Arrhythmia

An arrhythmia is an irregular heartbeat that can make your heart beat too fast, too slow, or in an uneven pattern. While some arrhythmias are harmless, others can lead to serious complications like stroke or heart failure if left untreated.

Table of contents

• What is arrhythmia?
• Types of arrhythmia
• Symptoms
• Causes and risk factors
• Complications
• Diagnosis
• Treatment options
• Living with arrhythmia

What is arrhythmia?

cardiac arrhythmia, heart arrhythmia, dysrhythmia, irregular heartbeat

An arrhythmia is a problem with the rate or rhythm of your heartbeat. It occurs when the electrical signals that tell the heart to beat don’t work properly^[2]. Your heart may beat too quickly, too slowly, or with an irregular pattern^[1].

Normally, your heart beats in an organized, coordinated way. A normal heart rate for adults at rest is between 60 and 100 beats per minute^[3]. For older adults, this range is typically between 60 and 80 beats per minute^[3]. In a typical heart rhythm, a tiny cluster of cells at the sinus node sends out an electrical signal. The signal then travels through the upper chambers (atria) to the lower chambers (ventricles), causing them to contract and pump out blood^[1].

An estimated 1.5% to 5% of people have arrhythmias^[4]. However, some people don’t have symptoms, making it difficult to estimate how many people actually have the condition. It is normal for your heart rate to speed up during physical activity and to slow down while resting or sleeping^[2].

• Heart
• Atria (upper chambers)
• Ventricles (lower chambers)
• Sinoatrial node
• Atrioventricular node

Types of arrhythmia

Arrhythmias are grouped by the speed of the heart rate and where they start in the heart. A fast heartbeat is called tachycardia, which means the heart rate is greater than 100 beats per minute^[1]. A slow heartbeat is called bradycardia, which means the heart rate is less than 60 beats per minute^[1].

Healthcare providers describe arrhythmias by where in your heart they start. Supraventricular arrhythmias begin in your atria, or the heart’s upper chambers. Ventricular arrhythmias begin in the ventricles, or the lower chambers. Bradyarrhythmias and junctional rhythms can happen because of issues in your heart’s conduction system^[4].

Common types of arrhythmias include^[3][8]:

• Atrial fibrillation (AFib): The most common type of arrhythmia, especially in older adults. It causes chaotic heart signaling and a rapid, uncoordinated heartbeat. About 10 percent of people in their 80s have it^[3].
• Atrial flutter: Usually a fast heart rhythm where the top chambers of the heart contract at a very fast rate, sometimes up to 300 beats per minute^[8].
• Supraventricular tachycardia (SVT): A very fast heart rhythm with different types^[8].
• Ventricular tachycardia: A fast heart rhythm that comes from the lower chambers of the heart^[3].
• Ventricular fibrillation: A serious ventricular arrhythmia that can be life-threatening^[3].
• Bradycardia: An abnormally slow heart rate that can result from a normally slow heart rate during sleep, certain medications, or problems with the heart’s electrical signals^[3].
• Heart blocks: Caused by a delay or blockage in the conduction system between the top and bottom chambers of the heart^[8].

Symptoms

Some arrhythmias are silent and may not cause any symptoms^[4]. However, when symptoms are present, they may include^[4][7]:

• Heart palpitations (a feeling that your heart is pounding, racing, fluttering, or missing a beat)
• Dizziness or lightheadedness
• Fainting episodes
• Shortness of breath
• Chest discomfort or pain
• Weakness or fatigue (feeling very tired)
• Anxiety
• Blurry vision
• Sweating

It is normal to feel as if your heart skips a beat occasionally, but only if the feeling is not accompanied by other concerning symptoms like chest discomfort or dizziness^[3]. A person needs to see a healthcare professional quickly if they have a history of irregular heartbeats, significant heart disease, unusual heartbeats that keep coming back or last longer than a few minutes, or other symptoms when the irregular heartbeats happen^[3].

Causes and risk factors

Arrhythmias happen when there’s a fault with the electrical system that makes your heart beat^[7]. This can be the result of a heart rhythm condition or other conditions that cause heart rhythm problems.

Arrhythmia causes include^[4][7]:

• Coronary artery disease
• High blood pressure
• Changes in your heart muscle (cardiomyopathy)
• Valve disorders
• Heart attack or injury from a heart attack
• The healing process after heart surgery
• Irritable tissue in your heart (due to genetic or acquired causes)
• Electrolyte imbalances in your blood (such as sodium or potassium)
• Infection or fever
• Certain medications, including antidepressants, decongestants, and high blood pressure medicines
• Problems with electrical signals in your heart
• Heart valve disease
• Wolff-Parkinson-White syndrome

You can also get an abnormal heartbeat from medicines, viruses, caffeine, alcohol, smoking, or drugs^[7]. Strong emotions, stress, or surprise can trigger arrhythmias^[4]. Other risk factors include diabetes, high blood pressure, COVID-19 infection, sleep apnea, problems with your thyroid gland, and anxiety^[4].

Risk factors for arrhythmia include^[4]:

• Using tobacco products
• Drinking alcohol
• Consuming drinks and foods that have caffeine
• Taking stimulants like cold medicines or herbal supplements
• Having high blood pressure
• Having a BMI (body mass index) higher than 30
• Having high blood sugar
• Having sleep apnea

Most arrhythmias happen because of an issue with your heart’s arteries, valves, or muscles^[4]. Older age is also a common risk factor, with arrhythmias becoming more common as people get older^[3].

Complications

Some types of arrhythmia are harmless and don’t require treatment. Others can put you at risk for serious complications^[4]. Without treatment, arrhythmias can lead to complications such as^[4][19]:

• Stroke: With arrhythmias, blood can pool in the upper chambers of the heart, causing blood clots to form. If a clot breaks off and travels to the brain, it can cause a stroke. The risk of stroke is five times higher for anyone with atrial fibrillation^[3][24].
• Heart failure: Repeat arrhythmias can cause cardiomyopathy, which can lead to heart failure. This is a serious condition that happens when your heart can’t pump enough blood to meet your body’s needs^[19].
• Cardiac arrest: Arrhythmias can cause your heart to stop beating suddenly and unexpectedly^[19]. During cardiac arrest, the heart suddenly and unexpectedly stops beating, causing death if it is not treated within minutes^[2].
• Weakening of your heart muscle (cardiomyopathy)^[4]
• Problems with thinking and memory: Conditions like Alzheimer’s disease and vascular dementia are more common in people who have arrhythmias, possibly because arrhythmias may reduce blood flow to your brain over time^[19].

Atrial fibrillation is responsible for about 24 percent of strokes among people in their 80s^[3]. Some arrhythmias may cause life-threatening symptoms and need immediate medical attention^[1].

Diagnosis

A healthcare provider can find an irregular heartbeat during an examination by taking your pulse and listening to your heart^[4]. After assessing your symptoms and performing a physical examination, they may order diagnostic tests to help confirm that you have an arrhythmia and to find the cause^[4].

Tests to diagnose a heart arrhythmia may include^[9]:

• Electrocardiogram (ECG or EKG): This quick test measures the electrical activity of the heart. Sticky patches called sensors are attached to the chest and sometimes to the arms or legs. It can show how fast or how slow the heart is beating.
• Holter monitor: This portable ECG device can be worn for a day or more to record the heart’s activity during daily activities.
• Event recorder: This portable ECG device is worn for up to 30 days or until an arrhythmia or symptoms occur. You typically press a button when symptoms occur.
• Implantable loop recorder: If symptoms are very infrequent, an event recorder may be implanted under the skin in the chest area. The device continuously records the heart’s electrical activity and can find irregular heart rhythms.
• Echocardiogram: This test uses sound waves to take pictures of the beating heart. It can show the structure of the heart and heart valves, measure the strength of the heart, and show how blood flows through the heart.
• Stress test: Some arrhythmias are triggered or worsened by exercise. During a stress test, the heart’s activity is watched while you ride on a stationary bicycle or walk on a treadmill.

You may also want to see an electrophysiologist, a cardiologist who specializes in heart rhythm disorders^[4].

Treatment options

Heart arrhythmia treatment may include medicines, devices such as pacemakers, or a procedure or surgery. The goals of treatment are to control or get rid of fast, slow, or otherwise irregular heartbeats^[1]. Many people may not need any treatment at all or will only need regular check-ups^[7].

Medications

You may need one or more medicines to treat a slow, fast, or irregular heartbeat^[11]. Medications can be an effective way to treat and prevent an irregular heart rhythm. These medications come in several different categories and include^[15]:

• Beta blockers (which reduce the heart’s sensitivity to adrenaline, such as metoprolol, atenolol, nadolol, carvedilol, acebutolol, and pindolol)
• Calcium channel blockers (which slow down electrical signals as they travel from the top half to the bottom half of the heart, such as diltiazem and verapamil)
• Medications called “antiarrhythmics” that directly change the electrical activity of heart cells (such as flecainide, propafenone, sotalol, dofetilide, amiodarone, procainamide, and dronedarone)
• Medications that reduce blood clotting (called anticoagulants or “blood thinners”) are prescribed when there is an arrhythmia or heart condition that could result in blood clots or a stroke (such as aspirin, warfarin, Pradaxa, Xarelto, or Eliquis)^[15]

If your dose is too high, medicines to treat arrhythmias can make your arrhythmia worse. This happens more often in women than in men^[11].

Procedures and surgery

The goal of any arrhythmia procedure is to eliminate symptoms and risk so that you can enjoy an improved quality of life^[15]. Some examples of procedures include^[7][15]:

• Cardioversion: Using electrical signals to reset your heart rhythm. It’s like a quick “reset” of the heart and is very effective for getting the heart back to its normal rhythm^[15].
• Ablation: Burning or freezing the section of heart that’s causing your faulty heart rhythm. This is a minimally invasive procedure that targets and destroys abnormal tissue causing the arrhythmia^[7][15].
• Pacemaker implantation: Having a small electronic device that helps monitor and correct your heart rhythm fitted under your skin^[7].
• Implantable cardioverter defibrillator (ICD): A device that monitors and corrects abnormal heart rhythms^[15].

You may also need treatment for any condition that’s causing your heart rhythm problems^[7].

Lifestyle changes

Sometimes there are associations between arrhythmias and other medical conditions or parts of life that can be addressed. For example, some arrhythmias can be related to caffeine, alcohol, stress, adrenaline-producing activities, dehydration, fatigue, or illness. If the triggers of an arrhythmia can be identified, sometimes the treatment may be to avoid the trigger, such as reducing alcohol or caffeine intake or getting more sleep^[15].

Obesity is a common cause of arrhythmias, both directly and due to the other medical problems it can create, such as sleep apnea, high blood pressure, or diabetes. For these individuals, weight loss is an excellent way to help control their arrhythmias^[15].

Living with arrhythmia

If you have been diagnosed with an arrhythmia, make sure to follow your treatment plan. Keep your regular appointments with your doctor and ask about steps you can take to keep your arrhythmia from happening again or getting worse^[19].

Managing symptoms at home

When you’re living with an arrhythmia, it can be an anxiety-inducing experience when you aren’t prepared. Fortunately, there are several things that you can do to protect yourself and prevent major incidents from happening^[17]:

• Lie down if you feel dizzy or faint or if you feel palpitations. Do not try to walk or drive. Tell your doctor about these symptoms^[19].
• Know your triggers. Understand what gets your heart going, and avoid things like high-intensity workouts, caffeine, and contact sports that could damage implantable devices^[17].
• Quiet your phone or change alarm tones to prevent sudden stressors or loud noises^[17].
• Talk to your doctor before you take any over-the-counter medications, supplements, or other products that may affect your heart or impede the medication that you are taking^[17].
• Learn how to check your pulse and what a normal pulse rate is for you. Carry a notebook around to track changes so you can report them to your doctor^[17].
• If you have a pacemaker or defibrillator, carry a medical device ID card or wear a bracelet or necklace. Include information about your doctor in case of emergency^[17].
• Have a plan in place for when issues arise. Let others around you in on the plan and ask for their assistance. Make sure everyone knows to call 9-1-1 if it’s serious^[17].

Lifestyle strategies

Lifestyle choices can play a key role in managing arrhythmia. A heart-healthy routine should include^[23]:

• A balanced diet low in sodium and processed foods. Adding nutritious foods to your diet can help you maintain a healthy weight and even lower your blood pressure^[25].
• Regular moderate exercise to support cardiovascular health. Ask your doctor which exercises are safe, and consider exercising with a friend^[17].
• Stress management through mindfulness, yoga, or therapy. Finding something to help you feel calm, whether it’s lighting a candle, practicing yoga, or keeping a journal^[25].
• Getting enough sleep. Sleep deprivation and sleep apnea can both lead to AFib. By getting enough sleep and keeping sleep apnea in check, you can help avoid AFib episodes^[25].
• Avoidance of stimulants like caffeine, nicotine, and alcohol, which can trigger arrhythmias^[23]. If you notice AFib symptoms after your morning cup of coffee, you may want to switch to decaf^[25].
• Quitting smoking. Smokers have a 32% higher chance of developing AFib. Quitting smoking gradually reduces this risk^[21].

Even small lifestyle improvements can make a big difference in symptom control and overall heart function^[23]. Most people can keep enjoying their work, hobbies, and even travel with just a few thoughtful adjustments and monitoring^[23].

When patients understand their condition and treatment options, they’re empowered to take control of their health^[23]. Many people live full lives with arrhythmias, but they may need to adapt their daily routines to manage symptoms, take medications consistently, and monitor their heart rhythm regularly^[23].