Introduction
Hello and welcome to this podcast on arrhythmias featuring electrophysiologist Dr. Laurence Epstein, Chief of the Cardiac Arrhythmia Service at Brigham and Women's Hospital, who will answer commonly asked questions about arrhythmias, also know as irregular heartbeats.
Dr. Epstein, can you give us an overview of what happens during a heartbeat?
The human heart beats roughly 100,000 times a day, pumping blood through its chambers to the rest of the body. Over a lifetime, that corresponds to more than 2.5 billion heartbeats. A heartbeat is triggered by an electrical impulse that signals the heart's chambers – the upper chambers called the atria and the lower chambers called ventricles – to contract at the proper time. Many people, however, have abnormal heart rhythms caused by cardiovascular disease, resulting in abnormally fast or abnormally slow heartbeats called arrhythmias.
Can you tell us more about arrhythmias?
Arrhythmias are abnormal beats of the heart – heartbeats that are too slow or too fast or produce extra beats, skipped beats or beats coming from abnormal areas of the heart. Arrhythmias are sometimes referred to as heart palpitations, rapid heart beats or irregular heart beats. Fortunately, through research and treatment advances, we are able to effectively treat most cardiac rhythm disturbances.
Are there different types of arrhythmias?
Yes, there are. The most common type, affecting more than two million Americans, is atrial fibrillation, or afib. Afib occurs when the upper chambers of the heart, the atria, quiver rapidly and irregularly due to chaotic electrical activity. Afib is typically not life threatening but it can compromise the quality-of-life of the patient due to a wide range of symptoms including palpitations, fatigue and shortness-of-breath. Sudden cardiac death, which is most often caused by a very rapid arrhythmia of the ventricles (the lower chambers of the heart), is the single leading cause of death in the United States. Another type of arrhythmia is bradychardia, which is an abnormally slow heartbeat. An unusually fast heartbeat, on the other hand, is called tachycardia, which is most often due to an electrical short circuit in the heart.
What are the symptoms of arrhythmia?
Some of the more noticeable symptoms include fainting, dizziness, sensation of light-headedness, sensation of heart fluttering, sensation of a missed or extra heart beat, weakness, fatigue, shortness-of-breath, chest pain, and an intolerance for activity. It is important to note that not all arrhythmias have symptoms.
How are arrhythmias diagnosed?
An electrocardiogram, or ekg, is commonly used during diagnosis and records the heart's electrical currents during each heartbeat, using electrodes attached to a patient's arms, legs and chest. Holter monitors and event recorders are portable electrocardiograms that record electrical activity 24-hours to one month. Echocardiograms use ultrasound waves to show the heart's size, structure and motion. Advanced cardiac imaging is crucial to accurate diagnosis. We have other specialized tests – depending on the patient – that record the heart's electrical current and activity.
There's been so much in the news about heart disease in women, are arrhythmias different for women?
Yes, arrhythmias are different in women. Some arrhythmias, such as afib, are more common in women – requiring specialized care. Also, delayed or missed diagnosis of an arrhythmia is a significant problem for women. Often, symptoms can be mistaken for other conditions including panic, stress, and anxiety and are usually not evaluated as cardiac problems. In addition, the frquency of arrhythmias can be impacted by hormonal fluctuations in women. Fortunately, this is an area where we are doing a great amount of rsearch to learn more.
Who treats arrhythmias?
Electrophysiologists are cardiologists with extensive specialized training in the diagnosis and treatment of heart rhythm problems. Electrophysiologists at the Brigham and Women's Hospital Cardiac Arrhythmia Service perform over 2,000 procedures every year and the program has grown into one of the most experienced laboratories in the country. We have become the "go to" resource within the field of arrhythmia research and care.
What are the treatments?
Medications remain a front-line treatment for abnormally fast heart rates, including afib. Several new medicines allow physicians to stabilize the heartbeat and prevent serious complications. Other types of cardiac arrhythmias can be treated with an implantable device, such as a pacemaker or an implantable defibrillator called an ICD. ICD's can function as a pacemaker and, in addition, when abnormal life-threatening heart rhythm is detected, deliver a shock to the heart to restore it to a normal rhythm.
What services are available at Brigham and Women’s Hospital?
For more information on the Cardiac Arrhythmia Service, to make an appointment, or to learn more about the services and locations of the Brigham and Women's Hospital Cardiovascular Center, call 1-800-BWH-9999 or visit us at www.brighamandwomens.org. On our website you also can find an archived video of a recent "Living with Atrial Fibrillation" presention featuring Brigham and Women's Hospital experts and webcasts of catheter ablation procedures.
Send Feedback to: 
