Types of Arrhythmias

By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

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:

  • Atrial fibrillation, or “a-fib”
  • Ectopic (skipped) heartbeats
  • Premature heartbeats: PACs and PVCs
  • Ventricular tachycardia
  • Ventricular fibrillation, or “v-fib”

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.

6 Natural Ways to Stop PVCs (Premature Ventricular Contractions)

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:

  • More than just jitters: Caffeine overdose – Depending on a person’s sensitivity, drinking too much coffee, tea or caffeinated soda can trigger rapid or skipped heartbeats. A nervous system stimulant, caffeine also acts as a diuretic, and can contribute to magnesium deficiency, which may lead to arrhythmias.
  • Electrolyte imbalances – Low potassium and other electrolyte imbalances in the blood can also cause arrhythmias. As electrolytes such as potassium, magnesium, sodium help conduct electric charge through the body, a balance of them is necessary to ensure proper muscle contraction and nerve impulses. We lose electrolytes when we sweat (or suffer from chronic diarrhea) and have to replenish them through food, drinks or supplements.
  • Sugar shock – Eating too much sugar in one sitting can cause a person’s insulin levels to surge, which can lead to electrolyte imbalance due to potassium deficiency. Too much chronic insulin release can also can cause arterial inflammation, as well as affect overall hormonal balance (including adrenal response). Researchers believe that oxidative stress and inflammation underlie AF because these problems affect localized electrical activity in atrial muscle tissue. Individuals with AF also have significantly higher levels of C-reactive protein (CRP), a marker of inflammation, in their blood.
  • More stress than your heart can handle – Like sugar overdose, stress overload can also disrupt hormonal balance, and cause the heart to continually beat faster while the body chronically operates on sympathetic nervous system overdrive. Stress is now considered a risk factor for hypertension and heart disease. Interestingly enough, more sudden deaths due to lethal arrhythmias or heart attacks occur on Mondays, as workers experience an “outpouring” of stress hormones as they gear up for work.
  • Drugs and medications – It’s not just illegal stimulant drugs like cocaine which can cause your heart to beat irregularly, prescription drugs like Ritalin (methyphenidate), which prescribed to treat attention deficit hyperactivity disorder, tricyclic antidepressants and even birth control pills can disrupt heartbeat. Sometimes the drugs used to correct the arrhythmia, itself, such as digitalis and calcium channel blockers can worsen it. Over-the-counter cold medications and asthma sprays containing ephedrine or pseudoephedrine may also speed up or bring on a more forceful heart rate.
  • Cigarette smoking – A cardiovascular nightmare for several reasons, cigarettes also contain nicotine, a stimulant drug, which can cause a racing heartbeat. Quit, if you haven’t already.
  • Alcohol – While many health experts agree that a glass of wine a day is a health mainstay, for people with arrhythmias, alcohol can exacerbate the situation. This is especially an issue during the holidays when people tend to mirthfully over-consume alcohol and food.
  • Overeating and eating disorders – Regular overeating, which can lead to overweight and obesity, can also increase risk of arrhythmias. Interleukin 6, a pro-inflammatory cytokine, is produced in fat tissue; hence people with excess body fat are more prone to low-grade systemic inflammation. Anorexia and bulimia are also associated with increased risk of ventricular arrhythmias.
  • Chemical food additives – As a rule of thumb, the more natural and simple ingredients in a food or drink product, the better. Chemical additives like monosodium glutamate (MSG), a form of glutamate added to food to make it tastier, are excitotoxins: they over stimulate brain neurons to the point of cell death. Not only do excitotoxins play a role in the development of depression, obesity and degenerative brain diseases like Alzheimer’s, but they also contribute to strokes, especially in people who are magnesium-deficient.
  • Environmental toxins – Pesticides, herbicides, cadmium, lead, mercury, and aluminum are also excitotoxins. Exposure to mercury from vaccines, toxic fish or dental fillings and lead from paints, batteries and some drinking water can cause oxidative stress and poison enzyme systems. Toxins also tend to consume magnesium, an electrolyte which support healthy heart function and structural integrity. Air pollution has also been shown to increase stress response, which can increase risk of arrhythmia in people with pre-existing heart disease and abnormal heart rate variability.
  • Electromagnetic fields (EMFs) – Some radio frequency (RF) emissions are now known to directly affect heart rate. A recent study showed that exposure to cordless phone RF (and comparatively, WiFi) directly increased heart rate, even causing tachycardia, and increased sympathetic nervous system activity (adrenal response), as demonstrated by heart rate variability (HRV) measurements. Wireless RF emissions also suppress HRV. Grounding, or attuning to the Earth’s natural electromagnetic potential, can counteract negative RF-related cardiac effects by balancing autonomic nervous system activity (as shown through improved HRV).
  • Sudden strenuous exercise – “Warming up” for at least 10 minutes before exercising heavily allows your heart to gradually adjust to increasing activity. Sudden bursts of activity catch the heart off guard and can lead to palpitations. It’s also important to engage in a 10-minute cool down after exercising, especially when exercising your legs. Mixing physical stress with competitiveness is another bad combination, so try to not get too emotionally invested in the outcome of whatever activity you’re engaged in.

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.

  • Relax…

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.

  • Heart-smart eats

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.

  • Nutraceutical supports

Nutritional supplements that can help stabilize erratic heart rhythms include:

  • Fish oil (2 to 4 grams daily) – Just like fish, capsules of fish oil are full of anti-inflammatory omega-3s.
  • Coenzyme Q10 (100 to 300 mg daily) – A sound intervention for arrhythmias, CoQ10 stabilizes membranes of the electrical conduction system. An antioxidant which helps protect against oxidative stress, CoQ10 also plays a crucial role in production of energy molecules (adenosine triphosphate, or ATP) that fuel heart function. For this reason alone, CoQ10 is probably the best supplement you can take for your heart. As a preventative and restorative nutrient, CoQ10 fights the heart disease which can mean the difference between a benign and malignant arrhythmia in many cases.
  • L-carnitine (1 to 3 grams daily) – Like CoQ10, L-carnitine assists in the production of ATP molecules which can prevent the heart from becoming diseased. As an antioxidant and vasodilator, L-carnitine is particularly helpful in the treatment of coronary artery disease: it helps deliver oxygen to blocked arteries and improves blood flow, while protecting against damage to the arterial lining.
  • D-ribose (5 to 15 grams daily): Supplementing with D-ribose helps the body maintain a steady pool of ATP as reserve energy. This is particularly important when the body’s ability to recycle ATP is exceeded by overall ATP expenditure, which is at issue in people with heart disease and more chronic or otherwise serious arrhythmias. While the body makes ribose, extra may be needed if energy reserves are facing depletion.
  • Magnesium (400 to 800 mg daily) – Essential for healthy heart function, magnesium also helps the body generate ATP. Deficiency (less than 130 mg per day) can result in electrolyte imbalances that may cause ectopic heartbeats.
  • Potassium (500 to 1,000 mg daily) – Crucial for the overall functioning of nerves and muscles, potassium is particularly important for maintaining proper heart rhythms. A mineral that helps counteract the blood-pressure-raising effects of sodium, potassium helps relax smooth muscle in blood vessel walls. People who take diuretics are especially vulnerable to potassium deficiency, as are people who consume excess caffeine and/or alcohol. Note: people with kidney problems should not supplement with potassium.
  • Hawthorn berry (500 mg, two to three times daily) – An herb with powerful antioxidant qualities, hawthorn can enhance coronary circulation and increase cardiac energy levels, and is often prescribed as a substitute for digitalis, one of the most commonly ordered medications for improving contractibility in a weakened heart; people taking digitalis or other hypertensive medications should talk to their physicians before supplementing with hawthorn berry.
  • Vitamin C (1,000 mg in divided doses with food) – As a powerful antioxidant, vitamin C helps combat arterial inflammation (people with AF have much higher levels of CRP in their blood streams) and helps keep blood pressure down. People tend to become depleted in vitamin C when under a lot of psycho-emotional stress, which increases their risk of stroke-related death. Essential for tissue growth and repair, vitamin C also plays an important role in the proper utilization and absorption of calcium and iron; as too much vitamin C can bring about iron overload states, people with hemochromatosis or thalassemia major should be especially careful not to ingest more than 200 mg per day.

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:

  • Fish oil (2 to 3 grams daily).
  • Garlic (1 to 2 grams daily in capsule form, or ½ to one clove raw garlic per day) – Not only is garlic a powerful antimicrobial agent (it can combat at least 23 different types of bacteria and 61 types of fungi) that helps to enhance the immune system, it is also a powerful anticoagulant; so much so, that it should not be taken in conjunction with oral anticoagulants like aspirin or Coumadin, or injectable agents like heparin. Garlic also has an ACE-inhibiting quality (ACE inhibitors are a class of antihypertensive drugs) and has been shown to help lower blood pressure.
  • Nattokinase (100 mg daily) – Nattokinase is an enzyme derived from fermented soybeans. It has powerful clot-busting and blood thinning potential. Nattokinase may be found in health food stores in supplement form.
  • Limbrokinase (20 mg capsules taken on an empty stomach 1 time per day) – Like nattokinase, lumbrokinase is an enzyme which helps prevent blood from forming and even helps dissolve existing clots.
  • Vitamin E (200 to 300 IU) – This fat-soluble anticoagulant and vasodilator helps reduce risk of heart attacks. As an antioxidant, it prevents damage to arterial lining and helps stabilize plaques. As there are 8 different types of vitamin E, it’s best to supplement with a mixed tocopherol product that contains gamma-tocopherol and tocotrienols.
  • Bromelain (600 mg) – An enzyme derived from pineapple, bromelain helps keep blood viscosity at a healthy levels. Not just for heart health, bromelain also contains chemicals that interfere with the growth of tumor cells, and, as an anti-inflammatory agent, can help prevent or reduce joint pain and swelling.

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.

References:

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