Cardiac Arrhythmia Treatment in Delhi, India

Cardiac arrhythmia, also known as an irregular heartbeat, is a condition in which the heart beats too fast, too slowly, or irregularly. This can happen because of a problem with the electrical signals that control the heart's rhythm. While some heart arrhythmias pose no significant risk, there are others that can lead to severe, life-threatening symptoms.

1. Fast Cardiac arrhythmias (tachyarrhythmia) – It can be classified in multiple ways. One common approach is to categorise them based on their origin: those originating in the upper two cardiac chambers are termed supraventricular arrhythmias, while those arising in the ventricles represent a different category.

These arrhythmias arise from the upper chambers of the heart, known as the atria. They include: - 

Paroxysmal supraventricular tachycardia (PSVT): This condition involves abnormally rapid heartbeats originating from the atrioventricular (AV) node or around the AV node. 

- Atrial flutter: This arrhythmia is characterised by rapid, fluttering atrial contractions that occur in a regular pattern. 

- Atrial fibrillation: Atrial fibrillation is the most common type of atrial arrhythmia, characterised by irregular, disorganised atrial contractions. 

- Ectopic atrial tachycardia: This condition involves abnormally rapid heartbeats originating from atrial tissue outside the sinoatrial (SA) node.

2. Slow cardiac arrhythmia: Slow cardiac arrhythmia are also known as AV block, a long pause in heart beat and may be associated with dizziness, blackout or fall Ventricular arrhythmias

These arrhythmias originate from the lower chambers of the heart, known as the ventricles. They include:

• Ventricular tachycardia (V-tach): This condition involves abnormally rapid heartbeats originating from the ventricles, potentially leading to life-threatening complications.
• Ventricular fibrillation (V-fib): This is a life-threatening arrhythmia characterised by chaotic, irregular ventricular contractions that prevent the heart from pumping blood effectively.

Understanding the origin of cardiac arrhythmias is crucial for proper diagnosis, treatment, and management.

Most cardiac arrhythmias can occur in paroxysms, starting suddenly often without provocation. The heart is like a pump that keeps blood flowing throughout our body. It has a special group of cells called the sinus node that acts like a pacemaker, sending out electrical signals to make the heart beat. These signals travel down a pathway called the AV node, which tells the upper and lower chambers of the heart when to contract and pump blood. However, certain factors can alter this process, causing arrhythmias. They include:

Heart damage and structural heart diseases

• Heart attack (myocardial infarction): A heart attack can cause damage to the heart muscle, disrupting the normal electrical signals and leading to arrhythmias.
• Coronary artery disease (blocked arteries): Narrowed or blocked arteries can restrict blood flow to the heart's muscles, including those responsible for generating and transmitting electrical signals, causing arrhythmia.
• Cardiomyopathy: Diseases affecting the heart muscle can lead to enlargement or thickening of the heart, causing arrhythmias.
• Valvular heart disease: Malfunctioning heart valves, such as mitral valve prolapse or aortic stenosis, can disrupt blood flow and contribute to arrhythmias.
• Rheumatic heart disease: A consequence of rheumatic fever, rheumatic heart disease is a structural heart disease that can contribute to the development of arrhythmias.
• Infiltrative diseases: Conditions where abnormal substances, such as amyloid deposits or sarcoidosis, infiltrate the heart muscle can lead to structural changes and arrhythmias.
• Congenital heart disease: Congenital heart disease are structural abnormalities present at birth, such as septal defects or abnormal heart valves, can lead to arrhythmias.

Note: Arrhythmias can occur without any evidence of structural heart diseases (some examples being A-V Nodal Reentrant Tachycardia, Pre-Excitation Syndrome, Fascicular Ventricular Tachycardia, Right Ventricular Outflow Tract (RVOT) Tachycardia, Tachycardias related to channelopathies. These occur in absolutely normal hearts and can cause sudden cardiac death.

• Diabetes: Diabetes can damage the heart's electrical system, making it more susceptible to arrhythmias.
• Hypertension: Chronic high blood pressure can thicken the heart's walls and interfere with the transmission of electrical signals.
• Thyroid gland dysfunction: An overactive or underactive thyroid gland can influence the heart's electrical activity.
• Sleep apnea: Sleep apnea, a condition characterised by pauses in breathing during sleep, can put additional stress on the heart and increase the risk of arrhythmias.
• Medications: Certain medications, such as those used to treat colds, allergies, or heart conditions, can have side effects that affect the heart's electrical system.
• Substance abuse: Excessive alcohol or caffeine consumption, illegal drug use, and drug misuse, all can cause arrhythmias.
• Genetics: A family history of arrhythmias can increase an individual's susceptibility to developing the condition.
• Smoking: Smoking can damage the heart's blood vessels and electrical system, increasing the risk of arrhythmias.
• Stress and anxiety: Chronic stress and anxiety can trigger the release of hormones that affect the heart's electrical activity.
• COVID-19 infection: COVID-19 infection can temporarily affect the heart's electrical system, increasing the risk of arrhythmias.
  

During an episode of arrhythmia, a patient may usually exhibit one or more of the following symptoms: 

• Palpitations
• Lightheadedness
• Loss of consciousness
• Chest pain
• Anxiety
• Sweating
• Fatigue
• Fainting
• Shortness of breath (especially in patients with structural heart disease)

Diagnosing cardiac arrhythmia requires a coordinated multidisciplinary approach involving several specialities, especially imaging. Max Institute of Heart and Vascular Sciences has the Department of Electrophysiology - a dedicated, special unit led by internationally acclaimed electrophysiologists. Today, MIHVS is one of the highest volume electrophysiology centres in the country, where highly complex arrhythmias are treated routinely. Investigations are individualised to a specific arrhythmia and the clinical aspects of the disease, and involve a combination of medical history, physical examination, and various tests to assess the heart's electrical activity and function. Here are the steps involved in the diagnosis of arrhythmia:

• Medical history evaluation and physical examination: The doctor takes a detailed medical history, including family history of arrhythmias, current medications, and past or present heart conditions, and also conducts a physical examination to check for signs of heart disease or other underlying conditions.
• Electrocardiogram (ECG or EKG): An ECG is a non-invasive test that measures the heart's electrical activity, providing insights into its rhythm and rate. It can detect arrhythmias that are present at the time of the test.
• Holter monitoring: A holter monitor is a portable ECG device worn for an extended period, typically 24-48 hours, to continuously record the heart's activity during daily activities. This allows for the detection of arrhythmias that may occur intermittently.
• Event recorder: An event recorder is another portable ECG device worn for up to 30 days. It is primarily used to detect arrhythmias that occur infrequently. The device typically records data when triggered by the patient pressing a button upon experiencing symptoms.
• Echocardiogram: An echocardiogram is a non-invasive test that utilises sound waves to create detailed images of the heart's structure, valves, and blood flow patterns. It can identify any structural abnormalities or underlying conditions that could be contributing to arrhythmias.
• Stress test: A stress test evaluates the heart's response to physical exertion, as certain arrhythmias are triggered or worsen during exercise.
• Tilt table test: A tilt table test assesses the heart's and nervous system's responses to changes in body position, particularly when transitioning from lying to standing, and is primarily used for individuals experiencing fainting episodes.
• Electrophysiological (EP) testing and mapping: An EP study utilises electrical stimulation to map the heart's electrical pathways and is particularly useful for diagnosing specific types of arrhythmias, particularly tachycardia, and identifying the precise location of the faulty signalling.

After a doctor determines an Arrhythmia, they check its severity - whether it's abnormal or a normal heart process. If the arrhythmia is abnormal and clinically significant, the doctor will suggest an arrhythmia treatment plan.

At Max Institute of Heart and Vascular Sciences (MIHVS), the latest arrhythmia treatment such as Leadless Pacemaker Implant, Alternate Site Right Ventricular Pacing, His Bundle Pacing and Left Bundle Pacing are routinely done. Our approach to the treatment of complex arrhythmia includes using a sophisticated 3-dimensional electroanatomical mapping system to enhance success rates and reduce X-ray exposure to a patient. We offer the following arrhythmia treatment options:

Medication

Medications play a crucial role in controlling arrhythmias and preventing complications. The specific type of medication prescribed will depend on the type of arrhythmia and its severity. Common medications for arrhythmias include:

• Antiarrhythmic drugs: These drugs work by altering the electrical signals in the heart to control the heart's rhythm.
• Beta-blockers: These drugs help to slow the heart rate and lower blood pressure, which can be beneficial for certain types of arrhythmias.
• Calcium channel blockers: These drugs help to relax the heart muscles, which can help to control certain types of arrhythmias.
• Anticoagulants: These drugs help to prevent blood clots, which can be a risk for certain types of arrhythmias, especially those associated\with atrial fibrillation.

Procedures

Cardioversion

Cardioversion is used to restore a normal heart rhythm in individuals with certain types of abnormal heart rhythms, particularly atrial fibrillation (AF) or atrial flutter. It is typically performed by delivering a controlled electric shock to the heart, either externally through paddles placed on the chest or internally via catheters, with the goal of resetting the heart's electrical activity and restoring a regular heartbeat.

Catheter ablation

It is a safe medical procedure to treat some types of arrhythmia and involves the use of radiofrequency (RF) energy. Specific treatment for cardiac arrhythmia is usually interventional and includes Radiofrequency Catheter Ablation, implanting devices such as Permanent Pacemakers, ICD (Implantable Cardioverter Defibrillator) and very rarely requires surgery. Radiofrequency Ablation Therapy is applicable for the treatment of many arrhythmias, and many, it is a cure (PSVT, WPW Syndrome Tachycardia, Atrial Flutter, Atrial Fibrillation, some Ventricular Tachycardia in a normal heart. In such patients, the success rates are very high, and the recurrence rate is only 1-2%.

Pacemaker implantation

Cardiac arrhythmias where the heart beats very slow, are called bradyarrhythmia. In a given person resting heart rates of even 50/min may be normal, especially in physically active persons. Bradyarrhythmias caused by disease of the electrical conduction system is a serious condition which can lead to loss of consciousness. In such cases, it usually needs implantable pacemakers as treatment.

Implantable cardioverter-defibrillator (ICD) implantation

An ICD is a device that is surgically implanted in the chest to monitor the heart's rhythm and deliver an electrical shock to the heart if it detects a dangerous arrhythmia, such as ventricular tachycardia or ventricular fibrillation. ICDs are used to prevent sudden cardiac death.

Automated external defibrillator

It is a type of portable device that inspects the heart rhythm. If required, it can send an electric shock to the heart to restore a normal rhythm. It is commonly used to treat sudden cardiac arrest.

Surgery

In some cases, surgery may be necessary to treat arrhythmias, such as those caused by heart valve problems or heart muscle damage. The type of surgery will depend on the specific underlying condition.

Adopting healthy lifestyle habits can significantly impact the management of arrhythmias and overall heart health. These changes include:

• Maintaining a healthy weight: Excess weight can strain the heart and contribute to arrhythmias. Losing even a small amount of weight can improve heart health.
• Exercising regularly: Regular physical activity strengthens the heart and improves its overall function. However, it's important to consult with a Cardiac arrhythmias doctor to determine an appropriate exercise plan, especially for individuals with pre-existing heart conditions.
• Eating a healthy diet: A balanced diet rich in fruits, vegetables, whole grains, and low in saturated and trans fats can help maintain a healthy heart.
• Avoiding smoking and excessive alcohol use: Smoking damages blood vessels and increases the risk of arrhythmias. Excessive alcohol consumption can also interfere with the heart's electrical system.
• Managing stress: Chronic stress can trigger the release of hormones that affect the heart's electrical activity. Finding healthy ways to manage stress, such as yoga, meditation, or spending time in nature, can be beneficial for heart health.

Max Institute of Heart and Vascular Sciences is a tertiary care centre equipped with cutting-edge technology that offers cardiac care programs to patients. We also offer an alternative treatment for end-stage heart failure patients with procedures like Pacemaker, ACD, CRT, Heart Hole surgeries (ASD, VSD, PDA), Paediatric Cardiac Surgery, Angioplasty/Angiography and more. The institute is a one-stop destination for several kinds of cardiac treatments like invasive and interventional cardiology, electrophysiology, pacemaker and arrhythmia services, management of abdominal and descending thoracic aneurysm and varicose veins. We are equipped with state-of-the-art Cath Labs, operation theatres, ICU beds and several other heart care technologies.

There are many electrical disorders in the heart, with complex causes and mechanisms, including genetic abnormalities. Due to such complexities, cardiac arrhythmia has now become a major subspecialty in Cardiology and is managed by cardiologists who are called electrophysiologists. At Max Institute of Heart and Vascular Sciences, we have a team of expert cardiologists who specialise in treating arrhythmia with Antiarrhythmic agents, Automated External Defibrillator, CCBs, Cardioversion, Catheter Ablation and other amenities.

How serious is cardiac arrhythmia?

The severity of cardiac arrhythmia can vary depending on the specific type of arrhythmia, the underlying cause, and the individual's overall health. Some arrhythmias are harmless and do not require any treatment, while others can be life-threatening.

Can cardiac arrhythmia be cured completely?

Whether cardiac arrhythmia can be cured completely depends on the type of arrhythmia and its underlying cause. Some arrhythmias, such as supraventricular tachycardia (SVT), can be cured with procedures like ablation, which involves destroying the abnormal electrical pathways in the heart. However, other types of arrhythmias, such as atrial fibrillation (Afib), cannot be cured completely and require ongoing management to control symptoms and prevent complications.

What are premature heartbeats?

Premature heartbeats are extra beats that occur one at a time, sometimes in patterns that alternate with a regular heartbeat.

What are premature atrial contractions (PACs) and premature ventricular contractions (PVCs)?

PACs occur when the extra beats come from the top chamber of the heart, while PVCs occur when they come from the bottom chamber.

How might a premature heartbeat feel?

A premature heartbeat may feel like your heart skipped a beat.

Are premature heartbeats generally a cause for concern?

Generally, premature heartbeats are not a concern. They rarely mean you have a more serious condition.

Can premature heartbeats trigger longer-lasting arrhythmias?

Yes, a premature beat can trigger a longer-lasting arrhythmia, especially in people with heart disease.

What might happen if there are very frequent premature ventricular beats?

Having very frequent premature ventricular beats may occasionally lead to a weak heart.

When do premature heartbeats occur?

Premature heartbeats may occur when resting, and they can also be triggered by stress, heavy exercise, and the use of stimulants such as caffeine or nicotine.

What is bradycardia?

Bradycardia is a medical condition characterised by a slow heart rate, defined as fewer than 60 beats per minute.

What are the types of bradycardias?

Types of bradycardias include Sick Sinus Syndrome and Conduction Block.

Does a heart rate below 60 beats per minute always indicate a problem?

No, a low resting heart rate doesn't necessarily indicate a problem, especially in physically fit individuals whose hearts can efficiently pump enough blood with less than 60 beats per minute.

What is Sick Sinus Syndrome, and what causes it?

Sick Sinus Syndrome occurs when the sinus node, which sets the heart's pace, malfunctions, causing the heart rate to fluctuate between too slow and too fast. It is often caused by scarring near the sinus node and is more common among older adults.

Who is most susceptible to Sick Sinus Syndrome?

Sick Sinus Syndrome is most common among older adults.

What are the potential causes of scarring near the sinus node in Sick Sinus Syndrome?

Scarring near the sinus node in Sick Sinus Syndrome can be caused by factors that slow, disrupt, or block heartbeat signals.

How does Conduction Block affect the heart?

Conduction Block refers to a block in the heart's electrical pathways, leading to slowed or stopped signals that trigger heartbeats. Some blocks may be asymptomatic, while others can cause skipped beats or slowed heartbeats.

Are there any symptoms associated with Conduction Block?

Conduction Block may cause no symptoms in some cases, while in others, it can result in symptoms such as skipped beats or slowed heartbeats.

Reviewed by Dr. Viveka Kumar, Principal Director & Chief of Cath Labs (Pan Max) - Cardiac Sciences, Cardiology, Cardiac Electrophysiology-Pacemaker, Interventional Cardiology on 08-Feb-2024.

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