Diagnosis and treatment evolve for arrhythmia -- a disease with 1,000 faces

The first week of June is World Arrhythmia Week.

Arrhythmia is a cardiovascular disease with a wide range of symptoms and treatments. It can come and go mildly, but in severe cases, it is a frightening ailment that can lead to cardiac arrest.

Korea Biomedical Review met with Professor Choi Eue-keun of the Department of Cardiology at Seoul National University Hospital to learn all about arrhythmia, a “disease with a thousand faces."

Question: What is arrhythmia?

Answer: Arrhythmia is a general term for any disorder related to forming and transmitting electrical signals in the heartbeat. When the heart produces or transmits abnormal electrical signals, normal and regular contractions cannot continue, and the heartbeat becomes irregular, such as abnormally fast or slow.

Q: What causes arrhythmia?

A: There are various known causes of arrhythmia, including congenital and acquired heart disease; lifestyle behaviors, such as tobacco, alcohol, and caffeine; comorbidities, including hypertension, diabetes, thyroid disease, obesity, advanced age, and inherited arrhythmia.

Q: They say there are different types of arrhythmia.

A: There are two main types of arrhythmia: tachycardia and bradycardia. Tachycardic arrhythmia includes atrial fibrillation, which is an irregular pulse, and premature beats, in which people suddenly feel like their heart is slamming down. Paroxysmal supraventricular tachycardia, a rapid heartbeat, is also characterized by its sudden onset and sudden stop.

On the other hand, Bradycardia is a very slow pulse, less than 60 beats per minute. The most common bradycardic arrhythmia is “sinus bradycardia,” which is caused by a weakening of the sinus that produces electrical impulses. Bradycardia can also occur when the conduction pathways that help the pulse spread throughout the heart and contract evenly are blocked, a condition called “conduction disorder.” These patients may feel dizzy, weak, or short of breath with the slightest movement.

Q: How is an arrhythmia diagnosed?

A: To diagnose arrhythmias, doctors need to identify electrical abnormalities in the heart, which is done by performing an electrocardiogram. An electrocardiogram consists of several electrodes placed on the body and lasts about 10 seconds. However, if it's not possible to make an accurate diagnosis in 10 seconds, there's a test called an “active electrocardiogram,” which is a device that people wear around the clock.

With this device attached, they can do their usual daily activities. More recently, single-induction activity electrocardiograms have also been used, allowing testing over longer periods (three to 14 days or more).

On the other hand, some patients with arrhythmias have symptoms that are rare but severe enough to cause major accidents, such as falling from dizziness and injuring their head. In these cases, a small device called an “implantable event recorder” is inserted under the skin around the heart and records every moment of the arrhythmia to help diagnose the arrhythmia quickly.

Q: What are the treatments for arrhythmia?

A: Lifestyle is the most important aspect of diagnosing arrhythmias. Especially for patients with tachycardic arrhythmias, such as atrial fibrillation, it's important to ensure that they don't have any lifestyle problems, including overwork, overdrinking, overeating, or stress. Lifestyle modification should go hand in hand with other treatments, as treatments are less effective without modifying risk factors.

If lifestyle modifications are not possible, medication is the next step. The most common medications are antiarrhythmic drugs, used to treat tachyarrhythmias, which are rapid heartbeats.

When using antiarrhythmic drugs, you may feel dizzy or weak after a period when your heart is beating fast, which means that your tachycardia has changed to bradycardia. It's best to see your doctor for a diagnosis in these cases.

On the other hand, if you have atrial fibrillation, the heart's ability to contract and flutter can cause blood to pool and form clots. If they travel around in the body, they can cause serious complications, such as stroke or embolism. To prevent this, anticoagulants are medications that prevent blood from clotting.

For bradyarrhythmia, a slow pulse that causes dizziness or collapse, a pacemaker is implanted inside the body to assist the heart. The pacemaker is connected to the heart and senses the pulse. When the heart beats slowly, the machine delivers electricity to help it beat normally.

If a patient survives a sudden cardiac arrest and is resuscitated, an implantable cardioverter defibrillator may be placed in the body to prevent recurrence.

For tachycardia, the goal is to find and treat the cause of the arrhythmia, which is why radiofrequency electrode ablation is performed to treat and eliminate the source locally. This allows us to find out where the arrhythmia is coming from, and by applying localized energy to that area, the arrhythmia is blocked.

If medication is ineffective, the blood pressure continues to drop, and the patient becomes unconscious, an electrical cardioversion procedure may be performed, in which an electrical shock is delivered to the heart to restore normal rhythm.

Q: What are some lifestyle tips for people with arrhythmia?

A: When a patient with bradyarrhythmia has a pacemaker implanted, there is a five-centimeter scar left over from the surgery, and it's best to avoid contact with water for a week or two. Also, because the pacemaker is connected to the heart, they should avoid heavy arm movements, lifting, and hanging.

Exercising during tachyarrhythmia (a heart rate of 120 beats or more) is dangerous, but moderate exercise is recommended once the arrhythmia is stabilized or in remission after treatment. The World Health Organization (WHO) recommends at least 150 minutes of walking and 70 minutes of running per week. Even if you don't have an arrhythmia, aerobic exercise can help prevent arrhythmias.

Also, in people with tachycardia, caffeine can increase the already fast pulse rate. However, if your arrhythmia is relatively stable and well-controlled, one or two cups of coffee are fine. However, it's best not to consume too much caffeine, especially if you're drinking one of the more popular energy drinks.

Q: Do you have any messages regarding arrhythmia in general?

A: Arrhythmia is a complex condition with many different types and treatments, but recent breakthroughs in diagnostics through wearable devices and various treatments are evolving rapidly. I recommend that people consult with a specialist rather than feeling vaguely anxious to get an accurate diagnosis and appropriate treatment.