Abnormal heart rhythms or arrhythmias

To diagnose an arrhythmia or find its cause, doctors use tests including:

EKG. An electrocardiogram records the electrical activity of your heart. You wear small electrode patches on your chest, arms, and legs for the quick, painless test, which you take in your doctor's office.

Holter monitor. This is a portable EKG (also called an "ambulatory electrocardiogram" or an ECG) about the size of a postcard or digital camera that you'll use for 1 to 2 days, or up to 2 weeks. The test measures the movement of electrical signals or waves through your heart. These signals tell your heart to contract (squeeze) and pump blood.  You'll have electrodes taped to your skin. It's painless, although some people have mild skin irritation from the tape used to attach the electrodes to the chest. You can do everything but shower or bathe while wearing the electrodes. After the test period, you'll go back to see your doctor. They'll download the information.

Event monitor. If your symptoms don't happen often, your doctor may suggest that you wear one of these, usually for about a month. When you push a button, it records and stores your heart's electrical activity for a few minutes. Try to get a reading when you notice symptoms. Your doctor will interpret the results.

Implantable loop recorder. Your doctor puts this under your skin, where it constantly records your heart’s electrical activity. It can send information to your doctor’s office.

Stress test. There are different kinds of stress tests. The goal is to check how much stress your heart can manage before having a rhythm problem or not getting enough blood. For the most common type of stress test, you'll walk on a treadmill or pedal a stationary bike while you get an EKG and have your heart rate and blood pressure monitored. Technicians slowly raise the intensity level of your exercise.

Echocardiogram. This test uses ultrasound to check your heart muscle and valves.

Cardiac catheterization. Your doctor will insert a long, thin tube, called a catheter, into a blood vessel in your arm or leg. They’ll guide it to your heart with help from a special X-ray machine. Then, they’ll inject dye through the catheter to help make X-ray videos of your heart valves, coronary arteries, and chambers.

Electrophysiology study. This test records your heart's electrical activities and pathways. It can help find out what's causing heart rhythm problems and find the best treatment for you. During the test, your doctor will safely trigger your unusual heart rhythm. Then, they may give you medications to see which one controls it best or to see what procedure or device you need to treat it.

Head-up tilt table test. Doctors use this test to find out what's causing fainting spells. It measures the difference in heart rate and blood pressure when you're standing up and lying down. You'll get this test in a lab. You'll lie on a stretcher, tilted at different angles while you get an EKG and specialists check your blood pressure and oxygen level. This shows if symptoms of passing out are due to your electrical system, nervous system, or vascular system.

Treatment will depend on what type of arrhythmia you have. Your doctor may recommend one or more of these.

Medications

Medicines that treat uneven heart rhythms include:

Adenosine (Adenocard)

Atropine (Atropen)

Beta-blockers

Calcium channel blockers

Digoxin (Digitek, Digox, Lanoxin)

Potassium channel blockers

Sodium channel blockers

Vagal maneuvers

These techniques trigger your body to relax by affecting your vagus nerve, which helps control your heart rate. Your doctor might tell you to:

Cough or gag

Hold your breath and bear down (Valsalva maneuver)

Lie down

Put a cold, wet towel over your face

Electrical cardioversion

If drugs can't control an uneven heart rhythm (such as atrial fibrillation), you might need cardioversion. For this, doctors put you under and then send an electrical shock to your chest wall to trigger your heart’s regular rhythm.

Pacemaker

This device sends small electrical impulses to your heart muscle to keep a safe heart rate. It includes a pulse generator, which houses the battery and a tiny computer, and wires that send impulses to the heart muscle.

Implantable cardioverter defibrillator (ICD)

Doctors mainly use ICDs to treat ventricular tachycardia and ventricular fibrillation, two life-threatening heart rhythms.

The ICD constantly tracks your heart rhythm. When it detects a very fast, unusual rhythm, it delivers an electric shock to the heart muscle to make it beat in a regular rhythm again. The ICD has two parts: the leads and a pulse generator. The leads are made up of wires and sensors that monitor the heart rhythm and deliver energy used for pacing or defibrillation. The generator houses the battery and a tiny computer. Energy is stored in the battery until it is needed. The computer receives information from the leads to determine how the heart is beating.

Your doctor programs the ICD to include one or all of the following functions:

Anti-tachycardia pacing (ATP). A series of small electrical impulses to the heart muscle restores a regular rate and rhythm.

Cardioversion. You may get a low-energy shock at the same time your heart beats to restore regular rhythm.

Defibrillation. When your heartbeat is dangerously fast or uneven, your heart muscle gets a higher-energy shock to restore a regular rhythm.

Anti-bradycardia pacing. Many ICDs give backup pacing to keep the heart rhythm if it slows too much.

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There are different types of ICDs, including:

Single-chamber ICD. A lead is attached in the right ventricle. If needed, energy is delivered to the ventricle to restore a normal heart rhythm.

Dual-chamber ICD. Leads are attached in the right atrium and the right ventricle. Energy can be delivered to the right atrium and then to the right ventricle, helping your heart to be paced in a normal sequence.

Biventricular ICD. Leads are attached in the right atrium, the right ventricle, and the coronary sinus adjacent to the left ventricle. This technique helps the heart beat in a more efficient way and is specifically used for patients with heart failure.

Your doctor will determine which type of ICD is best for you. Before you have your ICD implanted, ask your doctor what medications you can take. Your doctor may ask you to stop taking certain medications before the procedure. You will receive specific instructions.

After it’s implanted, you might not notice a low-energy shock. Or it may feel like a flutter in your chest. The high-energy shock lasts just a second, but it can hurt. Some people say it feels like being hit with a baseball bat or being kicked by a horse. Most people feel it more in their back than their chest. If you feel a shock, sit or lie down because you may pass out.

Talk to your doctor about what to do if you ever get shocked. If you do get shocked, call your doctor immediately.

Catheter ablation

Think of this procedure as rewiring to fix an electrical problem in your heart.

Your doctor will insert a catheter through your leg. It delivers high-frequency electrical energy to a small area inside your heart that causes the unusual rhythm. This energy "disconnects" the pathway of the unusual rhythm.

Doctors use ablation to treat most PSVTs, atrial flutter, atrial fibrillation, and some atrial and ventricular tachycardias.

Heart surgery for arrhythmias

The maze procedure is a type of surgery to correct atrial fibrillation. Your surgeon makes a series, or "maze," of cuts in your heart's upper chambers. The goal is to keep your heart's electrical impulses only on certain pathways. Some people need a pacemaker afterward.

Your doctor might recommend other procedures, such as a coronary bypass, to treat other forms of heart disease.