Heart Arrhythmia Diagnosis and Treatment

Heart arrhythmia, also called cardiac arrhythmia, is the medical term for an abnormal heart rhythm. Normally, the heart pumps in a steady rhythm, only speeding up or slowing down to accommodate the body's demands at exercise or rest. A person with arrhythmia has a heart that beats too quickly or too slowly and in an irregular pattern.

There are several types of arrhythmias and many conditions that can cause them. Some of these conditions include coronary artery disease, cardiomyopathy (a weak heart), diabetes mellitus, obesity, excessive alcohol or caffeine intake, a history of heart attack ("myocardial infarction") and obstructive sleep apnea. Rarely, some types of heart rhythm distrubances may be inherited and passed on to offspring of affected individuals. 

Symptoms include:

• Skipping beats
• Lightheadedness, dizziness, fainting
• Chest pain
• Shortness of breath
• Sweating
• Palpitations (pounding heart beats)
• Fatigue and weakness
• Anxiety

Some forms of arrhythmia don't produce symptoms. However, untreated arrhythmias, even if asymptomatic, can still lead to heart problems. While certain forms of arrhythmias are generally harmless, others can be dangerous. If you have a history of heart rhythm disturbances or arrythmias, you should discuss any symptoms with your doctor. Click here to download an arrhythmia information sheet.

Types of Cardiac Arrythmia

Arrhythmias are defined by both the heart rate and the specific chamber of the heart from which the abnormal rhythm originates. For example, a too-fast heart rate, called tachycardia, that originates in the lower chamber of the heart, called the ventricle, is ventricular tachycardia. Some types of arrhythmia include the following.

Atrial fibrillation (AF) is the most common type of arrhythmia. AF occurs when rapid, disorganized electrical signals cause the atria, the two upper chambers of the heart, to fibrillate. The term "fibrillate" means to contract very fast and irregularly. In AF, blood pools in the atria and isn't pumped completely into the ventricles, the heart's two lower chambers. As a result, the heart's upper and lower chambers don't work together as they should. 

AF is associated with an increased risk of stroke in many patients.  Symptoms of AF include shortness of breath, lack of energy and fatigue.  Some patients may feel an irregular heartbeat, but many do not.  Left untreated, AF may lead to stroke and/or a weakened heart. Treatment for AF includes stroke prevention and maintenance of sinus (normal rhythm). Click here to download an AF risk assessment tool from the American Heart Association. Source: National Heart Lung and Blood Institute; Heart Rhythm Society; AHA; StopAfib.org.

Atrial flutter is similar to atrial fibrillation (AF), but instead of the electrical signals spreading through the atria in a fast and irregular rhythm, they travel in a fast and regular rhythm. Atrial flutter is less common than AF, but it has similar symptoms and complications. Some patients with atrial flutter go on to develop atrial fibrillation. Source: National Heart Lung and Blood Institute; Heart Rhythm Society.

Paroxysmal Supraventricular Tachycardia (SVT) is a very fast heart rate that begins and ends suddenly. SVT occurs due to problems with the electrical connection between the atria and the ventricles. In SVT, electrical signals that begin in the atria and travel to the ventricles can reenter the atria, causing extra heartbeats. This type of arrhythmia may be seen in a wide variety of age groups, from children to seniors. In some cases, SVT may be associated with potentially serious conditions, such as Wolff-Parkinson-White Syndrome. SVT has the potential of generating very fast heart tates and in some instances, may cause fainting. Source: National Heart Lung and Blood Institute; Heart Rhythm Society.

Ventricular Tachycardia (VT) is a fast, regular beating of the ventricles that may last for only a short periods or for much longer. A few beats of ventricular tachycardia often don't cause problems. However, episodes that last for more than a few seconds can be dangerous. Ventricular tachycardia can turn into other, more dangerous arrhythmias, such as ventricular fibrillation (VF). There are a variety of forms of VT, ranging from VT seen in normal hearts, to VT occurring in patients with a history of heart attacks and/or weak hearts. VT represents a potentially life threatening arrhythmia and typically warrants further clinical evaluation by a heart rhythm specialist. Source: National Heart Lung and Blood Institute; Heart Rhythm Society.

Ventricular Fibrillation (VF) occurs when disorganized electrical signals make the ventricles quiver instead of pump normally. Without the ventricles pumping blood out to the body, you'll lose consciousness within seconds and die within minutes if not treated. To prevent death, the condition must be treated right away with an electric shock to the heart called defibrillation. VF may happen during or after a heart attack or in someone whose heart is already weak because of another condition. Health experts think that most of the sudden cardiac deaths that occur every year (about 335,000) are due to VF. Source: National Heart Lung and Blood Institute; Heart Rhythm Society.

Long QT Syndrome (LQTS) is a disorder of the heart's electrical activity. It may cause you to develop a sudden, uncontrollable, and dangerous arrhythmia in response to exercise or stress. The term"long QT" refers to an abnormal pattern seen on an EKG (electrocardiogram). The QT interval, recorded on the EKG, corresponds to the time during which the ventricles are triggered to contract and then build the potential to contract again. Normally the QT interval of the heartbeat lasts about a third of each heartbeat cycle on the EKG. However, in people who have LQTS, the QT interval usually lasts longer than normal. This can upset the careful timing of the heartbeat and trigger a dangerous, abnormal rhythm. Many types of LQTS exist, and may be causes by a genetic mutation.  Outpatient genetic testing obtained from a simple blood sample can often identify the genetic mutation responsible for LQTS.  This information may then be used to screen additional family members who may be at risk of having previously undetected LQTS. Source: National Heart Lung and Blood Institute; Heart Rhythm Society.

Sick Sinus - Aging or heart disease damages your sinus node's ability to set the correct pace for your heartbeat. Such damage can cause slower than normal heartbeats or long pauses between heartbeats. The damage also can cause your heart to alternate between slow and fast rhythms. This condition is called sick sinus syndrome.Source: National Heart Lung and Blood Institute; Heart Rhythm Society.

Conduction Block - Heart block is a problem that occurs with the heart's electrical system. With each heartbeat, an electrical signal spreads across the heart from the upper to the lower chambers. As it travels, the signal causes the heart to contract and pump blood. This process repeats with each new heartbeat. Heart block occurs if the electrical signal is slowed or disrupted as it moves from the upper to the lower chambers of the heart. Some people are born with heart block (congenital), while others develop it during their lifetimes (acquired). Congenital heart block may be found before or after a baby is born. Certain diseases that may occur during pregnancy can cause heart block in a baby. Some congenital heart defects also can cause congenital heart block. These defects are problems with the heart's structure that are present at birth. Often, doctors don't know what causes these defects. Acquired heart block is more common than congenital heart block. Damage to the heart muscle and its electrical system causes acquired heart block. Diseases, surgery, or medicines can cause this damage. Source: National Heart Lung and Blood Institute; Heart Rhythm Society.

Comprehensive Treatment for Cardicc Arrhythmias at Baptist Heart

At Baptist, physicians who specialize in the treatment of heart rhythm abnormalities, called cardiac electrophysiologists, treat patients with arrhythmias. These physicians use a number of state-of-the art diagnostic tests to determine the type and severity of your arrhythmia and the recommended treatment options.

Get to know the cardiac electrophysiologists on staff at Baptist.

Adam Berman, MD MPH FACC FHRS

Frank Haugland, MD PhD

Diagnostic EP Studies at Baptist

To fine tune your diagnosis, your physician may perform an electrophysiology (EP) study in Baptist's state-of-the-art EP Lab. This procedure is often a same day procedure, not requiring an overnight hospital stay. An EP study can be performed using catheter-based techniques that involve placement of small mapping catheters into the heart in a manner similar to a diagnostic coronary angiogram of the heart. During the study, your physician will use sophisticated equipment that maps the electrical system of the heart to pinpoint where the problem is.

Drs. Berman and Haugland perform EP Studies at Baptist.

Treatment Recommendations

Depending on what your physician discovers as a result your diagnostic tests, your treatment will range from medications to a procedure in our EP Lab, or possibly minimally invasive surgery. Baptist offers all the following treatment options:

Catheter Ablation

Catheter ablation represents potentially curative therapy for many forms of cardiac arrhythmias. Catheter ablation is minimally invasive, performed by inserting soft catheters into the heart through the blood vessels of the groin.  These catheters map and record the heart’s electrical activity. 

Once the abnormal area of electrical activity is identified, a special catheter that either heats or freezes heart tissue is used to ablate. After ablation, your electrophysiologist will test the heart’s electrical system to ensure that the ablation was successful. 

While medications may suppress arrhythmias, they do not cure them.  Catheter ablation has emerged as a first line option for many patients seeking cure of arrhythmia so they don’t have to take long-term medications. Many patients undergoing catheter ablation are able to be discharged home from the hospital the same day as their procedure. 

Common arrhythmias treated with catheter ablation include Atrial Fibrillation, SVT and Ventricular Tachycardia. 

Surgical Ablation

For some patients with Atrial Fibrillation, minimally invasive surgical procedures may represent a treatment option. These procedures combine the expertise of both cardiac electrophysiologists and cardiothoracic surgeons. Cardiothoracic surgeons and cardiac electrophysiologists at Baptist collaborate on Hybrid Atrial Fibrillation Ablation options. This approach may be appropriate for some patients with difficult to control atrial fibrillation despite catheter ablation or medication failure. 

Dr. Berman and Dr. Harris collaborate on Hybrid Atrial Fibrillation Ablations at Baptist Heart.

William H. Harris, MD, performs the "Mini Maze" procedure. Watch his video profile.

Pacemakers and Defibrillators

For some patients, the heart's rhythm can be best maintained by implanting a pacemaker device that provides a reliable electrical signal to keep the heart pumping in the correct sequence. In addition to conventional pacemakers, Baptist provides several state-of-the-art devices.

Implantable Cardioverter Defibrillators (ICD)

ICDs are stop-watch-sized devices implanted under the skin near the collarbone and connected to the heart with insulated leads. An ICD is used to treat abnormally fast and life-threatening arrhythmias such as Ventricular Fibrillation or Ventricular Tachycardia.

An ICD works by detecting dangerous fast rhythms and then delivering electrical energy to the heart to defibrillate a patient.  An ICD shock temporarily stuns the heart, breaking the fast cycle of beats and allowing the heart to "reset” back to a normal rhythm.  ICDs represent potentially lifesaving therapy to patients who have persistently weak hearts despite taking good cardiac medications.  Used preventively in people with heart failure and poor heart pumping function, these devices have been clinically proven to reduce the incidence of sudden cardiac death. ICDs are now routinely checked from a patient’s home using online technology that transmits the patient’s ICD information to Baptist Heart.

Cardiac Resynchronization Therapy (CRT)

CRT devices may be pacemakers alone, or may also be defibrillators.  These devices are specially designed to treat heart failure by pacing both the left and right sides of the heart. Standard pacemakers pace only one side of the heart. CRT allows the left ventricle to pump blood more efficiently. Modern CRT devices allow your Baptist Heart Failure team to remotely monitor your heart’s fluid status. Fluid accumulation of this type may signal worsening symptoms in heart failure patients. Early detection of fluid accumulation can assist in management of heart failure and prevent unnecessary hospitalization for fluid overload.

Physicians who treat patients with these devices include Adam E. Berman, MD MPH, F. Earl Fyke, III, MD and Frank Haugland, MD PhD.

Leadless Pacemakers

New technology allows your heart rhythm specialist to implant a pacemaker into your heart using a catheter based procedure. Leadless pacemakers are different than conventional pacemakers, as they lack any wires, or “leads”. Instead, these small devices attach directly to the heart and don’t have a traditional pacemaker battery under the collarbone. 

Leadless pacemakers represent a good option for patients who require pacemaker support for slow heart rhythms, but who may also be poor candidates for conventional pacemakers. 

Physicians who implant Leadless Pacemakers at Baptist Heart: Adam E. Berman, MD MPH

Left Atrial Appendage Occlusion Devices

Atrial Fibrillation patients with an increased risk of stroke are commonly treated with blood thinner medications. However, some patients with AF can’t take blood thinners because of bleeding, a history of falls, or other risk factors.

AF patients who need stroke prevention but can’t take blood thinners may be candidates for a left atrial appendage occlusion (LAAO) device.  LAAO devices work by sealing off the left atrial appendage, a small “dog ear” shaped structure that attaches to the left atrium.  In patients with AF, the left atrial appendage is often the site of clot formation that may lead to stroke.  By sealing off the left atrial appendage with an occlusion device, the patient’s risk of stroke may be reduced.  This procedure is performed by a special catheter that is inserted through the patient’s leg while under anesthesia. A special echo called a TEE is performed 6 weeks following insertion of a left atrial occlusion device.  If the device has sealed, the patient may then stop their oral blood thinner medications.

Physicians who perform Left Atrial Appendage Occluder Devices at Baptist Heart: Adam E. Berman, MD MPH and Ross Thurmond, DO. 

Medical Management

There are a number of medications, such as anti-arrhythmic medications, used to treat patients with arrhythmias. These medications can sometimes suppress abnormal heart rhythms from occurring, but they occasionally are ineffective or cause unwanted side effects that require their discontinuation. Other medications, such as oral blood thinners, are given to reduce the risk of complications that may arise from arrhythmias. For example, untreated atrial fibrillation may cause blood clots to form in the heart. These clots may travel to the brain and cause a stroke. Treatment with blood thinners does not cause the atrial fibrillation to go away, but it does reduce the risk of blood clots forming.

Cardiac Rehab

After you have begun treatment, your physician may recommend that you participate in Baptist's Cardiac Rehab program. This is an outpatient program that combines supervised exercise with heart-specific education. Cardiac rehab can help patients feel better and reduce their risk for future heart problems

Get help for Heart Rhythm Disorders at Baptist

If you would like to become a patient at Baptist, the first step is seeing one of our physicians. You can request an appointment at Baptist Heart by using the following link. Our multidisciplinary heart rhythm team features board certified cardiac electrophysiologists and cardiothoracic surgeons, cardiologists, advanced practice providers, dedicated outpatient EP nurses, and experienced procedural nurses and technicians.  

Request an appointment at Baptist Heart

About Baptist Heart

Baptist has earned several prestigious certifications, accreditations and awards for our care of patients with cardiovascular conditions. Additionally, Baptist is the only hospital in Jackson enrolled in the PROTECT-AF trial, a test of the "Watchman" left atrial appendage (LAA) closure device against warfarin for the prevention of stroke in patients with atrial fibrillation.

Preventing Heart Disease and Stroke

If you have a family history of heart disease and/or stroke, you may be interested in our low cost screening programs. These screenings are available year round and provide results you can have sent to your personal physician.

Learn more about our screening programs.