Arrhythmia

What Are the Types of Arrhythmias?

Arrhythmias are divided up by where they happen. If they start in the ventricles, or lower chambers of your heart, they’re called ventricular. When they begin in the atria, or upper chambers, they’re called supraventricular.

Doctors also group them by how they affect your resting heart rate. Bradycardia is a heart rate of fewer than 60 beats per minute. Tachycardia is more than 100 beats per minute.

Supraventricular arrhythmias include:

• Premature atrial contractions. These are early extra beats. They’re harmless and generally don't need treatment.
• Atrial fibrillation (AFib). The upper chambers of your heart contract in an unusual way. Your heart might beat more than 400 times a minute.
• Atrial flutter. This is usually more organized and regular than atrial fibrillation. It happens most often in people who have heart disease and in the first week after heart surgery. It often changes to atrial fibrillation.
• Paroxysmal supraventricular tachycardia (PSVT). This is a rapid heart rate, usually with a regular rhythm. It begins and ends suddenly.
• Accessory pathway tachycardias. You can have a rapid heart rate because of an extra pathway between your heart's upper and lower chambers. Think of it as an extra road on your way home as well as your usual route. When that happens in your heart, it can cause a fast rhythm.
• AV nodal reentrant tachycardia (AVNRT). This is caused by an extra pathway through a part of your heart called the AV node. It can cause heart palpitations, fainting, or heart failure.

How Are Arrhythmias Diagnosed?

To diagnose an arrhythmia or find its cause, doctors use tests including:

• EKG. An electrocardiogram records the electrical activity of your heart. You wear small electrode patches on your chest, arms, and legs for the quick, painless test, which you take in your doctor's office.
• Holter monitor. This is a portable EKG (also called an "ambulatory electrocardiogram" or an ECG) about the size of a postcard or digital camera that you'll use for 1 to 2 days, or up to 2 weeks. The test measures the movement of electrical signals or waves through your heart. These signals tell your heart to contract (squeeze) and pump blood.  You'll have electrodes taped to your skin. It's painless, although some people have mild skin irritation from the tape used to attach the electrodes to the chest. You can do everything but shower or bathe while wearing the electrodes. After the test period, you'll go back to see your doctor. They'll download the information.
• Event monitor. If your symptoms don't happen often, your doctor may suggest that you wear one of these, usually for about a month. When you push a button, it records and stores your heart's electrical activity for a few minutes. Try to get a reading when you notice symptoms. Your doctor will interpret the results.
• Implantable loop recorder. Your doctor puts this under your skin, where it constantly records your heart’s electrical activity. It can send information to your doctor’s office.
• Stress test. There are different kinds of stress tests. The goal is to check how much stress your heart can manage before having a rhythm problem or not getting enough blood. For the most common type of stress test, you'll walk on a treadmill or pedal a stationary bike while you get an EKG and have your heart rate and blood pressure monitored. Technicians slowly raise the intensity level of your exercise.
• Echocardiogram. This test uses ultrasound to check your heart muscle and valves.
• Cardiac catheterization. Your doctor will insert a long, thin tube, called a catheter, into a blood vessel in your arm or leg. They’ll guide it to your heart with help from a special X-ray machine. Then, they’ll inject dye through the catheter to help make X-ray videos of your heart valves, coronary arteries, and chambers.
• Electrophysiology study. This test records your heart's electrical activities and pathways. It can help find out what's causing heart rhythm problems and find the best treatment for you. During the test, your doctor will safely trigger your unusual heart rhythm. Then, they may give you medications to see which one controls it best or to see what procedure or device you need to treat it.
• Head-up tilt table test. Doctors use this test to find out what's causing fainting spells. It measures the difference in heart rate and blood pressure when you're standing up and lying down. You'll get this test in a lab. You'll lie on a stretcher, tilted at different angles while you get an EKG and specialists check your blood pressure and oxygen level. This shows if symptoms of passing out are due to your electrical system, nervous system, or vascular system.

How Are Arrhythmias Treated?

Treatment will depend on what type of arrhythmia you have. Your doctor may recommend one or more of these.

Medications

Medicines that treat uneven heart rhythms include:

• Adenosine (Adenocard)
• Atropine (Atropen)
• Beta-blockers
• Calcium channel blockers
• Digoxin (Digitek, Digox, Lanoxin)
• Potassium channel blockers
• Sodium channel blockers

Vagal maneuvers

These techniques trigger your body to relax by affecting your vagus nerve, which helps control your heart rate. Your doctor might tell you to:

• Cough or gag
• Hold your breath and bear down (Valsalva maneuver)
• Lie down
• Put a cold, wet towel over your face

Electrical cardioversion

If drugs can't control an uneven heart rhythm (such as atrial fibrillation), you might need cardioversion. For this, doctors put you under and then send an electrical shock to your chest wall to trigger your heart’s regular rhythm.

Pacemaker

This device sends small electrical impulses to your heart muscle to keep a safe heart rate. It includes a pulse generator, which houses the battery and a tiny computer, and wires that send impulses to the heart muscle.

There are different types of ICDs, including:

• Single-chamber ICD. A lead is attached in the right ventricle. If needed, energy is delivered to the ventricle to restore a normal heart rhythm.
• Dual-chamber ICD. Leads are attached in the right atrium and the right ventricle. Energy can be delivered to the right atrium and then to the right ventricle, helping your heart to be paced in a normal sequence.
• Biventricular ICD. Leads are attached in the right atrium, the right ventricle, and the coronary sinus adjacent to the left ventricle. This technique helps the heart beat in a more efficient way and is specifically used for patients with heart failure.

Your doctor will determine which type of ICD is best for you. Before you have your ICD implanted, ask your doctor what medications you can take. Your doctor may ask you to stop taking certain medications before the procedure. You will receive specific instructions.

After it’s implanted, you might not notice a low-energy shock. Or it may feel like a flutter in your chest. The high-energy shock lasts just a second, but it can hurt. Some people say it feels like being hit with a baseball bat or being kicked by a horse. Most people feel it more in their back than their chest. If you feel a shock, sit or lie down because you may pass out.

Complications of Arrhythmias

Without treatment, an uneven heart rhythm could cause dangerous problems such as:

• Alzheimer’s disease and dementia. These cognitive disorders may happen because your brain doesn’t get enough blood over time.
• Heart failure. Your heart might not pump as well as it should after repeated arrhythmias.
• Stroke. Blood that lingers in your atria can clot. If a clot travels to your brain, it may cause a stroke.
• Cardiac arrest. V-fib could cause your heart to stop.

Safe Driving Concerns

If you have an arrhythmia, you could faint behind the wheel. This could put you, other motorists, pedestrians, and property at great risk.

To figure out whether you can drive safely, your doctor will consider:

• What type of arrhythmia you have
• How serious yours is
• The treatment you receive for it (if any)
• How often you have symptoms and how serious they are

If you have no symptoms and you haven't had any serious heart rhythm problems, you should be able to drive as you always have. If meds keep your arrhythmia under control, your doctor may give you the green light to drive, too.

In addition to meds to help manage your heart rhythm, you may have two other treatments. Both would keep you out of the driver's seat for a while:

Ablation: This treatment will usually restrict you to the passenger's seat for about a week. It may keep you there longer, depending on your medical history.

Implantable cardioverter defibrillator: Usually after you get an ICD, you'll be asked not to drive for a week. If you got an ICD after fainting or surviving cardiac arrest, you may have to wait several months before you get back behind the wheel.

You can't drive commercially (as in a delivery truck or a taxi) at all if you have an ICD.

Arrhythmia Prevention

You can’t always prevent arrhythmias. Regular checkups with your doctor can help keep you from having more heart rhythm problems. Be sure they know all of the medications you’re taking. Some cold and cough medicines can trigger an arrhythmia, so talk to your doctor before using them.

They may also recommend some lifestyle changes:

• Eat a healthy diet. Get plenty of fruits and vegetables, fish, and plant-based proteins. Avoid saturated and trans fats.
• Keep cholesterol and blood pressure under control.
• Don’t smoke.
• Keep a healthy weight.
• Exercise regularly.
• Manage stress.
• Limit alcohol and caffeine.