Arrhythmia

What Is Arrhythmia? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Ashley Welch
By Medically Reviewed by 
Reviewed:
Medically Reviewed

An arrhythmia is an abnormal heart rhythm or heartbeat. It may feel like a fluttering or racing of the heart.

There are two basic types of arrhythmias:

  • Bradycardia The heartbeat is too slow, resulting in a heart rate of less than 60 beats per minute
  • Tachycardia The heartbeat is too fast, resulting in a heart rate greater than 100 beats per minute

Atrial fibrillation, sometimes called afib, is the most common type of arrhythmia. It is an irregular heartbeat that sometimes feels like quivering or fluttering in the chest.

Some arrhythmias are harmless and may have no noticeable symptoms.

Others can be serious or life-threatening. In some instances, abnormal or irregular heart rhythms can cause the heart to stop beating. This is called cardiac arrest.

Signs and Symptoms of Arrhythmia

Many arrhythmias don’t have any symptoms.

If they do, common signs and symptoms of an arrhythmia may include:

  • Palpitations (may feel like fluttering in your chest, like your heart is skipping a beat, or like it is beating too hard or too fast)
  • Feeling pauses between heartbeats or an irregular pattern
  • Fatigue, weakness, light-headedness
  • A slow heartbeat

Some arrhythmias are medical emergencies. During an arrhythmia, the heart may not be able to pump enough blood to the body and may stop working.

If you experience the following symptoms, call 911:

  • Significant weakness, dizziness, or light-headedness
  • Fainting
  • Shortness of breath
  • Chest pain
  • Blurred vision

Causes and Risk Factors of Arrhythmias

Arrhythmias happen when the electrical signals that control your heartbeat don’t work properly.

This can happen if the specialized heart cells that send the electrical signals are damaged or if the electrical signals don’t travel properly through the heart.

A normal heartbeat can also be disrupted if the heart produces too many electrical signals.

Sometimes the cause of an arrhythmia is unknown.

Arrhythmias are common in older adults, who are more likely to have heart disease, high blood pressure, and other health conditions that can cause arrhythmias.

Some medications can also cause arrhythmias as a side effect, including tricyclic antidepressants (TCAs), antihistamines, and beta-blockers.

Additionally, illegal drugs, such as cocaine, methamphetamines, and stimulants like caffeine and nicotine can cause arrhythmias.

Common risk factors for arrhythmias include:

  • Heart attack
  • Heart failure or cardiomyopathy
  • Abnormal heart valves
  • Congenital (present at birth) heart defects
  • High blood pressure
  • Sleep apnea
  • Smoking
  • Thyroid problems
  • Extreme emotional stress or anger

How Is Arrhythmia Diagnosed?

A number of tests and devices are used to detect an arrhythmia.

Diagnosis usually requires recording the heart’s electrical activity using an electrocardiogram, or ECG.

A Holter monitor — a portable, 24- or 48-hour ECG — may also be used if your doctor wants to see your heartbeat over a longer period.

During an ECG, small patches or stickers called electrodes are stuck to several spots on your chest and body.

These electrodes will generate a picture of your heart’s electrical activity so doctors can see where any irregularities may occur.

An echocardiogram — a type of ultrasound that uses sound waves to produce images of your heart — may also be used to diagnose heart problems that can lead to arrhythmias.

Stress tests, which use physical exertion (such as running on a treadmill) or drugs to simulate exercise, can trigger an arrhythmia and help a doctor make an accurate diagnosis.

Cardiac catheterization, a procedure in which a tiny tube is threaded through a vein or artery and into the heart, can help your doctor measure pressures in the heart or evaluate for potential blockage of the coronary arteries.

Your doctor may also order a chest X-ray to see if your heart is larger than normal and blood tests to check your thyroid levels. This can help determine if you have a thyroid issue that may be causing an arrhythmia. A sleep study could help determine if sleep apnea is the culprit.

Duration of Arrhythmia

The frequency and duration of arrhythmia depends on the cause. For example, when an arrhythmia is caused by a treatable condition, like an overactive thyroid, the irregular heartbeat may go away when the thyroid problem is treated.

Arrhythmias caused by progressive or permanent damage to the heart, however, tend to be long-term issues and may need to be managed with medications or treated with surgery.

Treatment and Medication Options for Arrhythmia

Arrhythmias can be treated with lifestyle modification, medications, or medical procedures/surgery.

Medication Options

Medications can slow down a heartbeat that is too fast. They can also be used to even out or stabilize an abnormal heart rhythm.

Drugs used to treat arrhythmias include:

  • Adenosine slows a racing heart by slowing its electrical signals.
  • Atropine temporarily treats a slow heart rate.
  • Beta-blockers work by slowing the heart rate and decreasing the effects of adrenaline on the heart, thereby lowering blood pressure.
  • Anticoagulants, or blood thinners, work by making it more difficult for blood to clot. These medications do not dissolve existing blood clots, but rather prevent new ones from forming or existing ones from growing bigger. Anticoagulants are commonly prescribed to people who are at risk of blood clots, such as those with atrial fibrillation.
  • Calcium channel blockers, or “calcium antagonists,” interrupt the movement of calcium into the heart and can slow the heart rate.

  • Digitalis helps slow the heart rate and can help the heart strengthen its contractions when its pumping function has been weakened.

Medical Procedures

Some arrhythmias, including heartbeats that are too slow, can be treated with a pacemaker.

A pacemaker is a medical device that’s placed under the skin on your chest. The device electronically monitors and, by sending electrical impulses to your heart, moderates your heartbeat.

If an arrhythmia is life-threatening, such as ventricular tachycardia or ventricular fibrillation, your doctor may recommend an implantable cardioverter defibrillator (ICD). An ICD is a battery-powered device that is placed under the skin and is connected to the heart by thin wires to keep track of your heart rate. If the device detects an abnormal heartbeat, it will deliver an electric shock to the heart to restore a normal heart rhythm.

Another option might be a minimally invasive surgical procedure known as a catheter ablation. In this approach, a surgeon uses a catheter to create small scars in the heart tissue where the arrhythmia is occurring. The goal is to purposely destroy the abnormal tissue that is causing irregular rhythms and restore proper function. Catheter ablation is often considered if medication options are not effective, notes the Cleveland Clinic.

Alternative and Complementary Therapies

Regardless of any medical interventions that are recommended for treating arrhythmia, your doctor may also advise common-sense lifestyle changes, including:

  • A healthy, low-fat, low-sodium diet
  • Regular exercise
  • Smoking cessation
  • Weight loss to avoid obesity

Additionally, some arrhythmias can be treated with simple home exercises called vagal maneuvers to help control heart rate.

Some vagal maneuvers include:

  • Gagging or coughing
  • Holding your breath and bearing down
  • Putting your fingers on your eyelids and pressing down gently
  • Dunking your face in ice water

Vagal maneuvers aren’t right for everyone, and they work only for certain types of arrhythmias.

Talk with your doctor before trying any of these exercises.

Prevention of Arrhythmia

Not all cardiac arrhythmias can be prevented. Still, there are steps you can take to reduce risk factors.

You can reduce your risk of an arrhythmia caused by coronary artery disease by:

  • Eating a heart-healthy diet rich in fruits and vegetables and avoiding saturated and trans fats
  • Maintaining a healthy weight
  • Getting regular exercise
  • Controlling high blood pressure and cholesterol
  • Quitting smoking
To minimize the chance of arrhythmias caused by drug interactions, be sure to talk to your doctor or pharmacist about the various medications you are taking. Reducing your dosage or switching to another medication may be needed to eliminate the arrhythmia.

Complications of Arrhythmia

Complications of arrhythmias can include:

Stroke Arrhythmias such as atrial fibrillation are associated with an increased risk of blood clots, which, if broken loose, can travel from the heart to the brain and block blood flow. This is what causes a stroke. Medications called blood thinners can greatly reduce the risk of stroke. Your doctor will determine if this medication is right for you, depending on the type of arrhythmia you have and your blood clot risk.

Heart Failure Ongoing arrhythmias can lead to a decline in the ability of the heart’s lower chambers to pump blood properly. Heart failure as the result of an arrhythmia is more common in individuals who already have heart disease.

Sudden Cardiac Arrest The heart may stop beating suddenly and unexpectedly as a result of a type of arrhythmia called ventricular fibrillation.

Research and Statistics: How Many People Have Arrhythmia?

Atrial fibrillation, the most common form of arrhythmia, affects at least 2.7 million people in the United States.

In 2018, afib was reported as the underlying cause of death in 25,845 death certificates and mentioned in a total of 175,326. By 2030, an estimated 12.1 million Americans will have afib.

Looking at all arrhythmias, a 2018 study of more than 500,000 adults in the United Kingdom found that 2.4 percent had a heart rhythm abnormality. The prevalence increased with age, with nearly 5 percent of those ages 65 to 73 affected. Atrial fibrillation and bradyarrhythmias were more common than supraventricular and ventricular arrhythmias.

Racial Disparity in Arrhythmia

Substantial differences in the risk of arrhythmias exist among various racial and ethnic groups, and some of them may be surprising. Research shows that despite having a higher prevalence of risk factors for arrhythmias, including hypertension and diabetes, Black Americans, Hispanics, and Asians have a lower rate of atrial fibrillation than white Americans.

Researchers hypothesize that the underlying reason for this may be that white people are genetically more susceptible to developing arrhythmias.

Related Conditions and Causes of Arrhythmia

Certain conditions make arrhythmias more likely, including hyperthyroidism, or an overactive thyroid, and sleep apnea.

Hyperthyroidism is a condition in which the thyroid gland produces too much of a hormone called thyroxine. This can accelerate your metabolism and lead to unintentional weight loss. It can also affect your heart, causing rapid or irregular heartbeats. Hyperthyroidism can be treated with medications or surgery.

Sleep apnea is a sleep disorder in which breathing repeatedly stops and starts during sleep. Loud snoring, gasping for air when you sleep, and excessive daytime sleepiness are all signs of sleep apnea. The condition increases the risk of heart problems, including heart attack, stroke, and arrhythmias like atrial fibrillation. Sleep apnea can be treated with lifestyle changes, such as weight management and smoking cessation, or with certain devices, like the continuous positive airway pressure (CPAP) machine.

Resources We Love

Favorite Organizations for Essential Information About Arrhythmia

American Heart Association (AHA)

The AHA is the nation’s leading organization for heart health and heart-related disorders. Learn about symptoms, diagnosis, and monitoring of arrhythmia, as well as tips for prevention and treatment of a heart rhythm disorder.

UpBeat.org

UpBeat.org is a subsite of the Heart Rhythm Society, an international non-profit organization representing medical and science professionals from more than 70 countries who specialize in cardiac rhythm disorders. Get the facts on arrhythmias and search the organization’s database for a certified heart specialist near you.

CardioSmart

CardioSmart is a patient engagement program from the American College of Cardiology (ACC) that provides information and resources on heart conditions. The ACC is committed to empowering patients to make better informed decisions about their health and has created “decision aids” to help those living with heart conditions like Afib navigate different treatment options.

Favorite Arrhythmia Support Group

My Afib Experience

Through this support network from the AHA, you can join a community of people with atrial fibrillation. Share your experiences and connect with others who are dealing with the same struggles of living with an arrhythmia.

Favorite Resource to Become an Advocate

Arrhythmia Alliance

Arrhythmia Alliance is a coalition of charities, patient groups, caregivers, and medical professionals with the mission to raise awareness and advance treatment and quality of life for people living with cardiac arrhythmias.

Additional reporting by Lindsey Konkel.

Editorial Sources and Fact-Checking

Show Less