Centers of Excellence

Heart & Vascular Center

Heart Rhythm Disorders

What Are Heart Rhythm Disorders?

Heart rhythm disorders, also known as cardiac arrhythmia, 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.

Heart Rhythm Disorder Information

What Are the Types of Cardiac Arrhythmia?
  • 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.
What Causes Cardiac Arrhythmia?

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

What Are the Symptoms of Cardiac Arrhythmia?

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

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

How is a Cardiac Arrhythmia Diagnosed?

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:

How is a Cardiac Arrhythmia Treated?

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.

Is Afib Hereditary?

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

Expertise in Heart Rhythm Disorders

The Cardiac Arrhythmia Service at the Brigham and Women's Heart & Vascular Center is known worldwide for its expertise in evaluating and treating heart rhythm disorders. Our physicians have long been innovators in the field, from being the first to use direct current cardioversion to restore normal heart rhythm in 1962 to being one of only three centers in the U.S. today to use needle catheter ablations to reach within the thickness of the heart wall and unique stereotactic radio ablation protocol to treat arrhythmias.

Our team in the Cardiac Arrhythmia Service includes some of the world's most experienced physicians in cardiac electrophysiology, who specialize in treating a full range of patients, including those with the most complex medical concerns. Our specially trained team performs more than 3,000 procedures annually, including catheter ablation, implantable cardioverter defibrillator (ICD), pacemaker implantation and cardiac resynchronization, which translates to better outcomes for patients.

Our team of specialists are seeing patients with in-person office visits and virtual visits. For initial consults, second opinions, treatment planning and follow-up care, you can receive individualized, expert cardiac care from the comfort of your home.

The Heart & Vascular Center offers the following for our patients:

  • Expertise in treating the most complex rhythm disorders, even those who have failed or have been deemed untreatable at other centers
  • A team approach to integrated care and better outcomes for patients, delivered by cardiac electrophysiologists, interventional cardiologists, cardiovascular imaging experts, radiologists, cardiac anesthesiologists, nurses and nurse practitioners, physician assistants, physical therapists, dietitians and social workers
  • Access to the most innovative procedures, techniques and devices, including ablation techniques not offered at most other centers such as stereotactic radio-ablation. Our clinicians are continually working to advance patient care, while ensuring an excellent safety record
  • Access to clinical trials and research, offering patients potential treatment options not available elsewhere
  • Access to the most innovative treatments, utilizing the latest treatment guidelines. These include a newer class of blood thinning drugs (non-vitamin K oral anticoagulants) that can reduce stroke risk, and a wide range of interventional and surgical procedures, such as catheter ablation, cardioversion, implantable cardioverter defibrillator, pacemaker implantation and transvenous lead extraction
  • Access to the latest, top of the line technologies and advanced imaging, including intracardiac ultrasound (echocardiography), innovative mapping systems and 4D CT, which translates to more accurate visibility and diagnosis and leads to more precise surgical and interventional care
  • Same-day discharge program for many patients undergoing procedures and follow-up with a provider the next day through a virtual visit
  • World-class training program dedicated to educating and mentoring the next generation of clinicians
  • Our Cardiovascular Genetics Program is at the forefront of research and care of inherited cardiac disorders. We specialize in managing Long QT syndrome and other inherited arrhythmias, including Brugada syndrome and catecholaminergic polymorphic ventricular tachycardia

What to Expect at the Heart & Vascular Center

The Heart & Vascular Center is located in the Shapiro Cardiovascular Center, across the street from our main 75 Francis St. entrance. The 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, your care will be provided by surgeons, anesthesiologists and nurses who specialize in surgery for patients with CHD. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care from 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.

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