Arrhythmia

There are different types of arrhythmia; some, such as ectopic beats, are ‘benign’. These are when your heart feels like it’s missed a beat or thumped suddenly and are unlikely to cause you any harm. You can find out more about ectopic beats in our FAQ: Ectopic heartbeat below. Other types of arrhythmias include:

• atrial fibrillation
• atrial flutter
• supraventricular tachycardia
• ventricular tachycardia
• ventricular fibrillation
• heart block
• sick sinus syndrome

Some are more serious than others.

 Atrial fibrillation

Atrial fibrillation is the most common type of arrhythmia and happens when the electrical impulses in your atria become disorganised, which overrides your heart’s normal rate and rhythm. This causes your atria to contract in an irregular manner or ‘fibrillate’. You may notice that your heartbeat feels uneven and it may be faster than usual. Attacks of atrial fibrillation can last from a few seconds to over a week, and can cause symptoms including:

• palpitations – an unpleasant awareness of your heartbeat, often described as a thumping in your chest
• tiredness – not being able to do as much physical activity as usual
• breathlessness
• dizziness or fainting
• chest pain

Atrial fibrillation can potentially lead to a blood clot forming in your heart – this is because your blood isn’t able to flow through properly. If a clot forms, it may travel to your brain and cause a stroke. 

Atrial flutter

Atrial flutter is similar to atrial fibrillation but what happens is slightly different, as is the way it’s treated. In atrial flutter, the electrical impulses that tell your heart when to beat form a smaller circuit in the top chambers of your heart (your atria). They beat much faster than they should, but the bottom chambers of your heart (your ventricles) can’t pump this fast. So, your atria and ventricles beat at different speeds, putting your heart under strain.

Supraventricular tachycardia

There are different types of supraventricular tachycardia (SVT) and most are caused by one or more extra electrical pathways in your heart, between the atria and the ventricles. This allows electrical impulses to ‘short-circuit’ and re-enter your atria instead of going to your ventricles. This means that the impulses end up travelling around your heart in a circle.

SVT can make your heart beat very quickly, between 140 and 250 beats per minute. Attacks often come and go spontaneously - SVT may only last for a few seconds but can last for several hours or, rarely, days.

Ventricular tachycardia

If you have ventricular tachycardia, your heart can beat faster, and it can sometimes develop into ventricular fibrillation (see below). The electrical impulses fire too quickly from your ventricles, causing blood to be pumped out faster than usual. Your ventricles may not have enough time to fill up properly with blood and this can sometimes cause your heart to stop pumping blood around your body (cardiac arrest).

 This can be life threatening and can therefore be the most dangerous type of arrhythmia, although not for everybody. Most people with ventricular tachycardia already have some problems with their heart, but (rarely) some people get ventricular tachycardia even though their heart’s healthy.

Ventricular fibrillation

Ventricular fibrillation happens when electrical signals fire off in different areas of your ventricles at the same time. It’s an extremely fast, life-threatening heart rhythm that results in your heart being unable to beat properly; so little (or no) blood is pumped out of your heart. If you have ventricular fibrillation, you’ll quickly lose consciousness and you may have a cardiac arrest. It’s normally fatal unless you get treatment immediately. This starts with cardiopulmonary resuscitation (CPR).

Heart block

If you have heart block, it means there is a problem affecting how the electrical impulses are transmitted from your atria to your ventricles. There are different types of heart block – it can occur in your atrioventricular (AV) node or in the muscle fibres that lead into your ventricles. Your AV node is found between the upper and lower chambers of your heart.

Sometimes heart block doesn’t cause any problems, but if it’s more serious, you might get symptoms such as dizziness, or you can even black out.

Tachy-brady syndrome (sick sinus syndrome)

If you have sick sinus syndrome, your sinoatrial node, which generates the electric pulses in your heart, doesn’t work properly. This causes your heart to beat slowly and then fast and abnormally.

 You might not get any symptoms, but if you do, you might feel dizzy or collapse.

Your symptoms will depend on the type and severity of your arrhythmia. How often you get them will also vary, ranging from every day to very infrequently, once or twice a year for example. With some types of arrhythmia, you may not get any symptoms, but general ones include:

• palpitations
• dizziness
• fainting or collapsing
• breathlessness
• chest pain
• tiredness

These symptoms aren't always caused by arrhythmia but if you have them, see a doctor.

Your GP will ask about your symptoms and medical history. They’ll examine you, checking your pulse and blood pressure. Your GP might refer you to a cardiologist (a doctor who specializes in identifying and treating conditions of the heart and blood vessels). Or they might send you to hospital straightaway for tests.

You might need to have one or more of the following tests to see if you have an arrhythmia.

• Blood tests. These can test for substances in your blood, such as potassium and calcium, and to check if your thyroid is working as it should.
• Electrocardiogram (ECG). This records the electrical activity of your heart to see how well it’s working. 
• 24-hour heart monitor (ambulatory ECG). This records the electrical activity of your heart while you go about your usual activities over 24 hours (or longer if necessary).
• Exercise ECG (cardiac stress test). This is when you have an ECG while you exercise to see how your heart works under pressure. It may trigger abnormal heart rhythms, but you're in the best place for this to happen as you'll be surrounded by a medical team.
• Echocardiogram or transthoracic echocardiogram. These use ultrasound (sound waves) to produce a clear image of your heart muscles and valves to see how well it’s working.
• Tilt table test. In this test, you'll lie down on a table, which will be tilted upwards. A technician will measure your heart rate, rhythm and blood pressure at different points.
• Electrophysiology study. This checks the electrical activity of your heart to see what’s causing an abnormal heart rhythm.

An arrhythmia can be caused by a number of things. This includes certain conditions such as:

• heart failure
• heart valve disease
• inflammation of your heart (myocarditis)
• thyroid disease
• diabetes
• high blood pressure
• a heart attack
• coronary heart disease
• chronic obstructive pulmonary disease (COPD)
• Wolff-Parkinson-White syndrome – an electrical abnormality in the heart that can cause SVT and atrial fibrillation

The risk of developing an arrhythmia increases as you get older, and you may also be more at risk if you’re pregnant or recently had heart surgery. Some types of arrhythmia may be caused by particular triggers, such as alcohol, caffeine, smoking tobacco or cannabis, and certain medicines.

Often it may not be possible to find a cause for your arrhythmia. It’s important to remember that having an arrhythmia doesn’t necessarily mean that you have a serious heart problem.

Your treatment will depend on the type, cause and severity of the arrhythmia that you have. If your arrhythmia is caused by an underlying health condition, your doctor will focus your treatment on that.

Self help

When your arrhythmia is unlikely to cause serious problems (ectopic beats), you may rely on self-help measures. Try to focus on exercising and cutting back on anything that triggers arrhythmia such as alcohol or caffeine, and not taking drugs, such as cocaine.

Medicines

Your doctor may prescribe medicines to help control your heart rhythm. These can include medicines to slow down your heart rate, such as beta-blockers, or antiarrhythmic medicines, such as amiodarone and flecainide – these work in different ways to control your heartbeat.

If you have atrial fibrillation, you may be advised to take blood-thinning medicines, such as warfarin, to reduce your risk of blood clots forming.

Procedures

If you need to have surgery, the exact procedure you have will depend on your condition. Your doctor will advise you on which one is most suitable for you. 

Cardioversion

This may be carried out if you have atrial fibrillation. In this procedure, your doctor will apply a controlled electric shock to your chest from a machine called a defibrillator. This aims to help restore your heart to its usual rhythm. Cardioversion is usually done under general anaesthetic, which means you will be asleep during the procedure, but it can sometimes be done using only a sedative – this relieves anxiety and helps you to relax. 

Pacemaker

Your doctor may suggest having a pacemaker if you have heart block or sinus node disease. A pacemaker is a small device, usually implanted under your skin in the upper part of your chest. Electrical signals are sent from the pacemaker to your heart to stimulate it to beat at a specific rate. Your doctor will usually fit your pacemaker under local anaesthesia – this will block pain from your chest area and you will stay awake during the operation. 

Catheter ablation therapy

You may have this procedure for atrial fibrillation, supraventricular tachycardia or ventricular tachycardia. In this procedure, your doctor identifies the abnormal areas in your heart and then inserts a catheter into your heart, via a large vein in your groin. Heat or freezing treatment is used destroy the area that is causing the abnormal rhythm. The procedure is usually done under local anaesthesia. 

Ablation of the AV node

If you have atrial fibrillation, it’s possible that your doctor will use catheter ablation to destroy your AV node. You will probably have a pacemaker fitted before the procedure is carried out. 

Implantable cardioverter defibrillator

An implantable cardioverter defibrillator (ICD) is similar to a pacemaker. If your doctor thinks you may be at risk of a ventricular arrhythmia, you may be fitted with an ICD. This can monitor your heart rhythm and deliver a small electric shock to correct your heartbeat if it detects a problem. ICDs are usually fitted under local anaesthetic in the same way as a pacemaker.

Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.

1. Sometimes my heart skips a beat – what is this?

If your heart has missed a beat or thumped suddenly, it’s likely to be an ectopic heartbeat. Ectopic beats are very common and are generally completely harmless. You don’t usually need any treatment. But occasionally, if they happen a lot, they can be a sign of a more serious condition, such as structural problems with your heart.

If your ectopic beats happen a lot, or are troublesome, your GP may refer you to see a cardiologist. A cardiologist is a doctor who specialises in identifying and treating heart conditions.

2. I think my medicine is affecting my heart rate – what should I do?

If you think a prescription medicine is affecting your heart rate, don’t stop taking it without speaking to your GP first. If you’re taking an over-the-counter medicine, ask your pharmacist for advice.

You might get an arrhythmia if you take certain prescription medicines, such as:

• digoxin, which treats heart failure
• calcium-channel blockers, which are mainly used to treat high blood pressure
• levothyroxine, which is used to treat hypothyroidism
• medicines for asthma
• antidepressants
• some antibiotics

Over-the-counter medicines that act as stimulants can also cause palpitations (a thumping in your chest), such as:

• antihistamines that are used to treat hay fever
• decongestants in cough and cold medicines
• some herbal and nutritional supplements

Always read the patient information leaflet that comes with your medicine. If you think your medicine is causing an arrhythmia or making it worse, speak to your pharmacist or GP for advice.

3. Can I drive a car or motorcycle with arrhythmia?

The rules depend on the type of arrhythmia you have, how well it’s controlled and the type of vehicle you want to drive. It’s essential that you don’t drive until your arrhythmia is under control so you don’t put yourself or others in danger.

As long as you don’t have any symptoms that could distract you when driving, you’ll probably be able to drive a car or motorcycle. But the cause of your arrhythmia must have been identified and your condition controlled for at least four weeks. Ask your doctor if they agree that your condition is controlled.

If you have symptoms, such as dizziness or breathlessness, you shouldn’t drive and you should see your doctor for advice as you might be able to try another treatment to control your symptoms.

If you’ve had a procedure to treat your arrhythmia, you won’t be able to drive for longer. This can range from a couple of days to several months depending on the treatment you have.

The rules about driving are different if you have an arrhythmia and drive a lorry, or are responsible for passengers. For example, you won’t be allowed to drive a lorry or bus if your heart function is below a certain level.

If you’re in any doubt about driving, always follow your doctor’s advice.

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