Cardiac Arrhythmias

“Arrhythmia” is the term applied to abnormal heart rhythms and includes skipped beats, and conditions in which the heart beats too fast, >100 beats per minute, or too slow, < 60 beats per minute.  The patient may or may not be aware of these irregular beats.  The cause of many arrhythmias is difficult to determine because there are often contributing factors that must be considered, from fluid and electrolyte disturbances, such as serum sodium and potassium, to abnormal heart valves or coronary disease. 

As in all of medicine it is important to have the correct diagnosis before moving on to treatments.  A diagnosis of an arrhythmia is made by taking an ECG.  Once a diagnosis is made the doctor will try to determine a cause and how best to manage the arrhythmia.  A new cardiac subspecialist called the Cardiac Electrophysiologist has been developed by doctors who devote their entire careers to the diagnosis and management of arrhythmias.  Your Doctor may refer you to an electrophysiologist for treatment.

In general we have moved away from using medications to control and manage arrhythmias, with certain exceptions, because they tend to aggravate the arrhythmia rather than control it.  The trend has been to use mechanical devices such as pacemakers and internal defibrillators that are inserted into the heart.  A procedure called “ablation” has been developed by the electrophysiologists to deliver a radio-frequency charge through a catheter placed in a specific location in the heart to destroy a site responsible for starting an arrhythmias  I have had patients in whom their bothersome arrhythmias is completely cured with ablation.

Thus there are two separate and distinct systems to consider in managing the patient with heart disease.  The first is the circulatory system that carries fresh blood through the coronary arteries to sustain the heart muscle and the other is the electrical system that is necessary to drive the heart.  Both are essential to normal heart function and both must be considered and managed in all patients.