It’s normal for your heart to beat faster with excitement, exercise or stress—and just as normal for it to beat slower when you’re asleep. But if your heart speeds up, slows down or beats erratically, you’re experiencing cardiac arrhythmia and should see your doctor.
Cardiac arrhythmias are abnormalities in the heart’s rhythm. They are treated by doctors such as Richard Trohman, MD, a cardiac electrophysiologist at RUSH University Medical Center. Electrophysiologists specialize in abnormal heart rhythms, perform curative procedures (called ablations), and implant pacemakers and defibrillators (ICDs).
What causes arrhythmias?
Normal heartbeats begin with an electrical impulse from the heart’s natural pacemaker, the sinus node. The impulse travels through the heart’s upper chambers, the atria, to the atrioventricular (AV) node (a filter and gateway) before proceeding through a specialized pathway to the heart’s lower chambers, the ventricles.
The simplest arrhythmia, extra beats, may arise from anywhere in the heart. They commonly develop as we age. When these minor arrhythmias occur in a healthy heart, the consequences are usually minimal. However, when prolonged arrhythmias are associated with structural heart disease, serious consequences—including stroke and sudden cardiac death—may occur. If you’re experiencing sensations such as fluttering or skipped beats, Trohman recommends seeing your doctor and having it checked out.
The most common worrisome arrhythmia, atrial fibrillation (AF), arises from the atria. AF affects more than 2 million Americans, most over age 65. AF can lead to fatigue, heart failure and stroke.
The most serious arrhythmias involve the ventricles. “The worst arrhythmia is ventricular fibrillation (VF),” Trohman says. “This is the cause of about 80 to 90 percent of cardiac arrest or sudden cardiac death.” VF almost always results from structural heart disease. In the United States, 200,000 to 400,000 individuals experience cardiac arrest each year. Patients with structural disease who have not yet had a serious arrhythmia may nevertheless benefit from ICD prophylaxis, which is 99 percent effective for preventing cardiac arrest.
Electrophysiologists at RUSH offer a full range of services to evaluate and treat arrhythmias, beginning with the electrocardiogram. If prolonged rhythm analysis is needed, patients may be given a portable external heart monitor. If the problem is infrequent and difficult to define, an internal recorder is also available.
Restoring healthy rhythm
Medications are limited by side effects and never cure arrhythmias. Sophisticated procedures performed in the electrophysiology lab often provide more definitive solutions. Many common arrhythmias can be cured by inserting catheters into the heart and burning away (ablating) errant electrical circuits.
Arrhythmias that are easily cured include nearly all rapid rhythms arising from the AV node and atria, as well as most idiopathic (cause unknown) ventricular rhythm disturbances. Treatments also include pacemakers for slow rhythms and implantable defibrillators that shock the heart from ventricular fibrillation back to a normal rhythm.
Cardiac resynchronization (pacing the right and left ventricles) therapy helps selected patients with heart failure; 70 percent experience improved quality of life. Cardiac resynchronization combined with an ICD reduces hospitalization rates and saves lives. So if your heart seems aflutter, check with your doctor to find out why and what can be done to restore your heart’s healthy rhythm.
There are solutions that can steady the beat. To find a RUSH heart specialist, call (888) 352-RUSH (7874).