doctor Find a doctor
OR
Breadcrumbs that show current page

Types of Arrhythmia

Atrial arrhythmias begin in the atria, which are the heart's upper chambers.

Atrial fibrillation

Atrial fibrillation, the most common type of arrhythmia, occurs when the atria beats at up to 600 times per minute, causing the chambers to quiver instead of contract effectively. A normal atria beats 60-80 times per minute.

  • There are three main types of atrial fibrillation: episodic, lasting from a few minutes to a few hours; persistent, lasting for days or weeks; or permanent.
  • In atrial fibrillation, blood does not fully pass through the atria. Instead, some blood pools in your heart, which can sometimes enable a blood clot to form and possibly enter your bloodstream. This clot can travel and block the blood flow in your brain, causing a stroke. Atrial fibrillation can also lead to cardiomyopathy (enlargement of the heart), which eventually weakens your heart.
  • The risk of atrial fibrillation is higher in people older than age 60, in men, and in people who have diabetes, high blood pressure, congestive heart failure or lung disease.

1. What are the symptoms of atrial fibrillation?

Although atrial fibrillation may not always cause symptoms, some symptoms include: palpitations, dizziness or feeling lightheaded, fainting (syncope), weakness, fatigue, dyspnea, and/or angina.

2. What causes atrial fibrillation?

Atrial fibrillation is most commonly caused by cardiovascular problems, such as: hypertension (high blood pressure), valvular disorders or disease, ventricular hypertrophy (enlargement of the heart's lower chambers), cardiomyopathy, atherosclerosis ("hardening of the arteries"), sick sinus syndrome, and/or pulmonary embolism.

3. How is atrial fibrillation diagnosed?

To help diagnose atrial fibrillation, Boston Medical Center's electrophysiologists use one or more of the following tests:

  • Electrocardiogram. This device tracks and graphs heart rhythm using electrical signals from the heart.
  • Trans-esophageal echocardiogram. This test produces real-time moving images on a monitor, taken from inside the esophagus and stomach.
  • Holter monitor. This device monitors and records the heart rhythm continuously for 24-48 hours.
  • Event recorder. An event recorder is activated during episodes of fibrillation and records the heart rhythm at that time.

4.How is atrial fibrillation treated?

The goal of treating atrial fibrillation is to slow the heart rate and prevent blood clots from forming, and to correct the heart rhythm. A doctor may recommend:

Medical treatments (medications)

  • Rate control and anticoagulation. These medications help return the heart to its normal rate and prevent clots from forming. The doctor may prescribe rate-control medications, such as beta-blockers, calcium channel blockers, and digitalis, as well as anticoagulation medication, such as Coumadin.
  • Anti-arrhythmic drug therapy. Anti-arrhythmic drugs restore normal heart rhythm by slowing the movement of the impulse through heart tissue or lengthening the shortest time possible between two connective beats.

Interventional treatments (procedures)

  • Cardioversion. This procedure restores normal heart rhythm using a brief electric shock through the chest.
  • AV nodal ablation and permanent pacemaker implantation. This treatment destroys the atrioventricular (AV) node, a part of the heart's electrical system through which electrical signals pass from the atria to the ventricles. The electrophysiologist destroys the AV node with a burst of energy, stopping the signals from reaching the ventricles. Following the ablation, your doctor implants a pacemaker to control your heart rhythm.
  • Pulmonary vein isolation. This procedure uses a burst of energy to destroy the tissue that produces the electrical signals that cause the arrhythmia and create scar tissue around the pulmonary vein, which blocks electrical signals from entering the atrium.

Atrial flutter

Atrial flutter occurs when the heart beats too quickly (typically 300 beats per minute) and therefore cannot pump blood efficiently. Atrial flutter that comes and goes is known as paroxysmal atrial flutter. When atrial flutter lasts longer--often for days to weeks at a time--it is called persistent atrial flutter. Left untreated, atrial flutter can lead to an increased risk of stroke.

1. What are the symptoms?

Symptoms can include feeling of fluttering or pounding in the chest (palpitations), shortness of breath, anxiety, weakness or fatigue, angina (chest pain), and/or syncope (fainting).  Some people, however, don't experience any symptoms.

2. What causes atrial flutter?

Causes of atrial flutter include coronary heart disease, myocardial infarction (heart attack), hypertension (high blood pressure), congestive heart failure, heart valve abnormalities, hyperthyroidism and/or lung diseases such as emphysema, chronic bronchitis, or asthma. In addition, some substances can contribute to atrial flutter, including alcohol, cocaine, amphetamines, and cold medicines

3. How is atrial flutter diagnosed?

Those suspected to have an atrial flutter will be referred to an electrophysiologist. At Boston Medical Center, skilled electrophysiologists use several different tests to help diagnose atrial flutter, including:

  • Electrocardiogram. This device tracks and graphs heart rhythm using electrical signals from the heart.
  • Holter monitor. This device monitors and records the heart rhythm continuously for 24-48 hours.
  • Event recorder. An event recorder is activated during episodes of fibrillation and records the heart rhythm at that time.
  • Trans-esophageal echocardiogram. This test produces real-time moving images on a monitor, taken from inside the esophagus and stomach.

4. How is atrial flutter treated?

The goal of treatment for atrial flutter is to control the heart rate and rhythm and to prevent the risk of stroke. To accomplish this, a cardiologist may use medical therapies such as:

Medical treatments (medications)

  • Ablation. This is performed by threading an electrode into the right atrium with a catheter through a vein in the leg. The short circuit, which causes atrial fibrillation, is eliminated by heating the electrode with radiofrequency energy. This cures atrial flutter, and is the most effective treatment for this arrhythmia.
  • Rate control and anticoagulation. These medications help return the heart to its normal rate and prevent clots from forming. A doctor may prescribe rate-control medications, such as beta-blockers, calcium channel blockers, and digitalis, as well as anticoagulation medication such as Coumadin.
  • Anti-arrhythmic drug therapy. Anti-arrhythmic drugs restore normal heart rhythm by slowing the movement of the impulse through heart tissue or lengthening the shortest time possible between two connective beats.

Interventional treatments (medications)

  • Cardioversion. Cardioversion restores normal heart rhythm using a brief electric shock through the chest. Recurrence of atrial flutter after cardioversion alone is common.

Paroxysmal supraventricular tachycardia (PSVT)

Paroxysmal supraventricular tachycardia (PSVT) is a rapid heart rate that occurs periodically. Paroxysmal means that it happens intermittently, or from time to time. A normal resting heartbeat is between 60 and 100 beats a minute. In PSVT, the heart can beat between 160 and 250 beats a minute, and this fast heartbeat is likely to start and stop suddenly. This can go on for minutes and sometimes hours. The three main types of PSVT include atrioventricular nodal reentrant tachycardia (AVNRT), Wolff-Parkinson-White syndrome, and atrial tachycardia.

Atrioventricular nodal reentrant tachycardia (AVNRT) occurs when the heart's electrical impulses move in a circle and reenter areas they have already passed through.

1. What are the symptoms of AVNRT?

While ANVRT may not always cause symptoms, some symptoms that do occur include palpitations, nervousness, anxiety, lightheadedness, neck and chest discomfort, shortness of breath, fainting.

2. What causes AVNRT?

AVNRT is most often caused by the presence of extra pathways in the AV node, although the cause of this is unknown. Women are more likely to develop the condition than men. The extra pathway is present since birth, but most often causes an arrhythmia after the heart has reached its full size when the patient is in their 20s or 30s.

To help diagnose AVNRT, electrophysiologists use one or more of the following tests:

  • Electrocardiogram. This device tracks and graphs heart rhythm using electrical signals from the heart.
  • Holter monitor. This device monitors and records the heart rhythm continuously for 24-48 hours.
  • Event recorder. An event recorder is activated during episodes of fibrillation and records the heart rhythm at that time.

3. How is AVNRT treated?

Treatment of AVNRT depends on the symptoms, how often arrhythmia is experienced, and whether or not another problem is causing the arrhythmia. Common treatments include:

Anti-arrhythmic therapy. This class of prescription medications works to suppress the underlying cause of an arrhythmia. Common antiarrhythmic medications include:

  1. Beta-blockers. Beta-blockers block receptor cells that respond to epinephrine, a molecule produced by the adrenal gland that stimulates the heartbeat. They slow and regulate the heart rate, reduce the force of heart contractions, and also lower blood pressure and relieve chest pain.
  2. Calcium channel blockers. Calcium channel blockers prevent calcium from entering the cells that transmit electrical signals. They can be effective in preventing AVNRT episodes.

Radiofrequency catheter ablation. Radiofrequency catheter ablation is the destruction of heart tissue using radiofrequency energy. During ablation, a catheter (a thin, flexible tube) with an electrode tip is positioned on the area of heart tissue that is involved in the arrhythmia. The catheter delivers a burst of energy to destroy tissue that is interfering with the normal transmission of impulses through the heart's electrical system. This same day procedure is over 99% successful in curing AVRNT.

Wolff-Parkinson-White Syndrome

Wolff-Parkinson-White Syndrome occurs when the heart beats too quickly. Normally, the heart beats in a coordinated way between 60 and 100 times per minute. The heart rate of a patient with Wolff-Parkinson-White syndrome can approach 240 beats per minute for a short period of time.

1. What are the symptoms?

Some people with Wolff-Parkinson-White syndrome never have symptoms. When symptoms do occur, they typically first surface between the ages of 11 and 50 and can include: palpitations, shortness of breath, lightheadedness, fatigue, angina, and/or syncope.

2. What causes Wolff-Parkinson-White Syndrome?

Wolff-Parkinson-White syndrome is caused by an abnormal extra pathway in the heart. It occurs only in people who are born with this abnormal pathway.

3. How is Wolff-Parkinson-White syndrome diagnosed?

Those suspected to have Wolff-Parkinson-White syndrome will be referred to an electrophysiologist. At Boston Medical Center, skilled electrophysiologists use several different tests to help diagnose this, including:

  • Electrocardiogram. This device tracks and graphs heart rhythm using electrical signals from the heart.
  • Holter monitor. This device monitors and records the heart rhythm continuously for 24-48 hours.
  • Event recorder. An event recorder is activated during episodes of fibrillation and records the heart rhythm at that time.

4. How is Wolff-Parkinson-White Syndrome treated?

When Wolff-Parkinson-White syndrome causes frequent and sustained symptoms, a cardiologist may recommend treatment, such as:

Medical therapy. Physicians may use medications to treat Wolff-Parkinson-White syndrome. Common medications for suppressing Wolff-Parkinson-White syndrome include beta-blockers and a category of drugs referred to as anti-arrhythmic agents.

Radiofrequency catheter ablation. During ablation, a catheter with an electrode tip is positioned on a small area of heart tissue. The catheter delivers a burst of radiofrequency energy to destroy this tissue, which blocks the extra abnormal pathway.

Ventricular arrhythmias

Ventricular arrhythmias begin in the heart's lower chambers, called the ventricles. Normally, a resting heart should beat between 60 and 100 times per minute. When a ventricular arrhythmia occurs, the ventricles beat abnormally fast -- up 300 beats per minute. Unlike an atrial arrhythmia, ventricular arrhythmias can be the most severe and life-threatening arrhythmias.

  • Ventricular Tachycardia occurs when the ventricles beat abnormally fast, between 100 and 250 beats per minute, occasionally reaching 300 beats per minute. When contractions of the ventricles are rapid, the heart can't completely fill with blood between beats and less blood is pumped through the body. If left untreated, ventricular tachycardia can lead to ventricular fibrillation, where almost no blood is being pumped out of the heart. A ventricular arrhythmia can be a very serious disorder, and if your doctor suspects that you are developing it, you should seek treatment immediately. 

1. What are the symptoms of ventricular tachycardia?

Symptoms can include palpitations, shortness of breath, lightheadedness, angina, and/or syncope (fainting).

2.    What causes ventricular tachycardia?

Ventricular tachycardia is typically caused by conditions that lead to scar tissue formation in the heart. Such conditions include:

  • Coronary heart disease (CHD) with prior heart attack
  • Cardiomyopathy -an enlarged or abnormally thickened heart
  • Congenital (inherited) heart disease
  • Valve disease

Rarely ventricular tachycardia occurs in otherwise normal hearts. This is called idiopathic ventricular tachycardia.

3. How is ventricular tachycardia diagnosed?

Those suspected to have ventricular tachycardia will be referred to an electrophysiologist. At Boston Medical Center, skilled electrophysiologists use several different tests to help diagnose this, including:

  • Electrocardiogram. This device tracks and graphs heart rhythm using electrical signals from the heart.
  • Holter monitor. This device monitors and records the heart rhythm continuously for 24-48 hours.
  • Event recorder. An event recorder is activated during episodes of fibrillation and records the heart rhythm at that time.
  • Electrophysiology (EP) study. In EP testing, a catheter (a thin, flexible tube) equipped with electrodes is used to record the heart's electrical activity to help map that arrhythmia's location.

4. How is ventricular tachycardia treated?

When ventricular tachycardia causes frequent and sustained symptoms, a cardiologist may recommend treatment, such as:

Medical treatments (medications)

Medical therapy. Physicians may use medications to treat ventricular tachycardia. Common medications for suppressing ventricular tachycardia include beta-blockers and a category of drugs referred to as anti-arrhythmic agents.

Interventional treatments (procedures)

Radiofrequency catheter ablation. During ablation, a catheter with an electrode tip is positioned on a small area of heart tissue. The catheter delivers a burst of radiofrequency energy to destroy this tissue, which blocks the extra abnormal pathway.

Implantable cardiac defibrillator (ICD): These small devices are implanted in the upper chest and connected to the heart with wires called leads. The ICD constantly monitors the heart rate, and when the device detects ventricular tachycardia, it electrically stimulates or shocks the heart to normalize its rhythm.

OR