What Is an Arrhythmia?
An arrhythmia (pronounced as “uh-RITH-me-uh”) is an irregular heartbeat. This means your heart is out of its usual rhythm. About 1.5%-5% of people have arrhythmias.
It may feel like your heart skipped a beat, added a beat, or is “fluttering.” It might feel like it’s beating too fast (which doctors call tachycardia) or too slow (called bradycardia). Or you might not notice anything.
Arrhythmias can be an emergency, or they can be harmless. If you feel something unusual happening with your heartbeat, get medical help right away so doctors can find out why it's happening and what you need to do about it.
Arrhythmia vs. dysrhythmia
You may see or hear these two terms used interchangeably when people write and talk about the condition, but there's no difference between them. Both terms mean the same thing, referring to an abnormal or irregular heartbeat.
What is a normal heart rate?
There is a range of resting heart rates that is considered normal and healthy. For most adults, 60-100 beats per minute is normal, though some athletes can have rates as low as the 40s. On the other end, a normal maximum heart rate—or how fast your heart beats when it's working hardest—is typically 220 minus your age in years.
The normal rhythm of your heart should sound or feel like a steady drum, a consistent “lup-dup.” If you have an irregular rhythm, it could feel like your heart is fluttering or racing.
An arrhythmia can be silent, meaning you don't notice any symptoms. Your doctor may spot an uneven heartbeat during a physical exam.
If you have symptoms, they may include:
- Palpitations (a feeling of skipped heartbeats, fluttering, or “flip-flops”)
- Pounding in your chest
- Dizziness or feeling lightheaded
- Shortness of breath
- Chest pain or tightness
- Weakness or fatigue (feeling very tired)
- Blurry vision
- Rapid heartbeat
- Slow heartbeat
You could have an arrhythmia even if your heart is healthy. The following could be irregular heartbeat causes:
- Heart disease
- The wrong balance of electrolytes (such as sodium or potassium) in your blood
- Heart injury or changes such as reduced blood flow or stiff heart tissue
- The healing process after heart surgery
- Infection or fever
- Certain medications, including antidepressants, decongestants, and high blood pressure medications
- Problems with electrical signals in your heart
- Strong emotions, stress, or surprise
- Things in your daily life such as alcohol, tobacco, caffeine, or exercise
- High blood pressure
- COVID-19 infection
- Sleep apnea
- Problems with your thyroid gland
- Changes in hormone levels
Types of Arrhythmias
Arrhythmias are classified based on where they happen. If they start in the ventricles, the lower chambers of your heart, they’re called ventricular. When they begin in the atria, the upper chambers, they’re called supraventricular.
Doctors also group them by how they affect your resting heart rate. Bradycardia is a slow heartbeat of fewer than 60 beats per minute. Tachycardia is a fast heartbeat of more than 100 beats per minute.
Supraventricular arrhythmias include:
- Premature atrial contractions. These are early extra beats. They’re harmless and generally don't need treatment.
- Atrial fibrillation (AFib). The upper chambers of your heart contract in an unusual way. Your heart might beat more than 400 times a minute.
- Atrial flutter. This arrhythmia is usually more organized and regular than AFib. It happens most often in people who have heart disease and in the first week after heart surgery. It often changes to AFib.
- Paroxysmal supraventricular tachycardia (PSVT). This is a rapid heart rate, usually with a regular rhythm. It begins and ends suddenly.
- Accessory pathway tachycardias. You can have a rapid heart rate because of an extra pathway between your heart's upper and lower chambers. Think of it as an extra road on your way home, in addition to your usual route. When that happens in your heart, it can cause a fast rhythm.
- AV nodal reentrant tachycardia (AVNRT). This is caused by an extra pathway through a part of your heart called the AV node. It can cause heart palpitations, fainting, or heart failure.
Ventricular arrhythmias include:
- Premature ventricular contractions (PVCs). These are among the most common arrhythmias. They're the “skipped heartbeat” that many of us feel sometimes.
- Ventricular tachycardia (V-tach). This is a rapid heart rhythm starting from your heart's lower chambers. Because your heart is beating too fast, it can't fill with enough blood. This can be a serious arrhythmia, especially in people who have heart disease, and it may be linked to other symptoms.
- Ventricular fibrillation (V-fib). This happens when your heart's lower chambers quiver and can't contract or pump blood to the rest of your body. It’s a medical emergency that must be treated with CPR and defibrillation as soon as possible.
- Long QT syndrome. Your heart’s lower chambers take too long to contract and release. This may cause dangerous rhythm problems and death.
This type of arrhythmia refers to a slow heart rhythm, which can be caused by your heart's electrical system disorders or by certain medications. It may make you pass out or feel like you will. Types of bradyarrhythmia include:
- Sinus node dysfunction. This is caused by a problem with your sinus node, which is your heart's natural pacemaker.
- Heart block. This happens when there is a delay or block in the electrical impulses that travel from your heart's sinus node to its lower chambers.
Arrhythmia Risk Factors
Things that may make you more likely to have an arrhythmia include your:
- Age. The chances go up as you get older.
- Genes. Your odds might be higher if a close relative has had an arrhythmia. Some types of heart disease can also run in families.
- Lifestyle. Alcohol, tobacco, and recreational drugs can raise your risk.
- Medical conditions. High blood pressure, diabetes, low blood sugar, obesity, sleep apnea, anxiety, thyroid disorders, lung disease, and autoimmune disorders are among the conditions that may cause heart rhythm problems.
- Environment. Things in the world around you, like air pollution, can make an arrhythmia more likely.
- Heart disease. If you were born with a heart disease or have had other heart problems in the past, you're more at risk for arrhythmias.
- Previous treatments for heart disease. You're more likely to have arrhythmia if you've had surgeries or other treatments for heart disease in the past.
If you are experiencing irregular heartbeats, your doctor will start to examine the problem by performing a physical exam. They will take your pulse and listen to your heart.
Then, to diagnose an arrhythmia or find its cause, doctors use tests and equipment, such as:
- EKG. An electrocardiogram (called an EKG or ECG) 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 1-2 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.
- Imaging tests. Your doctor may use CT scans or cardiac MRI to look for different physical signs that point to arrhythmia. These image tests can let them look at the structure of your heart chambers, see how well your heart is working, find scar tissue in the muscle, and check your arteries.
- 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.
Your doctor may refer you to an electrophysiologist, a cardiologist who specializes in treating heart rhythm disorders, to confirm an arrhythmia diagnosis.
Treatment will depend on what type of arrhythmia you have. Your doctor may recommend one or more of these.
Medicines that treat uneven heart rhythms include:
- Adenosine (Adenocard)
- Atropine (Atropen)
- Calcium channel blockers
- Digoxin (Digitek, Digox, Lanoxin)
- Potassium channel blockers
- Sodium channel blockers
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
If drugs can't control an uneven heart rhythm (such as atrial fibrillation), you might need cardioversion. For this, you will be given a sedative to keep you asleep during the procedure. Then, your doctor will send an electrical shock to your chest wall to trigger your heart’s regular rhythm.
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 maintain the heart rhythm if it slows too much.
There are different types of ICDs, including:
- Single-chamber ICD. A lead is attached to the right ventricle. If needed, energy is delivered to the ventricle to restore a normal heart rhythm.
- Dual-chamber ICD. Leads are attached to the right atrium and the right ventricle. Energy can be delivered to the right atrium and then to the right ventricle, which helps pace your heart in a normal sequence.
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.
Biventricular (B-V) pacemakers and defibrillators
Also known as cardiac resynchronization therapy (CRT), these types of implantable devices help sync up your heart's contractions so that the left and right sides of the lower chambers pump together to deliver oxygen-rich blood to your body. The devices are made up of three wire leads and a pulse generator, which contains a battery and a tiny computer.
When the pacemaker picks up on an abnormal rhythm, it sends electrical pulses through your heart's chambers to coordinate the contractions. The electrical signals are painless, and most people don't even feel the synchronization happening.
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.
Pulmonary vein isolation
This type of catheter ablation treats arrhythmias by targeting your pulmonary veins, which bring oxygen-rich blood to your heart. These veins are where the abnormal electrical signals that cause irregular heart rhythm usually start.
Pulmonary vein isolation uses very hot or cold temperatures to create scar tissue inside these veins, which will keep the faulty electrical signals from reaching your heart. This therapy can happen in two ways:
Radiofrequency ablation. This more common choice uses heat from radio waves to destroy targeted tissue areas.
Cryoablation. This method uses very cold temperatures to freeze and destroy specific tissue.
There are a few surgical treatment options:
- Coronary bypass surgery. This surgery helps improve blood flow to your heart. This procedure creates a new pathway for blood to get to the heart when there's a clogged or partially blocked artery. A healthy blood vessel from the chest or leg is connected beneath the blocked artery to open up a new passageway.
- Mitral valve repair or replacement. This option either repairs problems with this particular valve, which is located between the left heart chambers, or replaces it with a mechanical valve or one made from cow, pig, or human heart tissue.
- The maze procedure. During this procedure, 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. The maze procedure is often done in combination with coronary bypass surgery and mitral valve repair or replacement.
Lifestyle and alternative treatments
Alongside different medical treatments, your doctor may also suggest lifestyle changes and techniques to keep your heart healthy and help you manage arrhythmias.
Change what you eat. Incorporate more heart-healthy foods such as fruits, vegetables, and whole grains while limiting salt and solid fats. You may also want to limit caffeine because it can speed up your heart rate.
Exercise often. Shoot for at least 30 minutes a day. This can help you keep a healthy weight and avoid obesity, which can raise your chances of heart disease.
Drink moderately. Aim to cut back or stop drinking, as alcohol can raise your blood pressure. Moderate drinking for women of all ages and men older than 65 is up to one drink a day, and for men aged 65 and younger, it's up to two drinks a day.
Control cholesterol and blood pressure. Change your habits and take any prescribed medications to keep your cholesterol levels and blood pressure in check.
Quit smoking. Nicotine in tobacco can raise both your heart rate and blood pressure. Talk with your doctor about strategies to break the habit.
Limit stress. Managing stress can also help lower the chances of irregular heart rate or keep it from happening altogether. Some stress-relief techniques for arrhythmia include yoga, meditation, breathing exercises, and acupuncture.
Complications of Arrhythmias
Without treatment, an uneven heart rhythm could cause dangerous problems, such as:
- Alzheimer’s disease and dementia. These cognitive disorders may happen because your brain doesn’t get enough blood over time.
- Heart failure. Your heart might not pump as well as it should after repeated arrhythmias.
- Stroke. Blood that lingers in your atria can clot. If a clot travels to your brain, it may cause a stroke.
- Cardiac arrest. V-fib could cause your heart to stop.
Safe Driving Concerns
If you have an arrhythmia, you could faint behind the wheel. This could put you, other motorists, pedestrians, and property at great risk.
To figure out whether you can drive safely, your doctor will consider:
- What type of arrhythmia you have
- How serious your condition is
- The treatment you receive for it (if any)
- How often you have symptoms and how serious they are
If you have no symptoms and you haven't had any serious heart rhythm problems, you should be able to drive as you always have. If meds keep your arrhythmia under control, your doctor may give you the green light to drive, too.
In addition to meds to help manage your heart rhythm, you may have two other treatments. Both would keep you out of the driver's seat for a while:
Ablation: This treatment will usually restrict you to the passenger's seat for about a week. It may keep you there longer, depending on your medical history.
Implantable cardioverter defibrillator: Usually after you get an ICD, you'll be asked not to drive for a week. If you get an ICD after fainting or surviving cardiac arrest, you may have to wait several months before you get back behind the wheel.
You can't drive commercially (as in a delivery truck or a taxi) at all if you have an ICD.
You can’t always prevent arrhythmias. Regular checkups with your doctor can help keep you from having more heart rhythm problems. Be sure they know all of the medications you’re taking. Some cold and cough medicines can trigger an arrhythmia, so talk to your doctor before using them.
They may also recommend some lifestyle changes:
- Eat a healthy diet. Get plenty of fruits and vegetables, fish, and plant-based proteins. Avoid saturated and trans fats.
- Keep cholesterol and blood pressure under control.
- Don’t smoke.
- Keep a healthy weight.
- Exercise regularly.
- Manage stress.
- Limit alcohol and caffeine.
If you notice irregular heartbeats or other arrhythmia symptoms, see your doctor right away. Some arrhythmias are more serious than others, and the condition can have many different causes. Be open and honest with your doctor about your lifestyle and other health conditions so that you can find the treatment that's right for you.
What are four symptoms of arrhythmia?
At times, heart arrhythmias may be “silent” and not cause any symptoms at all. When they do, though, four common signs to look for include:
- Chest pain or discomfort
- Shortness of breath or trouble breathing
- Dizziness, lightheadedness, or fainting
Is arrhythmia life-threatening?
Irregular heart rhythms may be harmless, but there are types—such as ventricular tachycardia and ventricular fibrillation—that can be life-threatening.
Arrhythmias can also damage your brain, weaken your heart, or hurt your other organs if they keep your heart from pumping enough blood to your body. This could lead to life-threatening conditions such as stroke, heart failure, or a heart attack.
What are the bad symptoms of arrhythmia?
While signs of arrhythmia can vary and can result from stress, caffeine, or other reasons, there are a few serious symptoms to watch out for in particular.
You'll want to talk to your doctor, if you experience these often:
- Feeling faint
- Shortness of breath