Heart Rhythm Disorders

• Premature (extra) beats that feel like fluttering in the chest: the most common type of arrhythmia, are harmless most of the time and often do not require treatment.
• Supraventricular arrhythmias are tachycardias that start in the atria or atrioventricular (AV) node. Types include:
  • Atrial fibrillation (Afib), the most common type of serious arrhythmia, involves a very irregular and fast contraction of the atria. This condition typically starts in the left atrium (upper left chamber), and causes the upper chambers of the heart to beat in an unorganized rhythm. Afib can cause a normal heart rate of 60-100 beats per minute to jump to 150-200 beats per minute
  • Atrial flutter is less common than Afib but has similar symptoms and complications
  • Paroxysmal supraventricular tachycardia, a fast heart rate that begins and ends suddenly, occurs when the electrical connection between the atria and the ventricles doesn’t function properly
• Ventricular arrhythmia begins in the ventricles, the heart's lower chambers, and often require immediate medical care. Types include:
  • Ventricular tachycardia is a fast, regular beating of the ventricles that can last for a few seconds or much longer. Ventricular tachycardia starts in the heart's ventricles (lower chambers). Experts usually define ventricular tachycardia as three or more heartbeats in a row, at a rate of more than 120 beats per minute. If tachycardia lasts for more than a few seconds at a time, it can be life-threatening
  • Ventricular fibrillation is when electrical signals make the ventricles quiver instead of pump normally
• Bradyarrhythmias are when the heart rate is slower than normal, decreasing blood flow. This can cause fatigue, shortness of breath, dizziness and fainting. In most cases, bradycardia only needs to be treated if it is causing symptoms.

There are a number of factors that may contribute to the development of heart rhythm disorders, including:

• Alcohol
• Caffeine
• Congenital heart disease
• Coronary heart disease
• Diabetes
• Drugs and supplements
• Heart valve disorders
• High blood pressure (hypertension)
• Obesity
• Sleep apnea
• Smoking
• Thyroid problems
• Genetics

A patient with an arrhythmia may experience one or more of the following symptoms:

• Chest pain or tightness
• Dizziness or lightheadedness
• Fainting spells
• Low blood pressure
• Palpitations (a fluttering, fast heartbeat)
• Shortness of breath
• Weakness or tiredness

The symptoms of arrhythmia may resemble other conditions. Consult your doctor for a diagnosis.

Our cardiac arrhythmia specialists provide expert evaluation and diagnosis with the aid of the latest in advanced imaging technologies. Along with a careful physical examination, the cardiologist may order one or more of the following tests or procedures:

• Cardiac magnetic resonance imaging (MRI)
• Cardiac ultrasound (echocardiography)
• Electrocardiogram
• Electrophysiology studies
• Holter ECG monitor
• Event monitor
• Implantable loop recorder
• Standard exercise stress test
• Transesophageal echocardiogram

It is important to treat an arrhythmia because the condition can worsen over time as the heart muscles become overworked and weak, making it even more difficult for the heart to function properly. Specialists in our Cardiac Arrhythmia Service develop individualized treatment plans for patients based on:

• Age
• Overall health
• Medical history
• Severity and form of the disease
• Tolerance for specific medications or procedures
• Expectations for course of the disease
• Presence of other conditions

Treatment may involve a number of medical, surgical and interventional options.

Lifestyle modifications can include reducing stress and eliminating alcohol and caffeine.

Medication may be administered, the type of which will depend on the type of arrhythmia, the presence of other conditions and whether the patient is taking any other drugs

Interventional and surgical options include:

• Cardiac (catheter) ablation, which uses heat to eliminate small areas of the heart tissue causing heart rhythm problems
• Cardiac resynchronization therapy, which involves placing a small pacemaker in the chest to monitor irregular heartbeat and send electrical pulses to correct them
• Cardioversion: During brief sedation administered by an anesthesiologist, this procedure delivers an electrical current through the chest wall to the heart through special electrodes or paddles that are applied to the skin of the chest and back. The purpose of cardioversion is to interrupt the abnormal electrical circuit(s) in the heart and to restore a normal heartbeat. The mild shock causes all the heart cells to contract simultaneously, thereby interrupting and terminating the abnormal electrical rhythm without damaging the heart. The heart’s electrical system then restores a normal heartbeat.
• Implantable cardioverter defibrillator (ICD), a device placed under the skin that delivers an electric shock if your heart beats abnormally
• Pacemaker implantation, a small device implanted in the chest that helps the heart beat in a normal rhythm
• Transvenous lead extraction

We often see patients who have been told there’s nothing that can be done, or they aren’t good candidates for interventions. We pride ourselves in finding the right treatment plan based on each patient’s unique needs and health and having the diagnostic and clinical expertise to provide the right care for the right patient at the right time. Call 857-307-6048 or request a virtual visit to speak with one of our clinicians.

It can be. Atrial fibrillation that is inherited is called familial atrial fibrillation. Brigham and Women’s Heart and Vascular Genetics Program is on the forefront of research into the molecular basis for genetic cardiac disease and applying that knowledge to the clinical setting, enhancing the care of patients and their families.

If you have a relative who has been diagnosed with Afib and are concerned about your risks, talk with your doctor or make an appointment. We offer comprehensive evaluation, diagnosis, and management of those with inherited cardiac disorders and specialize in managing the following conditions:

• Familial atrial fibrillation
• Hypertrophic cardiomyopathy
• Marfan syndrome and connective tissue disorders
• Dilated cardiomyopathy
• Arrhythmogenic right ventricular dysplasia
• Long QT syndrome and other inherited arrhythmias, including Brugada syndrome and catecholaminergic polymorphic ventricular tachycardia
• Familial sudden cardiac death
• Inherited aortic aneurysms
• Premature coronary artery disease and myocardial infarction