Ventricular Arrhythmia

A ventricular arrhythmia is an abnormal heart rhythm that the lower chambers (ventricles) of your heart cause. A range of heart problems may cause this, like a blockage in your heart’s arteries, scar in your heart or even electrolyte abnormalities. Ventricular arrhythmias are serious and can even be fatal.

The ventricles are your heart’s pumps. Any disruption in their normal rhythm can cause problems. Abnormal heart rhythms that happen in the ventricles cause most cases of sudden cardiac death.

Ventricular arrhythmias are very common. They’re most likely to occur in people who already have heart problems, like coronary artery disease or heart failure. But they can also happen in people without any symptoms or clues that they have a heart condition.

Types of this condition

Ventricular arrhythmias range from harmless to life-threatening, depending on the type. Ventricular arrhythmia types include:

• Premature ventricular contractions (PVCs): These feel like extra heartbeats and are usually harmless. They may be more concerning if they happen often or for longer periods, or if you have a condition that has changed the shape of your heart.
• Ventricular tachycardia (VT): The lower chambers of your heart beat unusually fast. This can happen because of a problem in your heart's electrical system. In some cases, VT can turn into ventricular fibrillation, which is more dangerous.
• Ventricular fibrillation (V-fib): Your heart’s lower chambers quiver or twitch rather than expand and contract. They don’t pump blood. Your heart stops, sending you into cardiac arrest, and you pass out within seconds. This condition can be fatal.

Symptoms of ventricular arrhythmia

Ventricular arrhythmia symptoms depend on the type of heart rhythm problem. PVCs often have no symptoms. But you may feel faint or have dizziness or heart palpitations.

Ventricular tachycardia usually has the following symptoms:

• Chest pain (angina)
• Dizziness, lightheadedness or fainting
• Shortness of breath
• Heart palpitations

Ventricular fibrillation typically makes you collapse or pass out.

Ventricular arrhythmia causes

Common causes include:

• Heart attack
• Heart failure
• Electrolyte imbalance
• Medications
• Heart problems you’re born with (congenital heart conditions)
• Heart muscle problems (cardiomyopathy)
• Heart surgery

Risk factors

Ventricular arrhythmias are most common in people who have heart conditions. The chance of developing these arrhythmias increases as you age. Also, diseases that change your heart's structure have a much higher risk of causing these rhythms.

Other risk factors include:

• Prior heart attack
• High blood pressure
• Diabetes
• Tobacco product use

You usually can’t prevent these kinds of abnormal heart rhythms because you can’t predict them. But it may be possible to delay or avoid developing conditions that can cause these arrhythmias. This generally includes doing the following:

• Avoid or quit using all tobacco products.
• Eat heart-healthy foods.
• Get at least 30 minutes of physical activity on most days of the week.
• Maintain a weight that’s healthy for you.
• Use alcohol in moderation.

Complications of this condition

Complications of some ventricular arrhythmias include:

• Heart muscle problems (cardiomyopathy)
• Organ failure or damage, in severe cases
• Your heart can't pump enough blood to your body (cardiogenic shock)
• Your heart suddenly stops beating (sudden cardiac arrest)

Without CPR or the use of an automated external defibrillator (AED), cardiogenic shock and cardiac arrest are fatal within minutes.

How doctors diagnose this condition

A healthcare provider will often begin diagnosing an arrhythmia based on your symptoms and medical history. They’ll likely start with a physical exam that includes listening to your heartbeat.

They’ll use these tests to diagnose a ventricular arrhythmia:

• Electrocardiogram (ECG or EKG): Briefly records your heart’s electrical activity
• Holter monitor: Records your heart rhythm for one to two days
• Ambulatory monitor: Records your heart rhythm over a longer period (up to 30 days)
• Electrophysiology study: Examines your heart’s electrical activity
• Heart ultrasound (echocardiogram): Shows how your heart moves and pumps blood
• Heart MRI: Creates detailed images of your heart

How is it treated?

Depending on what causes a ventricular arrhythmia, it may be possible to cure it. A cure is unlikely if the cause is a chronic condition or disease — especially one you’re born with. When a healthcare provider can’t cure the abnormal rhythm, they’ll work to treat and manage it.

The treatment of a ventricular arrhythmia depends on the type.

You can manage less problematic arrhythmias like PVCs without treatment or with medications to suppress them. In some cases, if PVCs make your heart muscle weak or if you can’t manage symptoms with medication alone, your provider may refer you for a procedure called an ablation.

A provider can treat ventricular tachycardia with medications like beta-blockers and antiarrhythmics. They can also treat it with an ablation procedure at a specialized center. If you have a history of ventricular tachycardia or you’re at high risk for it, your provider may advise you to have an implantable defibrillator.

You may need emergency care for arrhythmias that are more dangerous.

Emergency treatments for ventricular arrhythmias include:

• CPR: Uses chest compressions to force blood throughout your body. Bystanders should start CPR right away for someone who's unresponsive and has absent or abnormal breathing.
• Automated external defibrillator (AED): Analyzes your heart rhythm. If needed, the AED can then send an electric shock to restore your heart rhythm to normal. Both ventricular tachycardia and ventricular fibrillation are “shockable” rhythms.
• Medication: Helps maintain a normal heart rhythm for both ventricular tachycardia and fibrillation.

The following methods can treat a ventricular arrhythmia in non-emergency situations:

• Ablation: Uses heat, cold or energy to damage small areas of your heart on purpose. This prevents an arrhythmia from happening.
• Implantable cardioverter defibrillator (ICD): Detects abnormal heart rhythms and delivers an electric shock that can return your heart to a normal rhythm.
• Anti-arrhythmia medication: May help with some types of arrhythmia. But medications may not work as well or may cause side effects.

When you’ll feel better

Your timeline for recovery depends on the type of arrhythmia and the treatment. If you have ablation or an ICD placement, you should recover from the procedure within days and feel better quickly. With medication, you should begin to notice changes within days or weeks.

When should I see my healthcare provider?

You should see your provider if you notice that your symptoms are changing or starting to affect your day-to-day life. You should also see a provider at least once a year for a physical. This can be a key way to catch health problems early.

Your provider can give you more information on things to watch for, especially things that could be signs of future problems.

You should go to the emergency room if you have more serious symptoms related to a ventricular arrhythmia. These include:

• Chest pain
• Shortness of breath
• Fainting or feeling lightheaded or dizzy for an unknown reason

Questions to ask your provider may include:

• Which tests do I need?
• What type of abnormal heart rhythm do I have?
• What’s the best treatment for me?
• How often do I need to see you to check the defibrillator I have?

What can I expect if I have this condition?

The outlook for ventricular arrhythmias greatly depends on which type you have and the cause. Your healthcare provider can explain the outlook for your situation.

Many people have PVCs and don’t need treatment for them. Others may need treatment because they develop heart muscle problems from PVCs.

Your prognosis with ventricular tachycardia can vary. Catheter ablation or an ICD may solve or help manage the problem.

If you have ventricular fibrillation, you need immediate care. Chances of survival drop with every minute that passes before defibrillation.