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Arrhythmia management & treatment

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Heart arrhythmias are common and are usually treatable

A recent study suggests that one-in-four adult Americans over age 40 could develop an irregular heartbeat, or arrhythmia.

At Novant Health, our clinical experts are dedicated to delivering the highest-quality care for heart arrhythmias – from diagnosis to treatment and recovery.

What are the types of arrhythmias?

  • Tachycardia: A fast heart rhythm with a rate of more than 100 beats per minute
  • Bradycardia: A slow heart rhythm with a rate below 60 beats per minute
  • Supraventricular arrhythmias: Arrhythmias that begin in the atria (the heart's upper chambers); "supra" means above; "ventricular" refers to the lower chambers of the heart, or ventricles
  • Ventricular arrhythmias: Arrhythmias that begin in the ventricles (the heart's lower chambers)
  • Bradyarrhythmias: Slow heart rhythms that may be caused by disease in the heart's conduction system, such as the sinoatrial (SA) node, atrioventricular (AV) node, or HIS-Purkinje network.

What causes arrhythmias?

Arrhythmias can be caused by:

  • Coronary artery disease
  • High blood pressure
  • Changes in the heart muscle (cardiomyopathy)
  • Valve disorders
  • Electrolyte imbalances in the blood, such as sodium or potassium
  • Injury from a heart attack
  • The healing process after heart surgery
  • Other medical conditions

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 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. Novant Health has a highly-skilled team of heart specialists committed to diagnosing and treating your heart arrhythmia.

After evaluating your symptoms and performing a physical examination, the cardiologist may perform a variety of diagnostic tests to help confirm your arrhythmia and its causes. Some tests that may be performed to confirm 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.
  • Holter monitor: A small, portable recorder that is attached to electrodes on your chest. It continuously records your heart's rhythm for 24 hours.
  • Stress test: A test that records arrhythmias that start or are worsened with exercise. This test also may be helpful in determining if there is underlying heart disease or coronary artery disease associated with an arrhythmia.
  • Echocardiogram: A type of ultrasound used to provide a view of the heart and 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 team inserts a catheter (a small, hollow, flexible tube) into a blood vessel and guides it 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 can be recorded. This test helps your doctor determine if the cause of an arrhythmia is coronary artery disease. It 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.

How is an arrhythmia treated?

Treatment depends on the type and severity of your arrhythmia. In some cases, no treatment is necessary. Treatment options include medications, lifestyle changes, invasive therapies, electrical devices, or surgery. Your doctor will work with you to determine the best treatment for your heart arrhythmia.

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 anticoagulant or antiplatelet drugs such as warfarin (a "blood thinner") or aspirin, 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; ask your doctor or pharmacist which medication is best for you.
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: If you have a persistent arrhythmia, such as atrial fibrillation, you might 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.
Electrical devices
  • Permanent pacemaker: This is a device that sends small electrical impulses to the heart muscle to maintain a normal heart rate. The pacemaker has a pulse generator (which houses a battery and a tiny computer) and leads (wires) that send impulses from the pulse generator to your heart muscle and sense your heart's electrical activity. Pacemakers are mostly used to prevent the heart from beating too slowly. Newer pacemakers have many sophisticated features that are designed to help manage arrhythmias, optimize heart rate-related functions and improve synchronization
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  • Implantable cardioverter-defrillator (ICD): This is an electronic device used primarily to treat ventricular tachycardia and ventricular fibrillation – two life-threatening, abnormal heart rhythms. An ICD constantly monitors your 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.
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 correct 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.

At Novant Health, we’re dedicated to supporting you every step of the way. You can count on us to help you get better and stay healthy.

To learn more about arrhythmia management and treatment, visit our online health library. To connect with a clinical expert, contact us today. We’re here to help.