Definition

Arrhythmia is a disorder that causes irregular heartbeats. Arrhythmias occur when the electrical signals that control the heart rate do not function properly. This disruption in electrical signals can cause the heart to beat too quickly (tachycardia), too slowly (bradycardia), or irregularly. These irregular heart rhythms can feel fast or slow and interfere with heart contractions.

An increase or decrease in a person's heart rate is not always abnormal. For example, the heart rate may increase while exercising or decrease while sleeping.  Arrhythmias are classified based on the heart rate:

• Tachycardia, where the heart rate becomes faster than normal, with a frequency of more than 100 beats a minute
• Bradycardia, where the heart rate becomes slower than normal, with a frequency of less than 60 beats a minute

Causes

Things that can cause a person to have an arrhythmia include:

• A current heart attack, or as a result of scar tissue that has formed due to a previous heart attack
• Blockages in the coronary arteries of the heart 
• Changes in the structure of the heart, such as heart muscle disorders in cardiomyopathy
• Diabetes
• High blood pressure
• COVID-19 infection
• Impaired activity of the thyroid gland
• Obstructive sleep apnea or stopping breathing for a few seconds during sleep
• Certain medications, including cold and allergy medications purchased without a prescription
• Drinking too much alcohol or caffeinated beverages
• Drug abuse
• Genetic or hereditary factors
• Smoking
• Stress and anxiety

Risk factor

Things that can increase the risk of arrhythmia include:

• Coronary artery disease, other heart diseases, and a history of heart surgery
• High blood pressure increases the risk of coronary artery disease and causes the wall of the left ventricle to become stiff and thick, altering the heart's electrical flow
• Congenital heart disease
• Thyroid disease
• Sleep obstructive apnea, or pauses in breathing during sleep
• Electrolyte imbalances such as potassium, sodium, calcium, and magnesium in the body can interfere with the heart's signals and cause irregular heartbeats
• Certain medications and supplements
• Excessive alcohol consumption
• Excessive caffeine, nicotine, or use of illegal drugs (amphetamines and cocaine) can cause the heart to beat faster and lead to the development of more serious arrhythmias

Symptoms

Arrhythmia may not cause any signs or symptoms. As a result, arrhythmias can be discovered unintentionally during routine medical examinations. Arrhythmias feel like heart palpitations and can be harmless. However, some arrhythmias can cause disturbing and even life-threatening signs and symptoms. 

In general, signs and symptoms of arrhythmias include:

• Rapid chest beat (tachycardia)
• Slow heartbeat (bradycardia)
• Irregular heartbeat
• Chest pain
• Shortness of breath

An irregular heartbeat can prevent the heart from pumping enough blood to all of your body's tissues. This can lead to symptoms accompanying arrhythmia, such as:

• Anxiety
• Fatigue
• Feeling floaty or dizzy
• Sweating
• Fainting or near fainting
• Blurred vision

Diagnosis

Arrhythmia is diagnosed using information about the patient's symptoms and medical history, as well as a physical examination and supporting tests.

Supportive examinations to support the diagnosis of arrhythmia include:

• Electrocardiogram (ECG) to assess the electrical activity of the heart
• Holter monitor to record heart activity as you go about your routine
• Event recorder to detect sudden onset of arrhythmia. This device can be worn for a longer period of up to 30 days or until the arrhythmia symptoms appear
• Echocardiogram to assess the size, structure, and movement of the heart
• Implantable loop recorder, used if arrhythmia is very rare. This device is implanted under the skin in the chest area to continuously record the heart's electrical activity and detect irregular heart rhythms

Management

The management of arrhythmias depends on whether the heart rate is too fast or too slow. Some arrhythmias do not require treatment. Generally, treatment is necessary if symptoms or risks of more serious heart problems arise.

Medications

The choice of medication depends on the type of arrhythmia and its potential complications. For instance, medications to control heart rate and restore normal rhythm are typically prescribed for tachycardia. In cases of atrial fibrillation (a condition characterized by very rapid and irregular heartbeats that can lead to stroke, blood clots, heart failure, etc.), anticoagulants may be prescribed to prevent clot formation.

Vagal maneuvers

For certain types of arrhythmias, particularly in emergencies, vagal maneuvers or cardioversion may be performed. Vagal maneuvers are used for supraventricular tachycardia (very rapid heartbeats originating above the ventricles). These maneuvers affect the vagus nerve, which controls heart rate, thereby slowing it down.

Cardioversion

Cardioversion is a method used to reset the heart rhythm, either with medications or with a device. In cardioversion, a shock is delivered to the heart through electrodes placed on the chest. This shock affects the heart's electrical signals, restoring a normal heart rhythm.

Surgical or other procedures

Arrhythmias may also be treated with catheter procedures or surgery to implant devices in the heart. Some arrhythmias might require open-heart surgery.

Procedures and surgeries for treating arrhythmias include:

• Catheter Ablation: This procedure creates small scars in the heart to block abnormal electrical signals and restore normal heart rhythm.
• Pacemaker: Used in cases of bradycardia or slow heart rate with no identifiable cause. The pacemaker stimulates the heart to maintain a normal rhythm if it slows down or stops.
• Implantable Cardioverter-Defibrillator (ICD): Utilized if there is a high risk of very rapid or irregular heartbeats in the ventricles (ventricular tachycardia or ventricular fibrillation).
• Maze Procedure: Involves creating a series of incisions in the atria to form a scar tissue pattern that blocks abnormal electrical pathways causing arrhythmias. This is for patients who do not improve with other treatments or require open-heart surgery for other reasons.
• Coronary Bypass Surgery: Performed for severe coronary artery disease to enhance blood flow to the heart.

Lifestyle and Home Remedies

Doctors may recommend lifestyle changes to keep the heart healthy, including:

• Eating a heart-healthy diet low in salt and saturated fats, rich in fruits, vegetables, and whole grains.
• Engaging in regular exercise, at least 30 minutes daily.
• Quitting smoking.
• Maintaining an ideal weight.
• Managing blood pressure and cholesterol levels through lifestyle changes and prescribed medications.
• Reducing alcohol consumption.
• Adhering to medication regimens and regular check-ups with your doctor.
• Practicing meditation and relaxation techniques.

Complications

The complications that occur depend on the type of arrhythmia. In general, arithmetic complications include:

• Stroke
• Sudden Death
• Heart failure
• Increased risk of blood clots, if blood clots break, clots can walk from the heart to the brain and cause stroke

Prevention

Changes in lifestyle to reduce the risk of heart disease can prevent arrhythmias. These healthy lifestyles include:

• Eat healthy foods in the heart
• Doing physical activity or regular exercise
• Maintaining ideal weight
• Not smoking
• Restricting or avoiding caffeine and alcohol
• Reducing stress or anger that can cause heart rhythm problems
• Taking medication according to the rules, including drugs purchased without a prescription

When to see a doctor?

If you feel your heart is beating too fast or too slowly, consult a doctor. Seek immediate medical help if you experience shortness of breath, weakness, dizziness, your head feels light, faint or almost faint, and chest pain. 

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