Arrhythmia

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For other uses, see Arrhythmia (disambiguation).

Arrhythmia

Other names Cardiac arrhythmia, cardiac dysrhythmia, irregular heartbeat,

heart arrhythmia

Ventricular fibrillation (VF) showing disorganized electrical activity producing a

spiked tracing on an electrocardiogram (ECG)

Specialty Cardiology

Symptoms Palpitations, lightheadedness, passing out, shortness of

breath, chest pain[1]

Complications Stroke, heart failure[2][3]

Usual onset Older age[4]

Types Extra beats, supraventricular tachycardias, ventricular

arrhythmias, bradyarrhythmias[3]

Causes Problems with the electrical conduction system of the heart[2]

Diagnostic method Electrocardiogram, Holter monitor[5]

 Treatment Medications, medical procedures (pacemaker), surgery[6]

Frequency Millions[4]

Arrhythmia, also known as cardiac arrhythmia or heart arrhythmia, is a group of

conditions in which the heartbeat is irregular, too fast, or too slow.  The heart rate that is [2]

too fast – above 100 beats per minute in adults – is called tachycardia, and a heart rate
that is too slow – below 60 beats per minute – is called bradycardia.  Some types of [2]

arrhythmias have no symptoms.  Symptoms, when present, may include palpitations or

[1]

feeling a pause between heartbeats.  In more serious cases, there may
[1]

be lightheadedness, passing out, shortness of breath or chest pain.  While most types [1]

of arrhythmia are not serious, some predispose a person to complications such

as stroke or heart failure.  Others may result in sudden death.
[2][3] [3]

There are four main groups of arrhythmia: extra beats, supraventricular

tachycardias, ventricular arrhythmias and bradyarrhythmias.  Extra beats [3]

include premature atrial contractions, premature ventricular contractions and premature

junctional contractions.  Supraventricular tachycardias include atrial fibrillation, atrial
[3]

flutter and paroxysmal supraventricular tachycardia.  Ventricular arrhythmias [3]

include ventricular fibrillation and ventricular tachycardia.  Arrhythmias are due to [3][7]

problems with the electrical conduction system of the heart.  Arrhythmias may also [2]

occur in children; however, the normal range for the heart rate is different and depends
on age.  A number of tests can help with diagnosis, including
[3]

an electrocardiogram (ECG) and Holter monitor. [5]

Most arrhythmias can be effectively treated.  Treatments may include medications,

[2]

medical procedures such as inserting a pacemaker, and surgery.  Medications for a fast [6]

heart rate may include beta blockers, or antiarrhythmic agents such as procainamide,

which attempt to restore a normal heart rhythm.  This latter group may have more [6]

significant side effects, especially if taken for a long period of time.  Pacemakers are [6]

often used for slow heart rates.  Those with an irregular heartbeat are often treated
[6]

with blood thinners to reduce the risk of complications.  Those who have severe [6]

symptoms from an arrhythmia may receive urgent treatment with a controlled electric
shock in the form of cardioversion or defibrillation. [6]

Arrhythmia affects millions of people.  In Europe and North America, as of 2014, atrial
[4]

fibrillation affects about 2% to 3% of the population.  Atrial fibrillation and atrial flutter [8]

resulted in 112,000 deaths in 2013, up from 29,000 in 1990.  Sudden cardiac death is [9]

the cause of about half of deaths due to cardiovascular disease and about 15% of all
deaths globally.  About 80% of sudden cardiac death is the result of ventricular
[10]

arrhythmias.  Arrhythmias may occur at any age, but are more common among older
[10]

people. [4]

Contents

 1Classification
 o 1.1Atrial arrhythmia
o 1.2Junctional arrhythmia
o 1.3Ventricular arrhythmia
o 1.4Heart blocks
o 1.5Sudden arrhythmic death syndrome
o 1.6Fetal arrhythmia
 2Signs and symptoms
 3Differential diagnosis
o 3.1Normal electrical activity
o 3.2Bradycardias
o 3.3Tachycardias
o 3.4Heart defects
o 3.5Automaticity
o 3.6Re-entry
o 3.7Fibrillation
o 3.8Triggered beats
 4Mechanism
 5Diagnostic approach
 6Management
o 6.1Physical maneuvers
o 6.2Antiarrhythmic drugs
o 6.3Other drugs
o 6.4Electricity
o 6.5Electrical cautery
 7Research
 8See also
 9References
 10External links

Classification[edit]
Sounds of an irregular
heart beat.

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Sound of an irregular
heart rhythm.

Problems playing this file? See media

help.

Sound of a teen's heart

during tachycardia.

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Sound of a racing heart
during an episode of
 tachyarrhythmia.

Problems playing this file? See media

help.

Broad classification of arrhythmias according to region of heart required to sustain the rhythm

Arrhythmia may be classified by rate (tachycardia, bradycardia), mechanism

(automaticity, re-entry, triggered) or duration (isolated premature beats; couplets; runs,
that is 3 or more beats; non-sustained= less than 30 seconds or sustained= over 30
seconds).
It is also appropriate to classify by site of origin:
Atrial arrhythmia[edit]

 Sinus bradycardia
 Premature atrial contractions (PACs)
 Wandering atrial pacemaker
 Atrial tachycardia
 Multifocal atrial tachycardia
 Supraventricular tachycardia (SVT)
 Atrial flutter
 Atrial fibrillation (Afib)
 AV nodal reentrant tachycardia
Junctional arrhythmia[edit]

 AV nodal reentrant tachycardia

 Junctional rhythm
 Junctional tachycardia
 Premature junctional contraction
Ventricular arrhythmia[edit]
 Premature ventricular contractions (PVCs), sometimes called ventricular extra
beats (VEBs)
o Premature ventricular beats occurring after every normal beat are
termed ventricular bigeminy
o PVCs that occur at intervals of 2 normal beats to 1 PVC are termed "PVCs
in trigeminy"
o Three premature ventricular grouped together is termed a "run of PVCs" in
general, runs lasting longer than three beats with an increased heart rate are
referred to as ventricular tachycardia
 Accelerated idioventricular rhythm
 Monomorphic ventricular tachycardia
 Polymorphic ventricular tachycardia
 Ventricular fibrillation
 Torsades de pointes
 Arrhythmogenic right ventricular dysplasia
 Re-entry ventricular arrhythmia
Heart blocks[edit]
These are also known as AV blocks, because the vast majority of them arise from
pathology at the atrioventricular node. They are the most common causes of
bradycardia:

 First degree heart block, which manifests as PR prolongation

 Second degree heart block
o Type 1 Second degree heart block, also known as Mobitz
I or Wenckebach
o Type 2 Second degree heart block, also known as Mobitz II
 Third degree heart block, also known as complete heart block.
First, second and third degree block also can occur at the level of the sinoatrial junction.
This is referred to as sinoatrial block typically manifesting with various degrees and
patterns of sinus bradycardia.
Sudden arrhythmic death syndrome[edit]
Sudden arrhythmic death syndrome (SADS), is a term used as part of sudden
unexpected death syndrome to describe sudden death because of cardiac
arrest occasioned by an arrhythmia in the presence or absence of any structural heart
disease on autopsy. The most common cause of sudden death in the US is coronary
artery disease specifically because of poor oxygenation of the heart muscle, that
is myocardial ischemia or a heart attack   Approximately 180,000 to 250,000 people die
[11]

suddenly of this cause every year in the US. SADS may occur from other causes. There
are many inherited conditions and heart diseases that can affect young people which
can subsequently cause sudden death without advance symptoms. [12]
Causes of SADS in young people include viral myocarditis, long QT syndrome, Brugada
syndrome, Catecholaminergic polymorphic ventricular tachycardia, hypertrophic
cardiomyopathy and arrhythmogenic right ventricular dysplasia.
[13][14]