Arrhythmia

– The information has been reviewed by Dr. Lo Ka Yip, David

Epidemiology

It is estimated about 70 to 80 thousand people in Hong Kong are affected by arrhythmia (also known as cardiac or heart arrhythmia), with the risk of the disease increasing with age. Atrial fibrillation and ventricular fibrillation are the most common types of arrhythmia. Generally if a patient with arrhythmia is not properly treated, their mortality rate will triple, and the risk of stroke and heart failure will be about 5 and 3 times higher respectively than that of ordinary people.

What is Arrhythmia?

Unusual heartbeats that are too fast (over 100 beats per minute), too slow (less than 50 beats per minute) or palpitations (intermittent fast or distrubed heartbeats) are collectively categorized as irregular heartbeats. The same is true for abnormal heartbeats, which contain “bradycardia” for less than 60 beats per minute, and “tachycardia” for over 100 beats per minute. The follow are the most common arrhythmia conditions:

Ventricular Fibrillation (VF): The most serious type of arrhythmia is also the “culprit” behind half of all sudden heart disease deaths. The rapid and chaotic heartbeat hinders the lower heart cavity from pumping blood and oxygen to the brain and may even stop the heart entirely, leading to death within a few minutes.
Atrial Fibrillation (AF): The upper heart chamber and atrium of the patient will vibrate rapidly and chaotically, causing the heartbeat to become irregular, sometimes as high as 200 beats per minute. Although not directly fatal, it may cause other heart problems and congestive heart failure. The risk of stroke also increases by 5 times compared to normal.
Ventricular Tachycardia (VT): Common symptom is an extremely fast heartbeat, which can turn into fatal ventricular fibrillation. Requires early monitoring and treatment.
Sick Sinus Syndrome (SSS): Also known as sinus node dysfunction, it refers to a series of malfunctions in the sinus node such as an abnormally slow heart rate during rest, failure to speed up during exercise, failure to respond to adrenaline regulation, and more.
Supraventricular Tachycardia (SVT): Risk is relatively low, and usually comes and goes suddenly ranging from a few minutes to a few hours. Can cause palpitations, dizziness, or shortness of breath

Symptoms

Some patients with arrhythmia may show no symptoms, or they may feel that their heart beat is fast, slow, or irregular. Normally when people are at rest, a normal heart range is between 60 to 100 beats per minute for adults. If the heart beats less than 60 beats per minute, they will experience fatigue, shortness of breath, dizziness, pannus, chest pain, weariness, or even dizziness and fainting.

Similarly, if the heart’s rhythm is abnormally fast or uneven, it can also affect oxygen flow to vital organs. In severe cases, it can cause dizziness, fainting, shock, or even sudden cardiac death.

Causes + Risk Factors

Arrhythmia is mainly caused by problems with the atrial sinus node. Once the function of this area is impaired, or atrial and ventricular conduction is affected, the electrical impulse responsible for coordinating heart contractions will be affected, which may cause arrhythmia.

Risk Factors

Genetic disease (genetic disorder), family history
Cardiovascular disease
Hypertension
Thyroid disorders
Diabetes
Imbalanced electrolytes
Pressure and mental stress from urban life

How is Arrhythmia diagnosed? + Treatment

24 Hour ECG Examination: Patients must carry a small “Holter” device with them to monitor and record their heartbeat, allowing cardiologists to assess the degree of palpitations or arrhythmia
Echocardiogram: Ultrasounds are used to obtain a clear image of the heart to detect irregular contractions. Depending on the patient’s condition, cardiologists may recommend that the patient undergo both exercise electrocardiography and coronary angiography
Electrophysiological Examination: Thin catheters are introduced into the heart through blood vessels to measure the heart current signal and conduction path. This allows for the patient’s heartbeat pattern to be uncovered, resulting in a detailed heartbeat frequency record

Treatment

There are many treatments for arrhythmia. A cardiologist will determine which is most appropriate according to the type of arrhythmia and the patient’s condition.

Catheter Ablation: The common and standard treatment method today, this minimally invasive surgery is usually performed under local anesthesia. The cardiologist guides the catheter towards the ventricle and uses electrodes at its end to find and correct parts causing the abnormal heartbeat. It can deal with a variety of arrhythmia problems with a high success rate, and is expected to replace medication in the future.
Instrument Implants: Artificial cardiac defibrillators, pacemakers, or cardiac resynchronization therapy devices are implants in the chest of arrhythmia patients. The heart is stimulated through preadjusted electrical pulses to correct the heartbeat’s rhythm, thus improving cardiac function and reducing the risk of sudden death.
Medication: The new generation of anticoagulant drugs proved to be effective against strokes. In addition to reducing its incidence rate, the risk of intracranial hemorrhages is lower than that of traditional anticoagulant drug warfarin. The new drug uses fixed doses, allowing patients to no longer have to undergo regular blood tests or restricted diets.

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