Cardiac arrhythmia

Cardiac arrhythmias occur for different reasons and in different forms. There are basically three types: when the heart beats too quickly (tachycardia), too slowly (bradycardia), and irregularly (arrhythmia). The treatment depends on the type and cause of the arrhythmia.

On average, the adult heart beats between 60 and 90 times a minute. A resting pulse of over 100 beats per minute is considered to be an accelerated heartbeat (tachycardia). A heart rate of more than 300 per min. is known as ventricular fibrillation. Ventricular fibrillation is another term for cardiac arrest and results in immediate death if it is not treated with defibrillation within the shortest possible time.  A resting pulse under 60 beats per minutes is considered to be a decelerated heartbeat (bradycardia). Sports people and very fit people normally have a resting pulse of between 50 and 60 beats per minute. An irregular heartbeat or arrhythmia is characterised by additional beats (extra systoles) and skips in the heartbeat. A special form, the [atrial fibrillation] is discussed in a separate chapter.

Typical symptoms of cardiac arrhythmia are a noticeably faster heartbeat (rapid heartbeat) and an irregular heartbeat (skipped heartbeats and palpitations). An irregular heartbeat is generally the manifestation of extra beats (extra systoles). They are often harmless; however, there can also be serious diseases underlying them. If the patient also experiences chest pain, dizziness, shortness of breath, fatigue or even loses consciousness, they should be immediately examined by a doctor.

Different diseases can cause cardiac arrhythmia. These include cardiac diseases such as angina pectoris, heart attack, heart valve defects, cardiac insufficiency or heart muscle inflammation. However, hyperthyroidism, drugs or certain medications can also cause cardiac arrhythmia. However, the causes of cardiac arrhythmia are rarely not organic.

An electrocardiogramm (ECG) is one of the most important examination methods for cardiac arrhythmias. It makes it possible to determine the underlying cause of the arrhythmia, such as uncoordinated activity in the electrical discharge rate (atrial fibrillation), a conduction disturbance from the atrium to the ventricles (atrioventricular block) or additional beats (extra systoles).

The treatment depends on the type and cause of the cardiac arrhythmia. Options include medication (antiarrhythmic drugs), surgery, a cardiac pacemaker or an electrophysiological procedure. Find out more about the different surgical options in the chapter entitled Surgery in the event of cardiac arrhythmia.

Different types of cardiac arrhythmias

Sinus rhythm

The sinus rhythm refers to a person’s normal, regular heartbeat. They are a normal consequence of the “ignition sparks” or electrical impulses triggered by the body’s own internal pacemaker: the sinus node

Atrial fibrillation

Atrial fibrillation is among the most common types of cardiac arrhythmia. It causes irregular electrical impulses in the atria with more than 300 excitations per minute. This stress prevents the heart from functioning properly. It pumps less blood and the cardiac output diminishes.

Possible treatments: antiarrhythmic agents, cardioversion or catheter ablation. Because atrial fibrillation promotes the formation of blood clots, which can cause a stroke, patients also need to take blood-thinner medications.

Ventricular fibrillation

At more than 400 beats per minutes, the frequency in the main ventricles is extremely high. The heart merely spasms but is not pumping any more blood. This immediately renders the person unconscious and, without taking immediate emergency measures (cardiac massage, defibrillation and resuscitation), death.

Treatment: Implanting of a cardioverter / defibrillator (ICD) is required

Ventricular flutter and ventricular tachycardia
(ventricular tachycardias)

Beating in the main ventricles is very fast – up to 300 times per minute. In this case, not enough blood is pumped into circulation. It is often due to a recent heart attack or one further in the past, but it can also be caused by a cardiac insufficiency. Immediate defibrillation (cardioversion) is life-saving.

Treatment: Long-term treatment usually involves implanting a cardioverter/defibrillator (ICD).

Supraventricular tachycardia

Supraventricular tachycardia can have several causes, e.g. bypass between the atria and main ventricles, double paths in the normal transmission (A-V node) or improperly functioning natural pacemaker (“defective spark plugs). The heart beats between 150 and 220 times per minute. Symptoms include heart palpitations, rapid heartbeat, dizziness and, in rare cases, unconsciousness.

Treatment: Emergency medication to control cardiac rhythm followed by electrophysiological examination with catheter ablation.

Extrasystoles

In the case of extrasystoles, a “misfiring” from the atria or main ventricles disrupts the normal sinus rhythm. These extrasystoles are very often harmless and usually unnoticeable. In some cases, the person complains of irregular heartbeat or skips in heartbeat.

Treatment: Treatment is not required in most cases.

Atrial flutter

Atrial flutter circles the right atrium at a flutter speed of 220 to 300 per minute. Only every second to third atrial excitation is transmitted to the main ventricles.

Possible treatments: blood-thinner medications, antiarrhythmic agents, cardioversion, catheter ablation.

Sinus rhythm

The sinus rhythm refers to a person’s normal, regular heartbeat. They are a normal consequence of the “ignition sparks” or electrical impulses triggered by the body’s own internal pacemaker: the sinus node

Atrial fibrillation

Atrial fibrillation is among the most common types of cardiac arrhythmia. It causes irregular electrical impulses in the atria with more than 300 excitations per minute. This stress prevents the heart from functioning properly. It pumps less blood and the cardiac output diminishes.

Possible treatments: antiarrhythmic agents, cardioversion or catheter ablation. Because atrial fibrillation promotes the formation of blood clots, which can cause a stroke, patients also need to take blood-thinner medications.

Ventricular fibrillation

At more than 400 beats per minutes, the frequency in the main ventricles is extremely high. The heart merely spasms but is not pumping any more blood. This immediately renders the person unconscious and, without taking immediate emergency measures (cardiac massage, defibrillation and resuscitation), death.

Treatment: Implanting of a cardioverter / defibrillator (ICD) is required

Ventricular flutter and ventricular tachycardia
(ventricular tachycardias)

Beating in the main ventricles is very fast – up to 300 times per minute. In this case, not enough blood is pumped into circulation. It is often due to a recent heart attack or one further in the past, but it can also be caused by a cardiac insufficiency. Immediate defibrillation (cardioversion) is life-saving.

Treatment: Long-term treatment usually involves implanting a cardioverter/defibrillator (ICD).

Supraventricular tachycardia

Supraventricular tachycardia can have several causes, e.g. bypass between the atria and main ventricles, double paths in the normal transmission (A-V node) or improperly functioning natural pacemaker (“defective spark plugs). The heart beats between 150 and 220 times per minute. Symptoms include heart palpitations, rapid heartbeat, dizziness and, in rare cases, unconsciousness.

Treatment: Emergency medication to control cardiac rhythm followed by electrophysiological examination with catheter ablation.

Extrasystoles

In the case of extrasystoles, a “misfiring” from the atria or main ventricles disrupts the normal sinus rhythm. These extrasystoles are very often harmless and usually unnoticeable. In some cases, the person complains of irregular heartbeat or skips in heartbeat.

Treatment: Treatment is not required in most cases.

Atrial flutter

Atrial flutter circles the right atrium at a flutter speed of 220 to 300 per minute. Only every second to third atrial excitation is transmitted to the main ventricles.

Possible treatments: blood-thinner medications, antiarrhythmic agents, cardioversion, catheter ablation.