In my day-to-day professional practice, as a cardiologist specially trained in cardiac arrhythmias, I am frequently consulted for an “arrhythmia”. In a summarized and colloquial way, I would like these sentences to serve as a guide for those who have this concern. Perhaps, using the usual questions, it will be easier to answer.
What are arrhythmias?
The term arrhythmia encompasses all those alterations of the normal cardiac rhythm, from the most trivial or benign ones that do not even cause discomfort, such as extrasystoles or premature beats, which do not require treatment, to the most dangerous and much less frequent ones that can lead to sudden death.
Types of arrhythmias
- Benign, which do not compromise the life of the individual, but have different medical management. Among them we could highlight, as being the most common:
– Extrasystoles, which are premature beats and generally do not require treatment unless they generate a lot of discomfort.
– Paroxysmal supraventricular tachycardias (intranodal tachycardia, hidden accessory pathways or Wolff-Parkinson-White, which are usually bothersome and require treatment with catheters, with good results and negligible risks).
– Atrial fibrillation (and atrial flutter), which depending on the patient’s characteristics (age, risk factors, etc.), are treated with drugs, or even eliminated with catheters, with somewhat less success than the previous ones and a higher risk of complications. - Malignant, which can potentially lead to death of the individual. Among them are ventricular tachycardias, which can be of different origin, either genetic or due to damage to the heart, and whose treatment is very variable and more complex: from treatment with drugs, with catheters, to the implantation of subcutaneous defibrillators (implantable cardioverter defibrillator or ICD).
Why arrhythmias occur
Malignant arrhythmias can have a genetic origin or a cause derived from damage to the structure of the heart, such as infarction or dilatation and loss of strength of the left ventricle.
In the case of benign ones, the causes are generally of a different origin:
- Extrasystoles, are generally more frequent when taking exciting foods/drinks, being in a situation of stress anxiety, etc.
- Paroxysmal supraventricular tachycardias have their origin in small congenital alterations, in which the electrical system of the heart has an “extra nerve or pathway”, which under certain circumstances gives rise to a short circuit, initiating the tachycardia.
- Atrial fibrillation is a very common arrhythmia in the population, characterized by a rapid and irregular rhythm, and is more prevalent at older ages or in the presence of hypertension, diabetes, or disorders in the anatomy of the heart. This arrhythmia has been and is the protagonist in the last decade due to advances in its treatment.
Are some people more prone to arrhythmias?
There are some causes that are genetic, so family members are more likely to present them; congenital arrhythmias are not, as they are disorders in the development of the embryo and do not have to be hereditary. Others are due to unfavorable lifestyle habits and the presence of risk factors such as hypertension, and others are due to damage, such as a history of myocardial infarction.
How to prevent them
In some cases, such as supraventricular tachycardias or those of genetic cause, they will appear capriciously, but others, such as atrial fibrillation or those caused by damage acquired in the heart throughout life, are preventable by following healthy lifestyle habits and controlling risk factors.
The follow-up that a patient with arrhythmias should undergo
With all of the above, it is clear that the follow-up will have to be individualized in each case, but there is no doubt that, in the presence of palpitations, it is essential to be assessed by a cardiologist to detect or identify the arrhythmia, and to provide information on the possibilities of treatment in each case.