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Types of Arrhythmias

Stephen Sinatra
EKG machine screen in a hospital room

EKG machine screen in a hospital room

Most of us take our heart’s continual and steady beating for granted, that is, until our heart skips beats or starts to palpitate, or race. When our heart gets out of sync, either by pulsating in an irregular rhythm or suddenly speeding up, we’re said to have an arrhythmia. An irregular heartbeat is one of the most common reasons people see cardiologists and may be benign or life threatening; one-third of all arrhythmias occur in normal hearts, and rarely are cause for concern.

Here are the basic types of arrhythmias, which I’ll get into below:

Understanding Arrhythmias

As long as you and your physician know what kind of arrhythmia you’re dealing with, abnormal heartbeat changes are very treatable. If your heartbeat is abnormally high, and you’re not exercising or emotionally upset, you are said to have tachycardia. If your heart rate slows to less than 50 beats per minute, you have bradycardia. A person who experiences both has brady-tachy syndrome.

Atrial Fibrillation

Sometimes referred to as “A-fib” or “AF”, atrial fibrillation is the most common type of serious arrhythmia. A-fib occurs when the heart’s upper two chambers (atria) do not contract in response to the pacemaker’s electrical impulses; rather, they start reacting to various other electrical signals scattered throughout them. Think of being on a guided museum tour where you can’t follow the tour guide because all the other tourists are shouting out directions and blocking your view. When the pacemaker is drowned out by other electrical signals, the atria do not forcefully contract and send blood into the ventricles to be pumped throughout the body. Instead, the atria “fibrillate,” or start rapidly vibrating, which can cause heart rate to increase up to 250 beats per minute.

A person may feel the fibrillation as quivering, or may not feel it at all. Other signs of A-fib include dizziness, weakness, shortness of breath, or general flu-like symptoms. Most people can tolerate the high and/or low heartbeats of A-fib for temporary periods; however, when episodes last more than 24 hours or heart rate variance is extreme, the heart can experience considerable strain, which may lead to heart attacks or even congestive heart failure. Regular occurrences of A-fib can also increase a person’s risk of stroke. Because blood is not forcibly contracted into the ventricles, but flows into them by virtue of gravity, it pools in the atria and the heart ultimately pumps less blood through the body. Eventually, clots may form on atrial walls, then break off and enter the arteries.

While A-fib does occur in healthy hearts, more often than not it is associated with heart disease. A-fib may be due to long-term high blood pressure, valvular disease, enlarged atria, or atria that do not contract properly. Malfunction of the heart’s electrical conduction system due to age or metabolic states like hyperthyroidism can also lead to A-fib. Most people experience recurrent A-fib, meaning that their condition comes and goes. The primary goals in treating recurrent A-fib are to normalize heart rate and rhythm through various therapies and to prevent the formation of blood clots (see “Arrhythmia Treatments” below).

Ectopic Heartbeats and Premature Heartbeats (PACs and PVCs)

Usually harmless, an ectopic beat is a skipped or extra heartbeat. Ectopic beats may occur for no apparent reason, or may be due to another issue such as an electrolyte imbalance in the blood, ischemia (lack of oxygen) caused by inadequate blood supply to the heart, or heart disease. Testing for ectopic beats is advisable in order to rule out other types of cardiac arrhythmias, though treatment is usually not necessary unless the irregular beats occur very frequently, are severe, or due to an underlying cause.

Premature heartbeats are extremely common, usually harmless, and may not cause any symptoms. If the premature beat occurs in the one of the top chambers of the heart it is a premature atrial contraction, or PAC. When in one of the ventricles, it is a premature ventricular contraction, or PVC. While the PAC or PVC may feel like a “skipped” beat, it is occurring earlier than expected and is followed by a quick pause.

PACs and PVCs usually occur due to stress, use of stimulants (caffeine or other drugs) or alcohol, or low potassium states. They can be caused by heart conditions, though, such as lack of oxygen, mitral valve prolapse, or aging conduction systems. Most cardiologists will not prescribe drugs to treat premature heartbeats unless they are happening frequently and on a regular basis, and are accompanied by heart disease.

The next two types of arrhythmias can be deadly, and require immediate attention, especially in people who have experienced heart failure or whose heart muscles are inflamed, dilated, and don’t pump well, or when their left ventricle is dilated.

Ventricular Tachycardia

Ventricular tachycardia, or “V-tach,” characterizes an intense and prolonged racing of the heart and is like a runaway PVC. V-tach becomes dangerous if it lasts for more than a few seconds; it can also turn into ventricular fibrillation.

Ventricular Fibrillation

With ventricular fibrillation, or “V-fib,” chaotic electrical signals throw the ventricles off rhythm and they begin to quiver or vibrate. This is very dangerous because when the ventricles do not forcibly contract, the heart can’t supply itself and the rest of the body with life-sustaining blood. V-fib may occur during a heart attack or in a person whose heart is already weakened due to disease or another condition.

Stop PVCs (Premature Ventricular Contractions) Naturally

Causes of Arrhythmia

While changes in heart rate are a normal part of living, the pattern of electrical charges that maintain heartbeats can get easily thrown off. The following situations often lead to or exacerbate an arrhythmia, especially when chronic:

Diagnosing Arrhythmia

While some people recognize that something’s not right with their heartbeat, others may be asymptomatic. If you notice a heartbeat irregularity or experience other cardiac symptoms like shortness of breath or chest pain, your physician can perform an echocardiogram (ECG or EKG) to test for arrhythmia and determine if it is serious, i.e. if heart muscle or valvular disease is at issue. Since palpitations not may occur during the actual EKG test, you may be instructed to wear a portable Holter monitor, which will record your heart rhythm during normal activities to demonstrate what type of arrhythmia you have and how frequently it is occurring.

Misdiagnosis happens, though, as chronic panic disorder (CPD) is often confused with arrhythmia. The recurrent episodes of fear and/or discomfort that characterize CPD can lead to excessive adrenaline release, and result in chest pain and heart palpitations. On a related note, EMF exposure may be an easily overlooked cause of arrhythmia; doctors need to start asking patients who experience irregular heartbeat about their use of cellular and cordless phones, wireless internet, baby monitors, etc.

Sinatra Solutions: Arrhythmia Treatments

The goal with arrhythmia treatments is to bring the heart back into rhythm. For otherwise healthy people with occasional bouts of arrhythmia, this can usually be accomplished through a few lifestyle changes: reducing stress, adding specific foods to the diet, and supplementing with a few key nutrients. People with more serious conditions like recurrent A-fib coupled with heart disease, ventricular tachycardia or ventricular fibrillation, may also require pharmaceutical and even surgical interventions.

Uncontrolled emotional stress not only causes arrhythmias, but is linked to the development of many health problems including hypertension, type II diabetes and obesity. Have you ever heard the saying, “10 percent is circumstances and 90 percent is how you deal with them”? Learn to deal with day-by-day stressors in a healthy way by cultivating lifestyle habits that help you relax.

Mind-body therapies like yoga, meditation and Tai Chi are particularly helpful to train your mind to more calmly process seemingly stressful information. These therapies also encourage deep abdominal breathing, which is especially important for people with arrhythmias. Deep breathing improves HRV, which increases your ability to cope with stress while reducing your likelihood of experiencing a sudden cardiac event. Regular, moderate exercise is great for keeping stress at bay, and activities like playing with your pets or children, getting a massage, gardening, playing games, or engaging in some kind of creative project may also relax you. The trick is to, on a regular basis, generate more activity from the parasympathetic branch of your autonomic nervous system, and decrease sympathetic branch activity.

Cold-water fish like salmon, scrod, mackerel, sea trout and even sardines are great sources of omega-3 fatty acids, which have been shown in studies to protect against sudden cardiac death caused by lethal arrhythmias. Anti-inflammatory omega-3s also relax the smooth muscle in blood vessel walls to keep blood pressure low, and can help keep the blood thin. Make sure to avoid farm raised (look for “wild-caught”) fish or fish that have otherwise been exposed to environmental pollutants like methyl mercury.

Consuming an abundance of dark, leafy greens like chlorophyll-rich kale and spinach can help prevent arrhythmias, as these veggies are full of magnesium. Magnesium, a mineral required for over 300 enzymatic reactions in the body, is also found in foods like avocados, almonds, pumpkin seeds, and whole grains. As low potassium levels can also cause arrhythmias, snacking on bananas, oranges, figs, and raisins, and incorporating more yogurt, whole grains and potatoes into your diet can help you get enough of this mineral important for electrolyte balance. A diet high in potassium is associated with lowered risk of stroke-related death.

In general, sticking to an anti-inflammatory diet most of the time supports cardiovascular health.

Nutritional supplements that can help stabilize erratic heart rhythms include:

People with occasional AF, and with normal heart size and valve function are at lower risk of blood clots, and can usually manage the viscosity of their blood by taking natural blood thinning supports like:

Note: People taking Coumadin (warfarin) should consult their physicians before supplementing with blood thinning nutrients to avoid thinning the blood too much.

Pharmaceutical and Surgical Interventions

People with troublesome A-fib or ventricular arrhythmias are candidates for anti-arrhythmic medications such as digoxin, which helps control ventricular contractions, calcium channel blockers, which can help regulate heartbeat, and beta blockers (Inderal, Lopressor, Corgard) which are used to control high heart rates. Other medications like Amiodarone, which relax heart muscle, may also be prescribed. Many of these drugs have a high rate of dangerous side effects, though, and can trigger arrhythmias and even sudden death. Natural treatments may be safer bets, unless patients are monitored in the hospital for negative side effects.

People who experience A-fib on occasion, and otherwise have healthy hearts, may benefit more from a hospital intervention known as electrical cardioversion. By sending a jolt of electricity into the atria through defibrillator paddles applied to the chest, this shock therapy helps reset a racing heart without risking side effects associated with antiarrhythmic drugs. Cardioversion is generally useful for people who have not been suffering from A-fib for more than six months.

As people with recurrent AF have to watch out for blood clotting, anticoagulation medications like Coumadin (warfarin) are usually warranted, especially if structural heart disease or other heart disease risk factors like family history, diabetes, leaky heart valves, or high blood pressure are present. While aspirin and natural blood thinning agents like fish oil, garlic, and nattokinase are effective blood thinners, they are not as effective as Coumadin.

In some cases, more invasive procedures may be necessary. Some patients with very slow heart rates may need a mechanical pacemaker implanted, as may patients with very high heart rates or heart rates which fluctuate between both extremes for whom medication has proved ineffective. Catheter ablation, another procedure which involves sending radio frequencies into the heart’s electrical “problem areas” to stop abnormal rhythms in their tracks, may also useful, especially when repeated; a recent French study (Weerasooriya R, et al.) demonstrated that arrhythmia-free rates significantly increased in patients with whom the procedure was performed twice.

Patients with life-threatening arrhythmias like ventricular fibrillation and ventricular tachycardia, may benefit from an automated implantable cardioverter defibrillator (AICD) devices. Surgically implanted into a patient’s abdominal wall, the AICD works like a “mini-defibrillator”: based on a programmed limit, it senses when the heart is electrically over-stimulated and fires an electrical discharge to break up the offending rhythm.

For more information on natural heart strengtheners, check out Lower Your Blood Pressure in Eight Weeks and The Sinatra Solution: Metabolic Cardiology.

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© Stephen Sinatra, MD. All rights reserved.

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