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Arrhythmias

Your heart is designed to beat at a certain pace and pattern. If your heart beats too slowly, too quickly or abnormally, you may have an arrhythmia (irregular heartbeat). 

Learning you have an irregular heartbeat can be frightening. But with the proper treatment, most people with arrhythmias can live full, active lives.

Arrhythmia treatment at Virginia Mason Franciscan Health: Why choose us?

The electrophysiology experts at the Center for Cardiovascular Health provide comprehensive treatment for the full range of arrhythmias. Our high-volume program is staffed by experts who are among the most experienced in the nation. Whether you need a diagnosis and answers, a second opinion or an advanced ablation procedure, we’re equipped to help.

Types of arrhythmias

There are many different types of arrhythmias, which may range from mild to severe. The most common types include:

  • AFib is the most common long-term arrhythmia in the U.S. and in the world. If you have AFib, your heart’s upper chambers (atria) don’t beat in a regular pattern. Learn more about AFib.

  • Like AFib, atrial flutter also starts in your heart’s atria. This arrhythmia means your atria are beating too quickly.

  • If your heart regularly beats slower than 60 beats per minute, you may have bradycardia (slow heart rate).

  • Also known as heart block, conduction disorders are problems with your heart’s natural electrical system. These types of arrhythmias include: 

    • Atrioventricular (AV) node block
    • Brugada syndrome
    • Left bundle branch block 
    • Long QT syndrome
    • Right bundle branch block 
    • Short QT syndrome
    • Sick sinus syndrome
  • A premature contraction means your heart’s electrical signal is premature (early), causing an extra heartbeat before your normal heartbeat. Premature contractions are usually not serious if they happen only occasionally. This type of arrhythmia may feel like your heart “skipped a beat.” 

    Types of premature contractions include:

    • Premature atrial contractions (PACs): In PACs, the premature signal comes from your heart’s atria.
    • Premature ventricular contractions (PVCs): If you have a PVC, the premature signal starts in your heart’s lower chambers (ventricles).
  • Tachycardia means your heart rate is too fast (over 100 beats per minute). Types of tachycardia include:

    • Sinus tachycardia: This fast heartbeat starts in your heart’s natural pacemaker (sinus node).
    • Supraventricular tachycardia (SVT): SVT happens when the fast heart rate starts in the upper chambers of your heart. Common SVTs include atrial tachycardia (AT), orthodromic reciprocating tachycardia (ORT) and atrioventricular nodal re-entrant tachycardia (AVNRT).
    • Ventricular tachycardia (VT): VT is a fast heartbeat that starts in your heart's lower chambers.
    • Wolff-Parkinson-White syndrome: An abnormal electrical pathway causes your heart to beat too quickly.
  • V-fib is the most severe arrhythmia and requires immediate medical care. This condition causes your heart’s lower chambers to fibrillate (quiver) instead of beating normally. With V-fib, your heart cannot pump blood, which results in cardiac arrest (when the heart stops beating).

Symptoms of arrhythmias

There are many arrhythmias, and each person’s symptoms can be different. Some arrhythmias don’t cause noticeable symptoms. For those that do, signs may include:

  • Anxiety
  • Breathing problems
  • Chest pain
  • Dizziness
  • Fainting
  • Fatigue (feeling tired)
  • Palpitations (feeling like your heart is racing, pounding or “skipping a beat”)
  • Pulse that is irregular, fast or slow

If you are having chest pain or trouble breathing, call 911.

Common arrhythmia causes

An arrhythmia happens when something interferes with your heart’s electrical system, which controls your heartbeat and pace. Many different factors can cause arrhythmias, including:

  • Congenital (present at birth) heart defect: Being born with a heart problem can cause an arrhythmia.
  • Genetics: Some arrhythmias can run in families.
  • Health conditions: Other health issues, such as sleep apnea or kidney or lung disease, can lead to an irregular heartbeat.
  • Heart disease: A previous heart attack or another heart problem, such as cardiomyopathy, can cause an arrhythmia. Some people develop an arrhythmia after open-heart surgery.
  • Lifestyle: Smoking, using street drugs or drinking too much alcohol over the long term can cause an arrhythmia to develop.
  • Medications: Some medicines can cause a change in your heart rate. Talk to your provider if you notice this side effect.

Arrhythmias also have triggers, or things that can cause a temporary change in your heartbeat’s pattern or speed. Triggers include:

  • Caffeine, including caffeinated beverages, energy pills or energy drinks
  • Dehydration
  • Exercise
  • Imbalance of electrolytes (minerals that balance your body’s fluids)
  • Street drugs
  • Stress or strong emotions
  • Vomiting or excessive coughing

Diagnosing an arrhythmia

Diagnosing an arrhythmia requires one or more medical tests, which may include:

  • Echocardiogram (echo): An echo is an ultrasound of your heart. It can show your heart’s structure and how it moves when it beats. This test cannot directly pinpoint an arrhythmia but may provide information about other heart conditions.

  • Electrocardiogram (EKG or ECG): An ECG is often the first test providers use to check for an arrhythmia. During this noninvasive test, your provider puts electrodes (stickers with wires) on your chest and connects them to a computer. The electrodes detect and record information about your heart’s electrical activity on the computer. 

  • Electrophysiology (EP) study: An EP study is more invasive than other tests, so providers may not use this test first. Your provider guides a thin wire (catheter) through a vein and into your heart. The catheter records and sends a “map” of your heartbeat to a computer. This test is often combined with ablation, a procedure that destroys the cells causing the arrhythmia.

  • Genetic tests: If your provider suspects you could have a genetic (inherited) arrhythmia, they may recommend genetic testing. These tests usually require a sample of your saliva or blood, which is sent to a lab for analysis.

  • Imaging tests: A cardiac CT scan or MRI can show highly detailed information about your heart’s structure and how it works. Like an echo, these imaging tests can help diagnose or rule out other heart conditions. They can also help your provider plan a procedure like cardiac ablation.

  • Patch monitor: If the arrhythmia only happens occasionally, you may need to wear a cardiac event monitor at home. These devices can detect an abnormal heart rhythm and send information to your provider.

Arrhythmia treatment

Your treatment depends on many factors, including the arrhythmia type and severity, your age and your overall health. Arrhythmia treatments include:

  • Medications: Many medications can correct a fast, slow or irregular heartbeat. Other medications may help prevent complications of arrhythmias, such as blood clots and stroke. Your provider may prescribe medications alone or in combination with other treatments.

  • Cardioversion: This procedure uses electrical impulses to “shock” your heart back into a normal rhythm. Providers may perform cardioversion in an emergency (such as cardiac arrest) or schedule it in advance for non-life-threatening situations. You will need anesthesia and stay in the hospital for a few hours after the procedure.

  • Cardiac catheter ablation: Catheter ablation is a minimally invasive alternative to open-heart surgery. Doctors use a catheter to pinpoint the cells in your heart causing the arrhythmia. Then, they use radiofrequency (heat) or cryoablation (cold) energy to permanently damage those cells. With cardiac catheter ablation, you have only small incisions and usually go home a few hours after the procedure.     

  • Pacemaker: A pacemaker is a small electronic device that doctors place in your heart during a surgical procedure. The device sends mild impulses that tell your heart to beat normally. The newest pacemakers are leadless (wireless), and doctors implant them with minimally invasive surgery.

  • Implantable cardioverter defibrillator (ICD): An ICD is a pacemaker and defibrillator that can shock your heart if you have a life-threatening arrhythmia. Doctors implant this device just under your skin in your chest. They implant the leads through a vein, so you don’t need large incisions.

Contact us

The Center for Cardiovascular Health at Virginia Mason Franciscan Health provides expert arrhythmia care in the Puget Sound area.