A Guide to Manage Arrhythmias

What are arrhythmias?

Arrhythmias are irregular heartbeats. An arrhythmia occurs when the heart’s electrical signals get disrupted and causes your heart to beat too fast, too slow, or irregularly. For adults, the heart normally beats (pumps) between 60 and 100 times per minute to circulate blood throughout the body.

If you have arrhythmias, you may experience a feeling of fluttering in the chest, dizziness or shortness of breath. Or you may not have any symptoms.

Many heart arrythmias are harmless. But if they are highly irregular or resulting from a weak or damaged heart they need to be treated with medication or procedures. Left untreated they can lead to stroke, heart failure and other complications.

Symptoms

• Heart palpitations (a feeling of fluttering or pounding in the chest)
• Shortness of breath
• Chest discomfort
• Fatigue
• Dizziness or lightheadedness

Types of arrhythmias

Some common types of arrhythmias include:

• Tachycardia: a heart rate faster than 100 bpm and/or beats irregularly.
• Bradycardia: a heart rate that’s too slow. Slower than 60 bpm.
• Atrial Fibrillation (Afib)

  The most common type of arrhythmia, affecting over 2.5 million Americans. The upper chambers (the atria) of the heart beat so fast they quiver or fibrillate, causing lower chambers (the ventricles) to beat out of sync.

• Ventricular fibrillation (VF)

  Tthe lower chambers quiver instead of pumping blood into the body. VF is a life-threatening condition that can lead to cardiac arrest.

Diagnosing arrhythmias

If you are experiencing symptoms or suspected of having an arrhythmia there are several different diagnostic tests that can be done.

• An electrocardiogram (ECG) is the most common test. It captures a short record of the electrical activity of your heart. If the abnormal rate isn’t always present, the ECG may not catch the abnormalities.
• Holter monitors are portable, 24-hour ECGs. They help detect arrhythmias that may come and go throughout the day.
• Echocardiogram is an ultrasound that provides a picture of the size, structure, and motion of your heart.

If your doctor doesn’t find an arrhythmia with the above tests, they may order a test that triggers the arrhythmia.

• Stress test is a test that monitors your heart rate during exercise. You’re asked walk on a treadmill or ride a stationary bicycle while your heart is monitored.
• Tilt table test—if you have fainting spells, your doctor may order a tilt table test. You lie flat on the table, then table will tilt from horizontal position to vertical position as if you are standing up. Your heart rate and blood pressure are measured while you’re on the table.
• Electrophysiological testing and mapping (EP)—catheters with electrodes on the tip were inserted through the blood vessels to the heart. The electrodes can map the electrical signals through the heart. It can trigger hidden arrhythmias.

Causes and risk factors

Causes

• Heart disease (coronary heart disease, heart failure) or abnormalities in the heart structure (congenial heart defects)
• Hight blood pressure (hypertension)
• Electrolye imbalances: low potassium, magnesium or calcium levels
• Overactive or underactive thyroid gland
• Certain medications
• Use of stimulants, such as caffeine or cocaine

Risk Factors

• Age: the risk of arrhythmia increases as you get older
• Family history (genetics)
• Health conditions: high blood pressure, heart disease, obesity, kidney disease, chronic obstructive pulmonary disease (COPD), sleep apnea, viral infections
• Lifestyle factors: smoking, use of illegal drugs, excessive alcohol consumption, stress, anxiety

Treatment

The treatment of arrhythmias depends on the type, severity, underlying cause of the condition. Your doctor typically recommends medication along with lifestyle changes. If they don’t treat your condition adequately, you may need a procedure or a device.

Procedures and devices

• Cardioversion: a procedure that uses electric shock to restore a normal heart rhythm.
• Catheter ablation: a procedure using radiofrequency (RF) or laser light to create a scar on the heart. The star prevents abnormal electrical signals from causing arrhythmias.
• Implantable devices: a pacemaker or a defibrillator can help regulate the heart's rhythm and prevent dangerous arrhythmias.

Medication options

Antiarrhythmics

Antiarrhythmics work by blocking electrical channels to slow down your heart rate and allow it to beat at a regular rhythm. Depending on your specific condition there are several different antiarrhythmics that may be best suited for you.

Examples of antiarrythmics include: amiodarone, flecainide, propafenone, sotalol, diltiazem

Beta-blockers

Beta blockers work by reducing the release of the hormones adrenaline and noradrenaline. Your body uses adrenaline and noradrenaline to activate your “fight-or-flight” response, which causes rapid heartbeat, high blood pressure, excessive sweating, anxiety, and heart palpitations. Beta-blockers work by slowing the heart rate and reducing the workload on the heart.

Examples of beta-blockers for arrythmias include: metoprolol, propranolol, carvedilol, bisoprolol, atenolol.

Blood thinners (anticoagulants)

Anticoagulants are often used to treat arrhythmias that increase the risk of blood clots, such as atrial fibrillation. When a blood clot forms in the heart or brain, it can lead to an event like a heart attack or stroke. By reducing the levels of clotting factors in your blood, blood thinners decrease the chance of these events occurring as a result of your arrhythmia.

Examples of anticoagulants for arrythmias include: warfarin, dabigatran, rivaroxaban, apixaban.

Calcium channel blockers (CCBs)

Calcium channel blockers decrease the amount of calcium that enter the heart and blood vessel walls. This relaxes the blood vessels and heart, resulting in improved blood pressure and a more controlled heart rate.

Examples of CCBs for arrythmias include: verapamil, diltiazem, nifedipine.

Digoxin

Digoxin works by slowing down the electrical impulses in the heart to control the heart rhythm. This puts less pressure on your heart and increases the amount of blood your heart can fill with and then pump out with each beat.