Arrhythmia: Symptoms, Causes, Treatment in Delhi NCR, India

Overview

Cardiac arrhythmia refers to a large group of conditions resulting from abnormalities in the electrical activity of the heart. It is the abnormality of the heart rhythm wherein the heart beats too slowly, rapidly, irregularly or with extra beats (premature atrial or ventricular beat).

There are several ways of classifying cardiac arrhythmias. A common way is to divide them into arrhythmias originating in the upper two cardiac chambers (an atrial arrhythmia) and those arising in the ventricles.

Arrhythmias that arise in the atria are:

Paroxysmal Supraventricular Tachycardia
Atrial Flutter
Atrial Fibrillation
Ectopic Atrial Tachycardia

Arrhythmias that arise in the ventricle include:

Ventricular Tachycardia
Ventricular Fibrillation

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

Palpitations
Lightheadedness
Loss of consciousness
Chest pain
Shortness of breath especially in patients with structural heart disease

Most cardiac arrhythmias can occur in paroxysms, starting suddenly often without provocation. They 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.

Arrhythmia can also occur when the patient is already suffering from a Coronary Artery Disease, Hypertension induced heart disease, heart disease consequent to Diabetes, Congenital Heart Disease, Rheumatic Heart Disease, and forms of Valvular Heart Disease and Primary Heart Muscle Diseases called Cardiomyopathies. The incidence of arrhythmia increases in all the above cases as the cardiac muscle starts getting weak.

Max Institute of Heart and Vascular Sciences(MIHVS) 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 (MIHVS), we have a team of expert cardiologists who specialize in treating arrhythmia with Antiarrhythmic agents, Automated External Defibrillator, CCBs, Cardioversion, Catheter Ablation and other amenities.

Cardiac arrhythmia needs a coordinated multidisciplinary approach involving several specialities, especially imaging. At Max Institute of Heart and Vascular Sciences, we have the Department of Electrophysiology - a separate, special unit led by internationally acclaimed electrophysiologists. Today, MIHVS is one of the highest volume Electrophysiology centres in the country. Very complex arrhythmias are routinely treated here. The latest treatments like Leadless Pacemaker Implant, Alternate Site Right Ventricular Pacing, His Bundle Pacing and Left Bundle Pacing are routinely done here.

Investigations are individualized to a specific arrhythmia and the clinical aspects of the disease. These include:

ECG, Echocardiography
Holter Monitoring, ELR (Extended Loop Record) and Implantable Loop Recorder (these are rhythm monitoring devices with a capability to record cardiac rhythm on an outpatient basis while the patient does all his activities)
Cardiac Catheterization and Coronary Angiography
Cardiac CT Scan
Cardiac MRI
Electrophysiology Study

Most arrhythmias are considered harmless and left untreated. After a doctor determines an Arrhythmia, he checks its severity - whether it's abnormal or a normal heart process. If the arrhythmia is abnormal and clinically significant, the doctor will set a treatment plan.

At Max Institute of Heart and Vascular Sciences(MIHVS), 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 treatment options for arrhythmia:

A) Medication

For heartbeat-related disorders: Antiarrhythmics are used to treat heartbeat related disorders. Antiarrhythmics work in a variety of ways to slow the electrical impulses in the heart so that the heart can regain a regular rhythm.
For Structural Heart Disease: When structural heart disease progresses to a stage of heart failure, cardiac arrhythmia accounts for almost 50 % of deaths. In patients with structural heart disease, optimal guideline-based medical treatment with drugs is mandatory as it provides for cardiac electric stability, e.g. treatment of Ischemia in coronary artery disease and heart failure management.

B) Automated External Defibrillator: It is a kind 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.

C) Calcium Channel Blockers: CCBs are effective medicines that have been shown to lower blood pressure and help prevent and treat the symptoms of Angina (chest pain).

D) Cardioversion: It is a procedure followed to restore fast or irregular heart rhythm to a normal rhythm.

E) 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 like 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%.

F) Pacemaker Insertion: 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.

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