What is an arrhythmia and when should we resort to a pacemaker

The term arrhythmia is the union of the prefix A, meaning SIN, and ritmia, meaning heart rhythm. Therefore, it consists of any deviation from the normal cardiac rhythm and can be divided into bradyarrhythmias (slow cardiac rhythms) or tachyarrhythmias (accelerated cardiac rhythms).

The mechanisms that produce a cardiac arrhythmia are multiple and complex. In general, 3 elements must coexist for them to occur: a substrate, which consists of electrical circuits that the patient has inherited or acquired throughout his or her life; a modulator, produced by the activity of the nervous system; and a trigger, which are small arrhythmias, such as extrasystoles, that trigger other arrhythmias of greater importance.

What are the different types of arrhythmias?

There are different types of arrhythmias and each has a different significance and prognosis. With regard to slow pulsations or bradyarrhythmias, the most common, and often benign, is sinus bradycardia. It is very common in athletes or people who practice sports on a regular basis, and can reach more severe forms such as atrioventricular block, which require an evaluation and assessment by a Cardiology specialist.

Tachyarrhythmias or accelerated cardiac rhythms are usually divided according to the place where they originate; above or below the bifurcation of the bundle of His. In supraventricular arrhythmias it is above it and in ventricular arrhythmias when they originate below this structure.

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What symptoms will the patient notice when an arrhythmia occurs and how to act? How to distinguish it from another cardiac pathology?

The patient’s symptoms will also be determined by the variant of the arrhythmia. If the arrhythmia is one that produces slow heart rhythms, the patient will present varying degrees of dizziness, a sensation of lightheadedness, instability, up to total loss of consciousness.

If we are in the presence of accelerated pulsations, the patient will notice more or less rapid palpitations and, according to the patient’s tolerance, chest pain, dizziness, profuse sweating and loss of consciousness may be added. The most prudent way to act in the face of this symptomatology is to go immediately to an emergency department, by your own means or through the medical emergency systems (061 or 112), to record the arrhythmia present through an electrocardiogram and treat it in a timely manner.

How should arrhythmias be treated?

The treatment of cardiac arrhythmias is the responsibility of the cardiologist and, even more so, of the cardiologist specializing in cardiac rhythm disorders called electrophysiologist. The treatment of this condition consists, first of all, in determining whether the patient, in addition to the arrhythmia, has a structural heart disease, which accompanies or is the cause of the arrhythmia. Tests would be performed to determine whether there is a coexisting heart muscle disease (cardiomyopathies), valvular conditions (valvulopathies) or coronary artery disease, since the best therapeutic option will depend on this.

The therapeutic variants range from medication (multiple antiarrhythmic drugs), electrical therapy (external electrical cardioversion) and, in the vast majority of cases, the interventional option, through radiofrequency ablation, the latter being the most advisable and the most effective in almost all cases.

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When should a pacemaker be used and why?

The cardiac pacemaker is a device that is only suitable for the treatment of bradyarrhythmias or slow heart rhythms. Its main objective is, as the word says, to mark the rhythm, or in other words, to prevent the patient’s heart rate from dropping below certain critical values, which could compromise the patient’s life or significantly affect his quality of life. For this reason, its indication is very well determined and is fundamentally applied to certain degrees of atrioventricular block, sinus node disease, neurocardiogenic syncope and bi- and trifascicular block.

Today’s pacemakers are a highly durable and effective cardiac pacing system that allows people to resume their normal life. In addition to saving the patient’s life in the vast majority of cases, since this would be impossible without this external generation of the electrical impulse, when it has already been exhausted in the heart itself.