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Treatment Program

Cardiac Arrhythmia

The multidisciplinary specialists at Mass General Brigham Heart are known worldwide for their expertise in the diagnosis and treatment of irregular heart rhythms. Learn more about the condition’s causes, symptoms, diagnosis, treatment, and FAQs.  

members of the heart care team viewing patient data at monitors

What is cardiac arrhythmia?

Cardiac arrhythmias, also known as heart arrhythmia, is an abnormal heart rhythm. The type of cardiac arrhythmia is determined by whether the irregular heartbeat is too fast or too slow. The two main categories of cardiac arrhythmia are bradycardia, when the heart beats too slowly, and tachycardia, when the heart’s rhythm becomes too rapid. The most common type of cardiac arrhythmia is a form of tachycardia called atrial fibrillation.

While it's normal for heart rates to alter with behavior—slower rates while resting or sleeping and faster rates while being physically active—cardiac arrhythmia occurs when the heart rate doesn't match the activity level. The resting heart rate can identify both types of heart arrhythmia. A healthy resting heart rate is between 60 and 100 beats per minute. When a person's resting heart rate is regularly outside of this range, they may have cardiac arrhythmia. 

Atrial Fibrillation: Risk Factors, Symptoms, and Treatment

What is atrial fibrillation or AFib? What are its risk factors? What are the symptoms of AFib? Paul Zei, cardiac electrophysiologist at Brigham and Women's Hospital, explains how atrial fibrillation is treated and how research is looking to improve those treatment options. 

What are cardiac arrhythmia symptoms?

Cardiac arrhythmia may not cause any symptoms. In cases where symptoms occur, people with cardiac arrhythmia can experience the following:

Arrhythmias are becoming more and more common in patients. Treatment for arrhythmias can be very technically complex and sophisticated, so patients benefit from the expertise and experience that Mass General Brigham can offer.

John F. Keaney, Jr., MD
Director, Cardiology Clinical Service
Mass General Brigham Heart

Cardiac arrhythmia conditions we treat

Our specialists are experienced in treating heart rhythm conditions, including all types of bradycardia and tachycardia.

Bradycardia cases typically have a resting heart rate of below 60 beats per minute.

  • Sinus node dysfunction: The sinus node is a part of the heart's anatomy that regulates the organ's rhythm. When this node becomes damaged or impaired, it can create irregular heartbeats 
  • Atrioventricular conduction block: The heart beats on electrical impulses. If those electrical signals become obstructed or otherwise impaired, the heartbeat can be affected. In cases of bradycardia, this signal block slows the heart rate below healthy levels 
  • Chronotropic incompetence
  • Premature ventricular contractions (PVCs)

Tachycardia can be broken into two primary categories. The difference between these conditions depends on where the problem occurs in the heart. Supraventricular arrhythmias occur within the upper parts of the heart, known as the atria. Ventricular arrhythmias occur lower in the heart, known as the ventricles. 

Supraventricular Arrhythmias 

  • Atrial Fibrillation: The heart can develop an irregular rhythm characterized by partial, rapid contractions of the heart with atrial fibrillation or AFib. Disorganized electrical signals within the atrium cause this irregular heartbeat.
  • Atrial Flutter: Highly rapid heartbeats (over 240 beats per minute) characterize atrial flutter. This form of heart arrhythmia occurs when a portion of the heart's electrical system signals on and off too quickly. 
  • Atrial Tachycardia: A speedy, irregular heartbeat that begins with the atrium beating too fast and out of sync with the ventricles.
  • Paroxysmal Supraventricular Tachycardia (PSVT): This type of tachycardia is characterized by a sudden onset and an equally sudden return to normal heart rhythms. With PSVT, the heart develops a rapid beat but lacks the chaotic rhythm associated with atrial fibrillation.

Ventricular Arrhythmias 

  • Ventricular Fibrillation: This dangerous form of tachycardia causes the lower portions of the heart (the ventricles) to lose significant functionality. Due to faults in the heart's electrical system, a chaotic series of electrical signals keep the ventricles from fully contracting. This condition prevents blood flow and can be fatal if it continues for even a relatively short while. 
  • Ventricular Tachycardia: An ineffective heart rhythm in the ventricles prevents proper blood flow. When these chambers beat too quickly, the heart can't propel enough blood with each beat. 
  • Brugada Syndrome: A rare disorder that can cause dangerous irregular heartbeats, and is sometimes inherited. 
  • Long QT Syndrome: A disorder of the heart’s electrical system that causes can cause sudden fainting and seizures. 

What are the causes and risk factors of cardiac arrhythmia? 

Causes of cardiac arrhythmia are varied and not always known. However, there are several suspected irregular heartbeat causes to consider. Many of these align with general causes of heart disease and can also be considered the dominant risk factors of cardiac arrhythmias.

While some, like genetic heart disease, may be outside of your control, other cardiac arrhythmia risk factors like alcohol consumption and smoking are behaviors you can avoid or manage. Similarly, risk factors like high blood pressure can often be managed with the assistance of medicine or lifestyle changes. Risk factors for cardiac arrhythmia include: 

How is cardiac arrythmia diagnosed?

Early indications of cardiac arrhythmia may lead to a more thorough examination with specialized tests. It's relatively common for arrhythmia to be identified through symptoms or during a regular checkup. Our cardiac imaging specialists offer the latest diagnostic procedures for all cardiac arrhythmias, which may include:

These tests use different techniques to create a picture of the heart so that doctors may analyze it for abnormalities. 

  • Cardiac MRI

These tests may be used to assess risk of arrhythmias:

  • Cardiac CT scans
  • Echocardiography

Because heart arrhythmias don't always occur regularly, portable heart monitors can continue to record data while a patient is at home. The prolonged recording increases the odds of finding an irregular heart rhythm if there is one. 

  • Holter monitor 
  • Event recorder
  • Patch monitor
  • Implantable loop recorder (ILR)

  • A stress test and tilt table test are physical tests that help determine how your heart rhythm impacts you
  • An electrophysiology (EP) study analyzes the detailed workings of your heart's electrical system
  • Electrocardiogram (ECG)
  • Electroanatomic mapping

Approach to treatment of cardiac arrhythmias

Once a diagnosis is made, we offer the most advanced treatments and procedures to help manage arrhythmias. Heart arrhythmia treatments can vary significantly between patients and conditions. While most cases may include some lifestyle recommendations, such as healthy exercise and diet, medication and surgery are common treatments. In some cases of cardiac arrhythmia, treatment may not be required to manage symptoms, but in more extreme cases, arrhythmias can lead to life-threatening risks if left untreated. 

Basic lifestyle recommendations are a frequent component of cardiac arrhythmia treatments. These include maintaining a healthy level of physical activity, consuming a heart-healthy diet, avoiding alcohol and tobacco consumption, and keeping a healthy sleep cycle.

Medications are the other primary, non-surgical treatment approach for cardiac arrhythmia. Depending on your case, condition, and severity, your physician may prescribe you a medication that can help regulate your heart's rhythm.  

Electrical cardioversion is a non-surgical procedure that can correct some cardiac arrhythmias. An electrical current is pushed through the chest, encouraging the heart to resume a normal rhythm. While this procedure is non-invasive, it often involves a sedative and can be fairly involved. 

Surgical heart arrhythmia treatments generally attempt to fix the problem within the heart directly or by implanting a device that can help regulate the heart's rhythm. 

  • Radiofrequency or catheter ablation: The surgeon can apply a burst of electricity with high precision using a catheter. This procedure effectively removes a short in the heart's electrical circuit 
  • Implantable cardioverter defibrillator: These devices can deliver a shock if the heart has an overly rapid rhythm or if it falters and temporarily loses its beat altogether 
  • Pacemaker implantation and cardiac resynchronization therapy: These devices deliver a regular electrical signal that helps your heart maintain a healthier rhythm
  • Advanced ventricular tachycardia (VT) management: This includes advanced catheter ablation techniques, stereotactic body radiotherapy (SBRT), surgical interventions (i.e. sympathectomy)
  • Comprehensive atrial fibrillation (AF) management
  • Fluoroless procedures 
  • Clinical trials and advanced technologies

How to prevent cardiac arrhythmia

While cardiac arrhythmia may not be preventable in many cases, it's often possible to lower your risk by addressing potential causes and risk factors. In general, follow heart-healthy lifestyle practices and maintain an awareness of your heartbeat. Even when prevention isn't an option, early detection can significantly affect prognosis.

Living with cardiac arrhythmia

Living with heart arrhythmia is similar in some ways to preventing it. The lifestyle changes that may reduce your risk of developing cardiac arrhythmia may also reduce your symptoms and risks if you already have heart arrhythmia. However, when living with this condition, it's vital to consult your doctor and ensure you receive any necessary treatments. 

Cardiac arrhythmia FAQs 

Atrial fibrillation is the most common type of cardiac arrhythmia. The risk of developing this type of heart arrhythmia increases with age. 

Occasionally, an irregular heartbeat may only occur briefly before returning to normal. However, if this happens often or in prolonged episodes, it can present several health risks. Depending on the type of heart arrhythmia in question, and other health factors, leaving this condition untreated could lead to stroke or other life-threatening problems.

In many cases, the condition is managed rather than cured. However, catheter ablation may be able to reverse the condition in some cases by eliminating arrhythmogenic tissue or abnormal electrical connections.

If you notice your heart beating too slowly or too rapidly, you may want to schedule an appointment to be examined. If you are experiencing severe symptoms of cardiac arrhythmia, seek medical aid promptly. 

Some mobile devices can detect an abnormal pulse or heart rhythm.
In particular, there are devices that identify atrial fibrillation and may present a more convenient option than more cumbersome medical devices that require a prescription. However, these personal mobile devices are not intended to diagnose cardiac arrhythmias on their own. Therefore, it is recommended that patients consult their doctor or cardiologist for a more thorough diagnostic testing if abnormal heart rhythms are detected.

Arrhythmia research and clinical innovation

Physicians at Mass General Brigham Heart have revolutionized medical care for cardiac arrhythmias. Whether it’s a novel scientific finding that may lead to a new treatment for atrial fibrillation or a ground-breaking imaging advance to improve disease diagnosis, we are at the forefront of the latest discoveries, bringing clinical breakthroughs directly to our cardiology patients.

Learn how our experts are advancing pacemaker lead extraction and revision and discover cutting-edge trials for patients with atrial fibrillation

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