Heart Rhythm Disorders

Heart rhythm disorders, or cardiac arrhythmias, are abnormal heartbeats that cause the heart to beat too fast (tachycardias), too slow (bradycardias) or irregularly. These disorders are caused by a problem with the heart’s electrical system, which stimulates the heart to squeeze and relax. Although cardiac arrhythmias sometimes occur in a healthy heart and have minimal consequences, they can also be a sign of a more serious problem. Underlying cardiovascular conditions can result in complications, such as stroke or sudden cardiac death – the leading cause of death in the United States.

The Cardiac Arrhythmia Service at the Brigham and Women’s Hospital (BWH) Heart & Vascular Center is devoted solely to the care of patients with irregular heart rhythms, heart palpitations and rapid heartbeats. Treatment is provided by some of the world's most experienced physicians in cardiac electrophysiology (the study of the heart’s electrical system), and many patients with complex cases are referred to our program. Our heart rhythm specialists perform more than 3,000 procedures annually, utilizing the latest medications, devices and innovative care approaches.

What are the types of cardiac arrhythmias?

Premature (extra) beats, the most common type of arrhythmia, are harmless most of the time and do not require treatment. They often feel like fluttering in the chest.

Supraventricular arrhythmias are tachycardias that start in the atria or atrioventricular (AV) node. Types include:

• Atrial fibrillation (AF), the most common type of serious arrhythmia, involves a very irregular and fast contraction of the atria.
• Atrial flutter is less common than AF 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 arrhythmias begin in the ventricles, the heart's lower chambers, and often require immediate medical care.

• Ventricular tachycardia, a fast, regular beating of the ventricles may last for only a few seconds or for much longer.
• Ventricular fibrillation is when electrical signals make the ventricles quiver instead of pump normally.

Bradyarrhythmias happen when the heart rate is slower than normal, decreasing blood flow. Fainting can result.

What are the risk factors for cardiac arrhythmia?

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

What are the symptoms of cardiac arrhythmia?

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 arrhythmias may resemble other conditions. Consult your doctor for a diagnosis.

How are cardiac arrhythmias diagnosed?

Our 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

What are the treatment options for cardiac arrhythmias?

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

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. Treatment may involve a number of options, including:

• Lifestyle modifications
• Reducing stress
• Eliminating alcohol and caffeine
• Medication can be used to help control arrhythmias. The type of medication will depend on the type of arrhythmia, the presence of other conditions, and whether the patient is taking any other drugs.
• Procedures and Surgery
• Cardiac (catheter) ablation
• Cardiac resynchronization therapy
• 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
• Pacemaker implantation
• Transvenous lead extraction

What can I expect?

The Heart & Vascular Center is located in the Shapiro Cardiovascular Center, across the street from BWH's main 75 Francis Street entrance. The Heart & Vascular Center brings together the full range of services in one location, fostering seamless and coordinated care for all cardiovascular patients.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Watkins Clinic for pre-operative information and tests.

The day of surgery, you care will be provided by surgeons, anesthesiologists and nurses who specialize in surgery for patients with heart rhythm disorders. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

During your surgery, family and friends can wait in the Shapiro Family Center. Staff members will provide surgery updates and caregivers who leave the hospital will be contacted by cell phone.

Download Cardiac Surgery: A Guide for Patients

Team-based care

Patients benefit from the teamwork of cardiologists, cardiac surgeons, cardiovascular imaging experts and radiologists, and anesthesiologists, all experts in heart rhythm disorders. They work alongside nurses, physician assistants, physical therapists, dietitians and social workers to achieve outstanding outcomes for our patients. Learn more about Our Heart & Vascular Team.

How do I book an appointment?

• Request Heart & Vascular Appointment

Where are you located?

• Heart & Vascular Locations

What other resources can I use?

Learn more about heart rhythm disorders in our health library.

Read about palpitations.

Visit the Kessler Health Education Library in the Bretholtz Center where patients and families can access computers and knowledgeable staff.

Access a complete directory of patient and family services.