Arrhythmias (Abnormal Heart Rhythms)

At the Montefiore Einstein Center for Heart and Vascular Care, you can access exceptional care for arrhythmias. As a global leader in cardiovascular medicine and surgery, we are an academic-based, national and international referral site for high-risk and complex cases. For more than a century, we have been at the forefront in treating heart disease.

Ranked in the top one percent of all hospitals in the nation for Cardiology, Heart & Vascular Surgery according to U.S. News & World Report, our specialists are passionate about uncovering the latest diagnostic approaches and treatments that can improve outcomes. Backed by a multidisciplinary team of specialists, Montefiore Einstein continues to make advances in the treatment of heart disease. In recent years, we have expanded our programs in advanced cardiac imaging, heart failure and interventional cardiovascular medicine and assembled a world-renowned cardiothoracic surgical team.

When you trust us with your care, you can expect compassionate, personalized treatment plans that meet the highest standards for quality and safety. In addition, we offer patients a full choice of support services, from nutritional guidance to rehabilitative therapies.

When you need arrhythmia care, turn to our dedicated providers who will develop a highly personalized treatment plan specific to you.

Arrhythmias differ from normal heartbeats in speed or rhythm. Arrhythmias are also grouped by where they occur—in the upper chambers of the heart, in its lower chambers, or between the chambers. The main types of arrhythmia are bradyarrhythmias; premature, or extra, beats; supraventricular arrhythmias; and ventricular arrhythmias.

To understand arrhythmia, it helps to understand how your heart’s electrical system works. Arrhythmias known as conduction disorders are covered separately.

Bradyarrhythmia is a slow heart rate—also called bradycardia. For adults, bradycardia is often defined as a heart rate that is slower than 60 beats per minute, although some studies use a heart rate of less than 50 beats per minute. Some people, especially people who are young or physically fit, may normally have slow heart rates. A doctor can determine whether a slow heart rate is appropriate for you.

A premature heartbeat happens when the signal to beat comes early. It can feel like your heart skipped a beat. The premature, or extra, heartbeat creates a short pause, which is followed by a stronger beat when your heart returns to its regular rhythm. These extra heartbeats are the most common type of arrhythmia. They are called ectopic heartbeats and can trigger other arrhythmias.

Arrhythmias that start in the heart’s upper chambers, called the atria, or at the gateway to the lower chambers are called supraventricular arrhythmias. Supraventricular arrhythmias are known by their fast heart rates, or tachycardia. Tachycardia occurs when the heart, at rest, goes above 100 beats per minute. The fast pace is sometimes paired with an uneven heart rhythm. Sometimes the upper and lower chambers beat at different rates.

Types of supraventricular arrhythmias include:

• Atrial fibrillation. This is one of the most common types of arrhythmia. The heart can race at more than 400 beats per minute.
• Atrial flutter. Atrial flutter can cause the upper chambers to beat 250 to 350 times per minute. The signal that tells the upper chambers to beat may be disrupted when it encounters damaged tissue, such as a scar. The signal may find an alternate path, creating a loop that causes the upper chamber to beat repeatedly. As with atrial fibrillation, some but not all of these signals travel to the lower chambers. As a result, the upper chambers and lower chambers beat at different rates.
• Paroxysmal supraventricular tachycardia (PSVT). In PSVT, electrical signals that begin in the upper chambers and travel to the lower chambers cause extra heartbeats. This arrhythmia begins and ends suddenly. It can happen during vigorous physical activity. It is usually not dangerous and tends to occur in young people.

These arrhythmias start in the heart’s lower chambers. They can be very dangerous and usually require medical care right away.

• Ventricular tachycardia is a fast, regular beating of the ventricles that may last for only a few seconds or for much longer. A few beats of ventricular tachycardia often do not cause problems. However, episodes that last for more than a few seconds can be dangerous. Ventricular tachycardia can turn into other more serious arrhythmias, such as ventricular fibrillation, or v-fib. Torsades de pointes is a type of arrhythmia that causes a unique pattern on an EKG and often leads to v-fib.
• Ventricular fibrillation occurs if disorganized electrical signals make the ventricles quiver instead of pumping normally. Without the ventricles pumping blood to the body, sudden cardiac arrest and death can occur within a few minutes.

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Arrhythmia is caused by changes to heart tissue. It can also occur suddenly as a result of exertion or stress, imbalances in the blood, medicines, or problems with electrical signals in the heart. Typically, an arrhythmia is set off by a trigger, and the irregular heartbeat can continue if there is a problem in the heart. Sometimes the cause of an arrhythmia is unknown.

The following conditions may cause arrhythmia:

• Changes to the heart’s anatomy
• Reduced blood flow to the heart or damage to the heart’s electrical system
• Restoring blood flow as part of treating a heart attack
• Stiffening of the heart tissue, known as fibrosis, or scarring

Strong emotional stress, anxiety, anger, pain, or a sudden surprise can make the heart work harder, raise blood pressure, and release stress hormones. Sometimes these reactions can lead to arrhythmias. If you have heart disease, physical activity can trigger arrhythmia due to an excess of hormones such as adrenaline. Sometimes vomiting or coughing can trigger arrhythmia.

An excess or deficiency of electrolytes, hormones, or fluids can alter your heartbeat.

• An excess of thyroid hormone can cause the heart to beat faster, and thyroid deficiency can slow your heart rate.
• Dehydration can cause the heart to race.
• Low blood sugar, from an eating disorder or insulin doses that are too high in someone who has diabetes, can lead to slow or extra heartbeats.
• Low levels of potassium, magnesium, or calcium can trigger arrhythmia. These electrolyte disturbances can occur after a heart attack or surgery.

Certain medicines can cause arrhythmia. These include medicines to treat high blood pressure and other conditions, including arrhythmia, depression, and psychosis. Some people also need to be careful about taking certain antibiotics and over-the-counter medicines, such as allergy and cold medicines.

An arrhythmia can occur if the electrical signals that control the heartbeat are delayed or blocked. This can happen when the nerve cells that produce electrical signals do not work properly or when the electrical signals do not travel normally through the heart. Another part of the heart could start to produce electrical signals, disrupting a normal heartbeat.

Disorders of electrical signaling in the heart are called conduction disorders.

Want to learn more about why arrhythmias occur?

As part of daily living, our hearts change pace to accommodate a wide range of activities, from sleeping to working out. These changes are controlled by the autonomic nervous system, which has two parts: the parasympathetic system and the sympathetic system. Overstimulation of either system can cause arrhythmia.

• The parasympathetic nervous system slows the heart rate and prepares other functions when the body is at rest. It is stimulated by extreme cold or bouts of coughing. Nerve activity slows electrical signals in the heart and extends the time it takes for the heart to relax and fill. Overstimulation of the parasympathetic nervous system can lead to bradycardia.
• The sympathetic nervous system prepares the body for action, making the heart beat faster and making it easier to breathe. The adrenal glands release the hormone adrenaline that sparks these changes. The sympathetic nervous system is active in the body’s response to stress. Overstimulation from intense stress can also cause tachyarrhythmias.

• Treatment will discuss heart-healthy lifestyle changes that your doctors may recommend if you are diagnosed with arrhythmia.

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An arrhythmia may not cause any obvious signs or symptoms. You may notice something that occurs only occasionally, or your symptoms may become more frequent over time. Keep track of when and how often arrhythmia occurs, what you feel, and whether these things change over time. They are all important clues your doctor can use. If left untreated, arrhythmia can lead to life-threatening complications such as stroke, heart failure, or sudden cardiac arrest.

You may be able to feel a slow or irregular heartbeat or notice pauses between heartbeats. If you have palpitations, you may feel like your heart skipped a beat or may notice it pounding or racing. These are all symptoms of arrhythmia.

More serious signs and symptoms include:

• Anxiety
• Blurred vision
• Chest pain
• Difficulty breathing
• Fainting or nearly fainting
• Foggy thinking
• Fatigue
• Sweating
• Weakness, dizziness, and light-headedness

What else will your doctor want to know about your symptoms?

Some arrhythmias tend to happen at certain times or under certain circumstances. If you notice signs or symptoms of arrhythmia, note when they happened and what you were doing. This information can help your doctor diagnose what is going on and find the right treatment. Here are questions to ask yourself.

• Did it happen at night?
• Did you stand up after sitting or lying down?
• Were you lying down?
• Were you playing a sport or otherwise exerting yourself?
• Were you swimming or diving?

Arrhythmias that are unrecognized or left untreated can cause sometimes life-threatening complications affecting the heart and brain.

• Cognitive impairment and dementia. Alzheimer’s disease and vascular dementia are more common in people who have arrhythmia. This may be due to reduced blood flow to the brain over time.
• Heart failure. Repeat arrhythmias can lead to a rapid decline in the ability of the lower chambers to pump blood. Heart failure is especially likely to develop or to grow worse as a result of arrhythmia when you already have heart disease.
• Stroke. This can occur in some patients who have atrial fibrillation. With arrhythmia, blood can pool in the atria, causing blood clots to form. If a clot breaks off and travels to the brain, it can cause a stroke.
• Sudden cardiac arrest. The heart may suddenly and unexpectedly stop beating as a result of ventricular fibrillation.
• Sudden infant death syndrome (SIDS). SIDS can be attributed to an inherited conduction disorder that causes arrhythmia.
• Worsening arrhythmia. Some arrhythmias trigger another type of arrhythmia or get worse over time.

• Diagnosis will explain tests and procedures used to detect signs of arrhythmia and help rule our other conditions that may mimic arrhythmia.
• Treatment will discuss treatment-related complications or side effects.

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You may have an increased risk of arrhythmia because of your age, environment, family history and genetics, habits in your daily life, certain medical conditions, race or ethnicity, sex, or surgery.

The chances of having arrhythmia grow as we age, in part because of changes in heart tissue and in how the heart works over time. Older people are also more likely to have health conditions, including heart disease, that raise the risk of arrhythmia.

Some types of arrhythmia happen more often in children and young adults, including arrhythmias due to congenital heart defects or inherited conduction disorders.

Some research suggests that exposure to air pollutants, especially particulates and gases, is linked to a short-term risk of arrhythmia.

You may have an increased risk of some types of arrhythmia if your parent or other close relative has had arrhythmia, too. Also, some inherited types of heart disease can raise your risk of arrhythmia. With some conduction disorders, genes mutations cause the ion channels that transmit signals through heart cells to work incorrectly or stop working.

Your risk for arrhythmia may be higher because of certain lifestyle habits, including:

• Drinking alcohol
• Smoking
• Using illegal drugs, such as cocaine or amphetamines

Arrhythmias are more common in people who have diseases or conditions that weaken the heart, but many conditions can raise the risk for arrhythmia. These include:

• Aneurysms
• Autoimmune disorders, such as rheumatoid arthritis and lupus
• Cardiomyopathy, which affects the heart muscle
• Diabetes, which increases the risk of high blood pressure and coronary heart disease
• Eating disorders, such as bulimia and anorexia, which cause electrolyte imbalance and severe malnutrition
• Heart attack
• Heart inflammation
• Heart failure, which weakens the heart and changes the way electrical signals move through the heart
• Heart tissue that is too thick or stiff or that has not formed normally. Arrhythmias can be more common among people who have had surgery to repair a congenital heart defect.
• High blood pressure
• Viral infections such as influenza (flu) or COVID-19.” Watch our video on how SARS-CoV-2, the virus responsible for COVID-19, may lead to or worsen an arrhythmia. Additionally, we offer information and resources on how we are working hard to support necessary COVID-19 research. 
• Kidney disease
• Heart valves. Leaking or narrowed heart valves make the heart work too hard and can lead to heart failure.
• Low blood sugar
• Lung diseases, such as chronic obstructive pulmonary disease (COPD)
• Musculoskeletal disorders
• Obesity
• Overactive or underactive thyroid gland, caused by too much or too little thyroid hormone in the body. The most common cause of excess thyroid hormone is Graves’ disease.
• Sepsis, a toxic immune response to infection
• Sleep apnea, which can stress the heart by preventing it from getting enough oxygen

Studies suggest that white Americans may be more likely than African Americans to have some arrhythmias, such as atrial fibrillation, although African Americans have higher rates of high blood pressure and other arrhythmia risk factors.

Some studies suggest that men are more likely to have atrial fibrillation than women. However, women taking certain medicines appear to be at a higher risk of a certain type of arrhythmia. Certain times of the menstrual cycle also appear to increase women’s risk of some arrhythmia events. If you are a pregnant woman, you may notice that an existing arrhythmia occurs more often. Benign extra beats are also more common during pregnancy. In some cases, the complications that can develop with arrhythmia also differ by sex.

You may be at a higher risk of developing atrial flutter in the early days and weeks after surgery involving the heart, lungs, or esophagus.

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Captured Date: 2018-08-29 19:34:00.0