rhythm of my heart: heart rhythm disorders

CardiacElectrophysiologyEric C. Mak, MD

Cardiology

www.SpringfieldClinic.comwww.SpringfieldClinic.com

Heart Rhythm Disorders

• An introduction to the normal electrical system of the heart, i.e. Sinus Rhythm

• Ectopy (extra beats)• Bradycardias (slow heart rhythms)• Tachycardias (fast heart rhythms)• Q/A

Sinus Rhythm


• Arrhythmias are abnormal heart rhythms, i.e. rhythms that are not sinus– They can be fast or slow– They can be symptomatic or asymptomatic– They can benign or serious


• Common Questions– Are arrhythmias bad?– What can I do if I have an arrhythmia?– Do I have to do anything if I have an

arrhythmia?– How do I know if I have an arrhythmia?


• Not all arrhythmias cause palpitations

• Not all palpitations are caused by arrhythmias

How do I know if I have an arrhythmia?


• EKG: 10 sec “snapshot”• Holter monitor: 24-48 hr• Event monitor: 1-4 weeks

• Implantable loop recorder: 3 years

Ectopy, aka extra beats

PACs / APDsPVCs / VPDs


• Symptoms• Prognosis• Treatment


• Symptoms– “skipped beats”– Tired / fatigue


• Prognosis– VERY common; everyone has a few PACs

and PVCs– Generally benign, though very frequent

PVCs (when PVCs are over 20-25% of total beats) can cause weakening of the heart


• Treatment– Do nothing– Medicines– Procedures


• Treatment– Do nothing– Medicines: beta blockers and calcium

channel blockers, though the side effects can sometimes be as bad or worse than the ectopy

– Procedures: very effective if the ectopic beats can be located; the more ectopic beats, the easier to locate them

Bradycardia, aka slow heart rhythms

Sinus node dysfunctionSick sinus

Heart block


• Symptoms– Tired / fatigue (worse with exercise)– Shortness of breath (worse with exercise)– Fainting / passing out


• Prognosis• Treatment

– Do nothing– Medicines– Procedures


• Treatment– Do nothing– Medicines: stop medications that slow the

heart rate– Procedures: pacemaker


• Prognosis– Sinus node dysfunction: pacing improves

symptoms, but does not prolong life– Heart block: pacing improves symptoms

and prolongs life

Tachycardia, aka fast heart rhythms

Atrial FibrillationAtrial FlutterAVNRTAVRTAtrial Tachycardia

Ventricular TachycardiaVentricular Fibrillation

SVTs (Supraventricular Tachycardias)Atrial FibrillationAtrial Flutter

AVNRTAVRTAtrial Tachycardia


SVTs (Supraventricular Tachycardias)



• Symptoms– Palpitations, usually starts and stops

abruptly– Sometimes with chest pain, shortness of

breath, and lightheadedness– Fainting and passing out is rare


• Prognosis– Generally very symptomatic, but benign


• Treatment– Do nothing: sometimes coughing, Valsalva

maneuvers can stop episodes– Medicines: adenosine given in the hospital

can often stop episodes; beta blockers and calcium channel blockers to prevent episodes at home

– Procedures: EP study and ablation

Atrial Fibrillation and Flutter



• Symptoms– Palpitations– Tired / fatigue– Shortness of breath


• Prognosis– Increased risk of stroke in patients with

other medical problems• Congestive heart failure• High blood pressure• Older patients• Diabetes• Prior strokes• Patients with previous heart stents• Women


• Treatment– Blood thinners / aspirin to reduce risk of

stroke– Rate Control

• Beta blockers and calcium channel blockers to control heart rate

• Ablate AV node and implant pacemaker

– Rhythm Control• Antiarrhythmic drugs• Catheter Ablation


• Catheter ablation success rates– Atrial flutter: 90%– Paroxysmal atrial fibrillation: 70-80%– Long persistent atrial fibrillation: <50% with

most patients requiring multiple procedures

• Ablation of atrial fibrillation has not been proven to reduce stroke risk, so generally need to continue blood thinners

Sudden Cardiac DeathAtrial FibrillationAtrial FlutterAVNRTAVRTAtrial Tachycardia


Sudden Cardiac Death



• Symptoms– Cardiac arrest– Passing out without warning– But most people have no symptoms


• Symptoms• Risk Factors• Prognosis• Treatment


• Risk Factors– Cardiomyopathy– Ejection Fraction of 35% or less


• Treatment– Do nothing– Medicines: heart failure medicines (beta

blockers, ace inhibitors, statins)– Procedures: implantable defibrillator


• Symptoms• Risk Factors• Prognosis• Treatment


• Prognosis– One third of patients that meet criteria for

ICD will die within 5 years– ICDs reduce the risk of death by over half

Hearth Rhythm Disorders



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rhythm of my heart: heart rhythm disorders

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