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Our heart is divided into four chambers - two upper auricles and two ventricles below them. These chambers contract and relax alternatively to ensure the circulation of blood within the heart and the body. The electrical impulses originate from the sino-atrial (SA) node in the left atrium, causing the atria to contract and pumping the blood to the ventricles. However, before reaching the ventricles, the electrical impulses pass through the atrioventricular (AV) node, slowing down the impulses a little, allowing the ventricles to receive the blood from the ventricles. As the ventricles receive the electrical signals, they contract and pump the blood to the body and the lungs. This coordinated contraction and relaxation and simultaneous pumping of the blood constitute one heartbeat. Under normal circumstances, our heartbeats for about 60 - 80 times in a minute.

What is Arrhythmia?

Arrhythmia is a term used to describe the irregular pattern of heartbeats due to aberration of the electrical signals. Arrhythmia may be unnoticed in some cases or maybe as severe as a life-threatening disease. Therefore, the treatment varies according to the intensity of the symptoms and associated illnesses.

Types of Arrhythmia

Arrhythmia may be classified according to the location of occurrence or the rate of the heartbeat. For example, when Arrhythmia occurs in the ventricles, it is termed ventricular Arrhythmia, and supraventricular Arrhythmia is the one that occurs in the auricles.

  • Bradycardia is the heart rate less than 60 beats per minute
  • Tachycardia is a rapid heartbeat with more than 100 beats per minute.

Supraventricular Arrhythmia

  • Premature atrial contractions: These are extra contractions of the atria that may not cause many problems to the functioning of the heart.
  • Atrial Fibrillation: The atrium contracts much faster than the usual rate at about 400 beats per minute. This rapid, uncoordinated contraction of the auricles leads to a similar pattern in the ventricles. This condition might be temporary, but if it persists, it requires immediate treatment. It may complicate further to a stroke.
  • Atrial Flutter :is similar to atrial fibrillation, but the heartbeats at a much slower rate and regularly. It may occur in people with heart disease or someone who is recovering from heart surgery. It may complicate further to atrial fibrillation.
  • Paroxysmal supraventricular tachycardia (PSVT): This is a rapid but regular contraction of the atria. It begins and ends suddenly.
  • Accessory Pathway Tachycardia: In this type of Arrhythmia, the electrical signals travel through another route in addition to the usual pathway. This causes the heart to beat at a much faster rate leading to a rapid heartbeat. It is usually a congenital condition that remains asymptomatic until adulthood. An example of this condition is Wolff Parkinson White Syndrome.

Ventricular Arrhythmia

  • Premature Ventricular Contractions (PVTs): This is one most common Arrhythmia in which there is a sensation of a skipped heartbeat.
  • Ventricular Tachycardia: In this condition, the ventricles flutter due to rapid electrical impulses. Due to this rapid heartbeat, the ventricles do not get enough time to contract and pump the blood to the rest of the body. It may be harmless when the heart is healthy, but with associated heart disease, it may be life-threatening.
  • Ventricular Fibrillation: It is the quivering of the heart due to rapid electrical activity in the ventricles. This may be a medical emergency if not treated timely. It is often observed in those individuals with prior heart disease.
  • Long QT Syndrome: It is a genetic condition that may be acquired from the preceding generations. It predisposes an individual towards rapid, uncontrolled heartbeats. An aberration causes this in the electrical conduction of the impulses in the heart. When it occurs, it may be considered a medical emergency.

Bradyarrhythmia: A condition in which your heart rate is less than 60 beats per minute and your heart cannot pump enough blood to your body. The might happen in two scenarios;

  • Sino Atrial node dysfunction: When the origin of impulses is not proper from the SA node, the heartbeat tends to fluctuate, leading to an impairment in the blood pumping work of the heart.
  • Conduction block: In this condition, the conduction of electrical impulses is delayed to the AV node or the ventricles. Due to this delay, the coordination of contraction and relaxation between the atria and ventricles is disturbed, leading to a slower heart rate.

What are the causes of Arrhythmia?

  • Heart Attack
  • In the recovery period after surgery
  • Heart diseases such as congenital heart disease and cardiomyopathy
  • High Blood Pressure
  • Thyroid disorders - Hypothyroidism or Hyperthyroidism
  • Coronary Artery Disease
  • Diabetes
  • Sleep Apnea
  • Covid19 infection

What are the risk factors of Arrhythmia?

Other than the causes, certain risk factors might increase the probability of Arrhythmia:

  • Age: The risk increases with age
  • Genes: If you have a family history of Arrhythmia, you are more likely to have it.
  • Electrolyte imbalance: The imbalance of sodium, potassium, calcium and magnesium in the blood may affect the electrical impulses of your heart.
  • Overindulgence in caffeine and alcohol
  • Anxiety and stress
  • Smoking
  • Certain medications

What are the symptoms of Arrhythmia?

The patient does not experience any symptoms in several instances, but Arrhythmia is diagnosed during a regular checkup or physical examination.

Symptoms, if present, may include:

  • Palpitations
  • Breathlessness
  • Faintness
  • Sweating
  • Chest pain or discomfort
  • Fatigue
  • Anxiety
  • Blurred vision
  • Weakness

How is Arrhythmia diagnosed?

Your doctor will take your complete history and family history and conduct a physical exam emphasising your cardiovascular system to diagnose an arrhythmia. He may also conduct the following tests to reach a diagnosis:

  • Electrocardiogram (ECG): The pattern of the electrical activity in the heart is recorded with the help of electrodes placed on your chest and taken as a printout on paper on evaluation. Any abnormalities in this heart rhythm may become evident in an ECG.
  • Holter Monitor: This is a portable ECG machine that records the electrical activity of your heart and can be downloaded for evaluation later on. You may be required to wear this monitor for a duration ranging from two days to two weeks.
  • Event Recorder: This is another portable ECG recorder that is used to record arrhythmia events. This is utilised when the patient does not experience symptoms too frequently. So, whenever the patient feels the symptoms, the patient has to press the button on the machine to record the electrical activity. Mostly, the patient is advised to wear the event recorder for at least a month.
  • Echocardiogram: The images of the heart and blood vessels are obtained with the help of sound waves.
  • Implantable Loop Recorder: This device may be implanted under the skin of your chest to record the electrical activity of your heart constantly. This device is used when the symptoms of Arrhythmia are too infrequent. The device records the all-time activity of the heart so that abnormal patterns can be detected.
  • Stress test: This test evaluates how well your heart will function in stressful situations such as exercise when the body's oxygen requirement increases abruptly. You may be asked to run on a treadmill or pedal a stationary bicycle for this test. A healthy heart would start beating rapidly and pump the blood faster to fulfil the oxygen demand, but when the heart is diseased, it may not keep up the pace and may show symptoms like Arrhythmia. Your blood pressure, pulse rate, and oxygen saturation will also be monitored in this test.
  • Tilt Table Test: In this test, you will be asked to lie down on a table, and then the table would be tilted gradually. This test is performed to check your heart's response to this change in angle, and your pulse rate & blood pressure will also be monitored.
  • Electrophysiological Study: In this test, the doctors study your heart's electrical activity and rhythm. They try to find out the origin of the Arrhythmia and study the pattern of electrical activity to devise a treatment plan for you.

How is Arrhythmia treated?

If you have an asymptomatic arrhythmia, then you may not require treatment, but for symptomatic patients, the following treatment options are available:

  • Medications: The medicines such as Beta Blockers, calcium channel blockers, and sodium channel blockers may be used.
  • Vagal Maneuver: These techniques help your body to relax by acting on the vagus nerve. These techniques include coughing, holding your breath, straining, putting a wet towel over your face, or lying down.
  • Electrical cardioversion: If your heart rate is not controlled with medications, the doctor might give you general anaesthesia and administer electrical stimulation to your chest to rectify your heart's rhythm.
  • Catheter ablation: In this procedure, a catheter with an electrode at its tip is inserted into your blood vessel and is directed to your heart with the help of a live x-ray machine. This electrode emits high-frequency electrical energy in a concentrated area of origin of Arrhythmia to create an electrical block for the pathway of the unusual rhythm.
  • Implantable devices: Two types of devices may be used:
    • Pacemaker: This device helps regulate the electrical impulses of your heart whenever it detects an aberration. It is implanted near your collarbone with the help of a minor surgical procedure.
    • Implantable cardioverter-defibrillator (ICD): The device is primarily used in the case of ventricular fibrillation and ventricular Arrhythmia. It constantly monitors the electrical activity of your heart, and whenever it detects an abnormality, it sends electric shocks to your heart to rectify the rhythm.
  • Surgical Procedures: The following surgical procedures may be performed by the doctor when other non-surgical procedures are unable to resolve the ailment:
    • Maze Procedure: In this procedure, the surgeon makes several incisions in the upper part of the heart, i.e. the atria, to sway the staggering electrical impulses interfering with the normal heartbeat.
    • Coronary Bypass Surgery: This procedure is opted when you have coronary artery disease in addition to Arrhythmia

What are the complications of Arrhythmia?

  • Heart failure: Continuous Arrhythmia may get complicated to cause heart failure.
  • Stroke: The accumulation of blood in the heart due to inefficient pumping increases the risk of blood clots, which may travel to the brain and block a blood vessel, resulting in a stroke.

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