have symptoms, which makes it difficult to know how many people actually have this condition. In the U.S., atrial fibrillation is the most common type of cardiac arrhythmia.

Types of this condition

Some types of arrhythmias are harmless and don’t require treatment. Other types can put you at risk for cardiac arrest. Many are in between these two extremes. Most arrhythmias in children are self-limited, but some may need additional treatment or close follow-up. A healthcare provider can tell you which type of arrhythmia you have and what kind of treatment you need, if any.

Healthcare providers describe arrhythmias by where in your heart they start. These types include:

• Supraventricular arrhythmias: These begin in your atria (your heart’s upper chambers). “Supraventricular” means above your ventricles (lower chambers of your heart).
• Ventricular arrhythmias: These begin in your heart’s ventricles or lower chambers.
• Bradyarrhythmias and junctional rhythms: These can happen because of issues in your heart’s conduction system, like the sinoatrial (SA) node, atrioventricular (AV) node or His-Purkinje network.

Symptoms of arrhythmia

A cardiac arrhythmia may not cause any symptoms. In rare cases, the first symptom may be a seizure or sudden cardiac death.

Heart arrhythmia symptoms may include:

• Heart palpitations
• Difficulty eating, which may be the only symptom you see in a newborn
• Dizziness or lightheadedness
• Fainting episodes
• Extra fussiness in babies
• Shortness of breath
• Chest discomfort
• Weakness or fatigue

Arrhythmia causes

Most arrhythmias happen because of an issue with your heart’s arteries, valves or muscles. Causes of arrhythmia in adults and children include:

• Coronary artery disease
• High blood pressure
• Weakness in your heart muscle (cardiomyopathy)
• Valve disorders
• Electrolyte imbalances in your blood
• Injury from a heart attack
• The healing process after heart surgery
• Inherited conditions, like long QT syndrome (when your heart’s electrical system takes too long to recharge)
• Certain medications, like drugs children get when they’re critically ill
• Fever, infection, dehydration, stress, inflammation or lack of sleep

Risk factors

Adults and children can have cardiac arrhythmias. Risk factors include:

• Using tobacco products
• Drinking beverages with alcohol
• Consuming drinks and foods that have caffeine
• Taking stimulants like cold medicines or herbal supplements
• Having thyroid problems
• Having overweight
• Having high blood sugar
• Having sleep apnea

How to lower your risk

Here are some ways to lower your risk of arrhythmia:

• Stop using tobacco products.
• Limit your intake of alcohol.
• Limit or stop using caffeine. This includes tea, coffee, colas and some over-the-counter medications.
• Don’t take stimulants. They may be in cough and cold medications and herbal or nutritional supplements.
• Manage high blood pressure.
• Work toward a weight that’s healthy for you.
• Manage blood sugar levels.
• Treat sleep apnea.
• Avoid activities that appear to trigger an arrhythmia.
• Get regular physical activity.

Complications of this condition

Without treatment, heart arrhythmias can lead to complications, like:

• Weakening of your heart muscle (cardiomyopathy)
• Heart failure
• Cardiac arrest
• Stroke
• Sudden infant death syndrome

How doctors diagnose this condition

A healthcare provider can find an irregular heartbeat by taking your pulse and listening to your heart. After reviewing your symptoms and performing a physical exam, they may order diagnostic tests to help confirm that you have an arrhythmia. This can also help find the cause.

You may also see an electrophysiologist. This is a heart expert who has extra training in diagnosing and treating heart rhythm disorders.

Some tests that can check for an irregular heart rhythm and related diseases include:

• Electrocardiogram (ECG or EKG)
• Blood tests
• Heart monitors
• Stress test
• Echocardiogram
• Cardiac catheterization
• Electrophysiology study (EPS)
• Tilt table test
• CT
• Heart MRI

How is it treated?

Heart arrhythmia treatment depends on the type and severity of your heart rhythm. In some cases, you don’t need any treatment. Options include:

• Medications
• Changes to daily habits
• Procedures
• Devices
• Surgery

Medications

Many medications can treat heart arrhythmias. Because everyone is different, you may have to try several medications and doses to find the one that works best for you. Medicines include:

• Antiarrhythmic drugs that prevent an arrhythmia or convert it to a normal rhythm
• Medicines that control your heart rate
• Anticoagulant or antiplatelet therapy drugs (like warfarin or aspirin) that reduce the risk of blood clots forming
• Medications that treat related conditions (like infections) that may cause an abnormal heart rhythm

Changes to daily habits

Simple changes to the way you live can help with arrhythmias. These changes may include:

• Managing blood pressure and blood sugar levels
• Avoiding tobacco products
• Cutting back on alcohol intake
• Avoiding caffeine and stimulants
• Getting regular physical activity
• Working toward a weight that’s healthy for you

Procedures

In addition to medicine, some people need procedures to treat abnormal heart rhythms. Your healthcare provider will determine the best treatment for you and discuss the benefits and risks of these with you.

Procedures include:

• Cardioversion: A controlled electric shock can reset your heart to a normal rhythm.
• Cardiac ablation: A catheter sends energy, heat or cold to a small area of tissue inside your heart to “disconnect” the abnormal rhythm’s pathway.
• Pulmonary vein isolation: This type of ablation creates rings of scars to isolate areas that may cause atrial fibrillation.

Devices

A cardiologist may insert certain devices during a procedure in the electrophysiology lab. Devices to treat a heart arrhythmia include:

• Permanent pacemaker: This device sends small electrical impulses to your heart muscle to maintain a normal heart rate and keep your heart from beating too slowly.
• Implantable cardioverter defibrillator (ICD): This device constantly monitors your heart rhythm. When it detects a very fast, abnormal heart rhythm, it delivers energy to your heart muscle to make it beat in a normal rhythm.
• Biventricular pacemakers and defibrillators (also called cardiac resynchronization therapy or CRT): These devices help synchronize the contraction of your left ventricle. In addition to the leads that go to the right side of your heart, they have a lead that goes to your left ventricle.

Surgery

If you have an arrhythmia, you may need heart surgery for any of these reasons:

• To use valve surgery or coronary artery bypass surgery to treat heart disease that may be causing the arrhythmia
• To use a maze procedure to correct atrial fibrillation that doesn’t respond to medications or nonsurgical treatments
• To place biventricular pacemaker leads (tiny wires) on your heart using minimally invasive or surgical techniques

Recovery time

Depending on the procedure or surgery, recovery afterward can take weeks or months. If you have a procedure like catheter ablation or pulmonary vein isolation, you may still have arrhythmias for several weeks while you’re healing. Your provider can tell you what to expect.

When should I see my healthcare provider?

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

You’ll need to visit your provider for regular follow-up visits to:

• Make sure your arrhythmia treatments are working
• Adjust your medications
• Check how well any implanted devices are working
• Make sure you’re staying healthy and not having other medical issues

Get immediate medical care if you have:

• Trouble breathing
• Chest pain
• Dizziness
• Fainting episodes

Questions to ask your provider may include:

• Which type of arrhythmia do I have?
• Do I need treatment?
• What’s the best treatment for me?
• Are there some activities I (or my child) should avoid?
• What do I need to do to maintain my device?

What can I expect if I have this condition?

Depending on the type of cardiac arrhythmia you have, you may have mild or severe symptoms or none at all. You may not need treatment, but some people need medicine or a procedure. With heart arrhythmia treatment, many people can live full lives. Some people with more serious arrhythmias may have a cardiac arrest and may or may not survive.

Harmless arrhythmias go away and come back in response to what triggers them. But people with other types of arrhythmias — especially those that put you at risk for cardiac arrest — need treatment for the rest of their lives.

Most types of irregular heartbeat in children are harmless. And most go away with treatment of the underlying cause, like a fever or infection. But some types can be serious.

Is there anything I can do to feel better?

If you or your child experiences arrhythmia symptoms, a Valsalva maneuver may help. You can do this by:

• Forcing a cough or gag
• Holding an ice pack against your face
• Closing your nose and mouth and straining to breathe out