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At the heart of arrhythmia

Justin Lundbye, M.D. [November 05 2010]

Has your heart ever skipped a beat? If you have experienced an uncomfortable awareness of your own heartbeat, you could have an arrhythmia.

An arrhythmia is any change in your heart rhythm. The heart may beat too fast, too slow or beat irregularly. Arrhythmias can occur when there is a disruption or problem with the heart's electrical system. The risk of developing an arrythmia depends on many factors, including the condition of your heart, blood chemistry, endocrine abnormalities and past heart attacks. Often stress, anxiety, excessive caffeine or nicotine can contribute to arrythmia. In addition, some medications and illicit drug use may cause it. A relatively common arrhythmia, called atrial fibrillation, is more prevalent in men and in the older population. Atrial fibrillation usually involves a rapid and irregular heart beat and is frequently managed with blood thinners and other medications.

What's going on?
Most people have a heart rate between 60 and 100 beats per minute that fluctuates during the day. Heart rate speeds up during exercise and slows during sleep. Physicians classify the many types of arrhythmias based on the type of heart rate they cause as well as where in the heart they originate. Tachycardia is defined as a rate faster than 100 beats per minute. Bradycardia is a rate slower than 60 beats per minute.
During an arrhythmia, you may have no symptoms or you may experience:
• palpitations or a feeling that your heart's skipped a beat or is beating too hard
• a fast, slow, or irregular heartbeat or pauses between heartbeats
• tiredness or light-headedness
• loss of consciousness or feeling faint
• shortness of breath
• chest pain
• excessive sweating
• anxiety

Treating your arrhythmia
Not all arrhythmias require treatment, but you need to manage an arrhythmia that causes significant symptoms or increases risk for a more serious condition. Treatment depends on the type and degree of the arrhythmia and may include:
• Lifestyle measures. Because many arrhythmias arise from underlying heart disease, doctors may recommend more exercise, an improved diet, better stress management, not smoking and limiting caffeine and alcohol as ways to reduce episodes.
• Drugs. Beta-blockers such as metoprelol, calcium channel blockers such as diltiazem and digitalis are common drugs used for managment of arrhythmias. Other drugs such as sodium channel blockers and potassium channel blockers, are drug types that may slow or suppress arrhythmias.
• Vagal maneuvers. Some types of tachycardia can be treated by stimulating your vagal nerves — the part of the nervous system that regulates your heart rate — which respond by slowing your heart rate. These “maneuvers” include holding your breath and straining, and coughing.
• Implantable devices. Surgery to implant an artificial pacemaker is a common treatment for bradycardia. This device, implanted under the skin and attached to the heart, sends an electrical impulse whenever the heart rhythm slows or becomes erratic. Another device, the implantable cardioverter defibrillator (ICD), can be placed in the chest to correct an abnormally fast and/or lethal heartbeat.
• Cardioversion. This treatment uses drugs or an electrical shock to reset the heart to its regular rhythm.
• Catheter ablation. Catheters are threaded through blood vessels to the heart and deliver radiofrequency energy to carefully destroy (ablate) the abnormal portions of the heart causing the arrhythmia. This method is highly successful in treating tachycardia and is done by speccialized cardiologists, electrophysiologists.
• Open-heart surgery. Cardiothoracic surgeons perform open-heart surgery, known as the Maze procedure, to regulate electrical impulses usually only after patients haven't responded to other treatments.

Justin Lundbye, M.D., is a member of The Hospital of Central Connecticut (HCC) medical staff and director of HCC's Division of Cardiology. For referrals to HCC physicians, please contact our free Need-A-Physician referral service by phone at 1-800-321-6244 or online, www.thocc.org. Learn more about HCC's cardiology services