Normally, the heart beats 60-100 times a minute. One heartbeat equals a complete contraction of the four chambers of the heart, the two atria (top) and the two ventricles (bottom). A normal heartbeat starts in the atria and, milliseconds later, continues into the ventricles.

With an arrhythmia, the heartbeat may be interrupted, go too fast or too slow or follow a different pattern. “When or if the symptoms last for more than 15 minutes, it is important to seek medical attention,” cautions Seth Worley, MD, The Heart Group, and Medical Director of the Lancaster General Heart Center Electrophysiology Lab.

Symptoms of an arrhythmia can include:

• shortness of breath
• heart palpitations (“fluttering” sensation)
• chest pains
• dizziness
• feeling lightheaded

Various conditions can contribute to the development of an arrhythmia. Common factors include aging, coronary artery disease, thyroid abnormalities, electrolyte disturbances, anemia, congenital abnormalities and abnormal pathways in the heart.

Douglas Gohn, MD, a partner with Dr. Worley at The Heart Group, says arrhythmias are either supraventricular (coming from above the ventricle) or ventricular (coming from the ventricle). More people have supraventricular arrhythmias, which are generally not considered life-threatening.

On the other hand, ventricular arrhythmias could be more problematic. External factors, such as coronary artery disease, age and general physical condition, can play a greater role in their development.

Nicholas Mandalakas, MD, Cardiac Consultants, says that the depth and sophistication of tests makes it easier to understand arrhythmias. By using the leading-edge technology at the Lancaster General Heart Center Electrophysiology Lab, cardiologists can determine what triggers an arrhythmia, if it requires treatment and the most appropriate way to manage it.

An electrocardiogram (ECG or EKG) records the timing of a patient’s heartbeat. Cardiologists can record an ECG with several types of diagnostic tools, including:

• Holter monitor: Small, portable ECG recorder that monitors a patient’s heartbeat continuously for 24-48 hours. During the testing, the patient can perform normal activities and does not need to be in the hospital.
• Event recorder: Another type of small, portable ECG recorder that a patient attaches and uses when he or she experiences symptoms (also known as an “event”).        
• Tilt table: This test indicates if a patient’s heart rate and blood pressure change as he or she lies down or stands up.
• Treadmill stress test: Some arrhythmias are exercise-related. A patient’s heart rate is monitored while he or she walks or runs on a treadmill.

Sometimes, a single test will give the cardiologist enough information to make a diagnosis and recommend a course of treatment. However, cardiologists may need more specific information. The Electrophysiology (EP) Lab can perform additional testing.

EP testing enables cardiologists to evaluate the precise type of arrhythmia and the part of the heart that is causing it. By recording the heart’s electrical signals, EP tests “map” the movement of a heartbeat. During an EP test, cardiologists can electrically stimulate the heart to learn more about how a patient’s heart functions.

For instance, a patient with weaker heart muscles may react better to one course of treatment. Although a prescription drug may help treat one type of arrhythmia in a young, relatively healthy patient, that same drug could lead to a negative interaction when taken by a patient who has other health concerns.

In addition to medical drug therapy, common treatment options include:

• Ablation: Identifying and destroying specific sections of the heart muscle to eliminate the abnormal electrical connection and normalize the heartbeat.
• Pacemaker: Offers pacing support by providing small doses of electricity to keep the heart beating in a regular pattern. Useful when the heart beats too slowly.
• Implantable cardioverter defibrillator (ICD): Monitors heartbeat and delivers signals to get the heart to return to a normal rhythm by delivering a small electric shock. Often used when the heart beats too rapidly.