Atrial Tachycardia

Atrial tachycardia is a period of rapid and regular heart beats that begins and ends abruptly. The heart rate is usually between 160 and 200 beaters per minute. This is usually caused by a group of abnormal cells other than the SA node, located in the right or left atrium.

Paroxysmal (abrupt beginning and ending) atrial tachycardia may have several causes. The arrhythmia may be caused by a premature atrial beat that leads to tachycardia that may be focal in origin or may be a very small loop of electrical activity. Other causes stem from anxiety, stimulants, over active thyroid and in some women, the onset of menstruation.

Though seldom life threatening, this arrhythmia can be annoying, symptoms include: light headedness, chest pain, palpitations, anxiety, sweating and shortness of breath.

Your doctor may suggest that during an episode of atrial tachycardia you attempt to bear down as in a bowel movement. The doctor may also massage an area in your neck to terminate the tachycardia. A medication called adenosine may be used by the doctor to stop the arrhythmia. In some cases an electric cardioversion may be used to terminate the tachycardia.

Atrial Fibrillation

Atrial fibrillation is a disorder found in about 2.2 million Americans. During atrial fibrillation, the heart’s two small upper chambers (the atria) quiver instead of beating effectively. Blood isn’t pumped completely out of them, so it may pool and clot. If a piece of a blood clot in the atria leaves the heart and becomes lodged in an artery in the brain, a stroke results. About 15 percent of strokes occur in people with atrial fibrillation.

Causes:

• Heart disease (coronary heart disease and heart failure)
• Mitral valve prolapse
• Hyperthyroidism
• Pneumonia
• Chronic lung disease
• Heavy drinking of alcohol
• Electrolyte imbalances
• Certain medication

Symptoms:

• Some people have chest pain. This is due to an irregularly pumping heart that may drop your blood pressure.
• Occasionally the first symptom may be a stroke caused by a blood clot to the brain.
• Some people have no symptoms

Other symptoms include:

• Irregular heart rate
• Fast heart rate
• Weakness
• Fatigue
• Lightheadedness
• Shortness of breath

Classifications:

Atrial Fibrillation is divided into three classifications:

1. Paroxysmal:
   1. Terminates spontaneously.
   2. Occurs intermittently, varies in frequency.
   3. Duration from a few to several days.
   4. Short term goal is rate control, conversion to sinus rhythm and anticoagulation.
   5. Long term goal is maintenance of sinus rhythm.
   6. Tends to occur in younger people ages 30 to 50 years of age.
2. Persistent
   1. Does not terminate spontaneously, but can be converted to sinus rhythm
   2. Typically seen in the older population
   3. Rise in embolic risk with duration of atrial fibrillation.
   4. Short term goal is rate control and cardioversion to sinus rhythm.
   5. Long term goal is cardioversion and maintenance of sinus rhythm and rate control.
   6. Requires continued electrical or pharmaceutical intervention.

3. Permanent:
   1. Unable to restore sinus rhythm
   2. Long standing atrial fibrillation (>1 year)
   3. Short term goal is rate control and anticoagulation
   4. Long term goal is rate control

Complications:

The most serious complication is stroke caused by a blood clot to the brain. This is caused by the blood becoming stagnant while the atrium is not beating properly. Clots may then travel in the bloodstream to the brain where they can block flow to a part of the brain and cause a stroke to occur. Many patients with atrial fibrillation are put on anticoagulants (blood thinners) to reduce the risk of clot formation.

Treatment:

• Several approaches are used to treat and prevent abnormal beating:
• Medications are used to slow down rapid heart rate associated with atrial fibrillation. These treatments may include drubs such as digoxin, beta blockers (atenolol, metoprolol, propranolol), amoiodarone, disopyramide, calcium antagonists (verapamil, dilitazam), sotalol, flecainide, procainamide, quinidine, propafenone, etc.
• Electrical cardioversion may be used to restore normal heart rhythm with an electric shock, when medication doesn’t improve symptoms.
• Drugs (such as ibutilide) can sometimes restore the heart’s normal rhythm. These drugs are given under medical supervision, and are delivered through an IV tube into a vein, usually in the patient’s arm.
• Radiofrequency ablation may be effective in some patients when medications do not work. In this procedure, thin and flexible catheters are introduced through a vein and directed into the top chambers of the heart. Then a burst of radiofrequency energy is delivered to destroy tissue that triggers abnormal electrical signals or to block abnormal electrical pathways.

Atrial Flutter

Atrial flutter occurs when the upper chambers of the heart (atria) beat in a repetitive gasion at 300 beats per minute. This is compared to the normal 60 to 100 times per minute. The rapid heart rate reduces the effectiveness of the heart and decreases the amount of blood flow. Atrial flutter is usually seen with classic sawtooth pattern of flutter waves with negative polarity in leads I. II, III, and a VF.

Typical atrial flutter is isthmus dependant with the circuit going through the isthmus in clock-wise or counter clock-wise direction. Atypical flutter is thought to result from reentru around other functional or structional barriers to conduction.

Causes:

Atrial flutter may be caused by abnormalities or diseases of the heart itself, by a disease elsewhere in the body that affects the heart, or by consuming substances that change the way electrical impulses are transmitted through the heart. In a few people, no underlying cause is every found.

Heart disease or abnormalities that can cause atrial flutter include the following:

• Decreased blood flow to the heart (ischemia) due to coronary heart disease or blood clot.
• High blood pressure
• Disease of the heart muscle (Cardiomyopahty)
• Abnormalities of the heart valves (especially the mitral valve)
• An abnormally enlarged chamber of the heart (hypertrophy)
• After open heart surgery

Diseases elsewhere in the body that affect the heart include the following:

• Overactive thyroid gland
• Blood clot in a blood vessel in the lungs (pulmonary embolism)
• Chronic (ongoing) lung diseases (COPD), such as emphysema that lowers the amount of oxygen in the blood.

Substances that may contribute to atrial flutter include the following:

• Alcohol (wine, beer or hard liquor)
• Stimulants such as cocaine amphetamines, diet pills, cold medicines, sometimes even caffeine.
• Atrial flutter is also closely associated with atrial fibrillation. These two sometimes alternate back and forth.

Symptoms:

Symptoms include heart palpitations, shortness of breath, chest pain and dizziness. Some people may experience no dizziness.

Treatment:

The goals of treatment are to control the heart rate, restore normal sinus rhythm, prevent future episodes and prevent stroke.

Control rate: The first treatment goal is to control the ventricular rate.

• If you experience serious clinical symptoms, such as chest pain or congestive heart failure related to the ventricular rate, the health care provider in the emergency department will decrease your heart rate rapidly with IV medications or electrical shock (defibrillation.)
• If you have no serious symptoms, you may be given oral medications.
• Sometimes you may require a combination of oral medications to control your heart rate.
• Surgery may be done to control heart rate, but this is rare.

Restore and maintain normal sinus rhythm: Some people with newly diagnosed atrial flutter convert to normal sinus rhythm spontaneously in 24-48 hours. The goal of treatment is to convert the atrial flutter to normal sinus rhythm and preven recurrence of atrial flutter.

Not everyone with atrial flutter needs anti-arrhythmic medication

The frequency with which your arrhythmia returns and the symptoms it causes partly determine whether you receive anti-arrhythmic medication.

Medical professionals carefully tailor each person’s anti-arrhythmic medications to produce the desired clinical effect without creating unwanted side effects, some potentially lethal.

Prevent future episodes: This is usually done by taking daily medication to keep the heart at a safe and comfortable rate.

Prevent future episodes: This is usually done by taking daily medication to keep the heart at a safe and comfortable rate.

Prevent stroke: Stroke is a devastating complication of atrial flutter. It occurs when a piece of blood clot formed in the heart breaks off and travels to the brain, where it blocks blood flow.

• Co-existing medical conditions, such as congestive heart failure and mitral valve disease, significantly increase the risk of stroke.
• Patients with persistent atrial flutter need a “blood-thinning” drug called warfarin to lower this risk. Warfarin blocks a certain factor in the blood that promotes clotting.
• People at lower risk of stroke and those who cannot take Warfarin may use aspirin. Aspirin is now without its own side effects, including bleeding problems and stomach ulcers.

Catheter ablation: Ablation means removal. This technique inactivates the abnormal conduction pathways in the right atrium.

• The abnormal pathway(s) is found and a catheter is placed at this precise location in the conduction system.
• After proper placement, the catheter delivers radiofrequency energy, which burns or ablates a portion of the abnormal electrical conduction pathway. This inactivates the abnormal pathway to provide more consistent flow of electrical impulses.
• This technique is safe and is recommended for some, not all patients. When it is performed, atrial flutter is permanently cured. Unlike surgery, it requires little recovery time.

Bi-Ventricular Electrophysiology and Pacing.

To understand biventricular pacing and congestive heart failure, it helps to understand how a normal heart works compared to a “sick” heart.

Heart failure affects almost 5 million people in the United States, with 550,000 new cases reported each year. People diagnosed with heart failure can live a full and active life as long as they follow closely the treatment, diet and exercise plan their doctor has given them.

Do not be alarmed or mislead by the term “heart failure”. This does not mean the heart has failed and cannot work anymore. This simply means the heart is failing to pump the adequate amount of blood the body needs.

If you have had any heart problems in the past or if you have a family history of heart problems, it is important to recognize these signs and symptoms early and share them with your doctor. Swelling of your feet and/or ankles, swelling of your abdomen, shortness of breath with or without exercise, a lower then normal exercise tolerance, shortness of breath while lying down, frequent urination at night, loss of appetite, fatigue or tired feeling, confusion or palpitations. Due to the body’s attempt to compensate for the heart failure, by the time symptoms appear, damage has already been done. Therefore, the earlier you recognize the symptoms and get them treated the better the outcome will be.