Cardiac Arrhythmias

John A Kastor, University of Maryland, Baltimore, Maryland, USA
Magdi M Saba, University of Maryland, Baltimore, Maryland, USA

Published online: December 2009

DOI: 10.1002/9780470015902.a0002112.pub2

Cardiac arrhythmias are disturbances in the rhythm of the heart manifested by irregularity or by abnormally fast (tachycardias or tachyarrhythmias) or abnormally slow (bradycardias or bradyarrhymias) rates. Some produce no symptoms, whereas others can endanger the patient's life. Among the most benign are premature beats that interrupt the normal rhythm of the heart. Tachyarrhythmias include atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia, ventricular tachycardia and ventricular fibrillation. Bradycardias include heart (atrioventricular) block and sick sinus syndrome. Antiarrhythmic drugs, cardiac pacing, ablation and implantable defibrillators can control most arrhythmias that need treatment.

Key Concepts:

  • Cardiac arrhythmias are disturbances in the rhythm of the heart in which the heart beats are irregular, too fast, or too slow.
  • Cardiac arrhythmias range in severity from asymptomatic to life-threatening.
  • Most arrhythmias that require treatment can be controlled by antiarrhythmic drugs, cardiac pacing, ablation and implantable defibrillators.
  • Some arrhythmias can be treated with ablation in which the physician locates the source of the arrhythmia and, using electrode-catheters, destroys it.
  • Premature beats are among the most common cardiac arrhythmias. Specific treatment is seldom required if the patient can be assured that they are benign, which is usually the case.
  • Atrial fibrillation is the most common sustained cardiac arrhythmia.
  • Atrial flutter is a rapid rhythm that is best treated with ablation.
  • In heart block, the electrical signals from the atria cannot reach the ventricles. Symptoms develop when the heart rate slows excessively. Treatment with pacemakers usually relieves the symptoms.
  • When patients have ventricular tachycardia, the rapid heart rate can produce syncope (fainting). This is a dangerous condition, and electrophysiological treatment is usually required.
  • Ventricular fibrillation is the arrhythmia that most frequently causes cardiac arrest.

Keywords: arrhythmias; premature beats; fibrillation; flutter; Wolff–Parkinson–White syndrome; torsades de pointes

 References
    Aliot EM, Stevenson WG, mendral-Garrote JM et al. (2009) EHRA/HRS expert consensus on catheter ablation of ventricular arrhythmias: developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA). Europace 11(6) : 771–817.
    Bhandari AK, Scheinman MM, Morady F et al. (1984) Efficacy of left cardiac sympathectomy in the treatment of patients with the long QT syndrome. Circulation 70(6) : 1018–1023.
    Blomstrom-Lundqvist C, Scheinman MM, Aliot EM et al. (2003) ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias–executive summary. A report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society. Journal of American College of Cardiology 42(8) : 1493–1531.
    Brugada P and Brugada J (1992) Right bundle-branch block, persistent St segment elevation and sudden cardiac death – a distinct clinical and electrocardiographic syndrome – a multicenter report. Journal of American College of Cardiology 20(6) : 1391–1396.
    Buxton AE, Fisher JD, Josephson ME et al. (1993) Prevention of sudden death in patients with coronary artery disease: the Multicenter Unsustained Tachycardia Trial (MUSTT). Progress in Cardiovascular Diseases 36(3) : 215–226.
    Connolly SJ, Kerr CR, Gent M et al. (2000) Effects of physiologic pacing versus ventricular pacing on the risk of stroke and death due to cardiovascular causes. New England Journal of Medicine 342(19) : 1385–1391.
    Cox JL (1991) The surgical-treatment of atrial-fibrillation.4. Surgical technique. Journal of Thoracic and Cardiovascular Surgery 101(4) : 584–592.
    Daoud EG, Weiss R, Bahu M et al. (1996) Effect of an irregular ventricular rhythm on cardiac output. American Journal of Cardiology 78(12) : 1433–1436.
    Epstein AE, Dimarco JP, Ellenbogen KA et al. (2008) ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Journal of American College of Cardiology 51(21) : e1–e62.
    Fuster V, Ryden LE, Cannom DS et al. (2006) ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 guidelines for the management of patients with atrial fibrillation) developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Europace 8(9) : 651–745.
    Grimm RA, Black IW and Klein AL (1993) Transesophageal echocardiography before cardioversion. New England Journal of Medicine 329(8) : 577–578.
    Haissaguerre M, Jais P, Shah DC et al. (1998) Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. New England Journal of Medicine 339(10) : 659–666.
    Jackman WM, Beckman KJ, McClelland JH et al. (1992) Treatment of supraventricular tachycardia due to atrioventricular nodal reentry, by radiofrequency catheter ablation of slow-pathway conduction. New England Journal of Medicine 327(5) : 313–318.
    Jackman WM, Wang XZ, Friday KJ et al. (1991) Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current. New England Journal of Medicine 324(23) : 1605–1611.
    Kalman JM, Vohra JK, Jayaprakash S and Sparks PB (1997) Radiofrequency ablation for cure of atrial flutter. Australian and New Zealand Journal of Medicine 27(6) : 653–657.
    Kannel WB, Wolf PA, Benjamin EJ and Levy D (1998) Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. American Journal of Cardiology 82(8A) : 2N–9N.
    Kastor JA (1990) Multifocal atrial tachycardia. New England Journal of Medicine 322(24) : 1713–1717.
    Kerr CR, Connolly SJ, Abdollah H et al. (2004) Canadian trial of physiological pacing: effects of physiological pacing during long-term follow-up. Circulation 109(3) : 357–362.
    Lamas GA, Lee KL, Sweeney MO et al. (2002) Ventricular pacing or dual-chamber pacing for sinus-node dysfunction. New England Journal of Medicine 346(24) : 1854–1862.
    Lee RJ and Shinbane JS (1997) Inappropriate sinus tachycardia. Diagnosis and treatment. Cardiology Clinics 15(4) : 599–605.
    Man KC, Knight B, Tse HF et al. (2000) Radiofrequency catheter ablation of inappropriate sinus tachycardia guided by activation mapping. Journal of American College of Cardiology 35(2) : 451–457.
    Moss AJ (1997) Background, outcome, and clinical implications of the Multicenter Automatic Defibrillator Implantation Trial (MADIT). American Journal of Cardiology 80(5B) : 28F–32F.
    Moss AJ, Zareba W, Hall WJ et al. (2000) Effectiveness and limitations of beta-blocker therapy in congenital long-QT syndrome. Circulation 101(6) : 616–623.
    Orsinelli DA and Pearson AC (1993) Usefulness of transesophageal echocardiography to screen for left atrial thrombus before elective cardioversion for atrial fibrillation. American Journal of Cardiology 72(17) : 1337–1339.
    Pappone C, Santinelli V, Manguso F et al. (2003) A randomized study of prophylactic catheter ablation in asymptomatic patients with the Wolff-Parkinson-White syndrome. New England Journal of Medicine 349(19) : 1803–1811.
    Parke A and Rothfield NF (1985) Congenital heart block, systemic lupus erythematosus, and anti-Ro antibodies. Arthritis and Rheumatism 28(9) : 1077–1078.
    Paventi S, Parafati MA, Pellegrino CA, Bevilacqua U and Paggi A (1999) Atrial stunning and pharmacologic cardioversion in idiopathic atrial fibrillation of recent onset. Minerva Cardioangiologica 47(7–8) : 239–244.
    Piccolo E and De PB (1998) Atrial stunning after atrial fibrillation. Cardiologia 43(6) : 577–579.
    Rosso R and Kistler P (2009) Focal atrial tachycardia. Heart, 7 April.
    Ruberman W, Weinblatt E, Goldberg JD, Frank CW and Shapiro S (1977) Ventricular premature beats and mortality after myocardial infarction. New England Journal of Medicine 297(14) : 750–757.
    Ruskin JN (1989) The cardiac arrhythmia suppression trial (CAST). New England Journal of Medicine 321(6) : 386–388.
    Sagar S, Jahangir A, Friedman PA et al. (2004) Long-term right ventricular apex pacing in patients with congenital AV block does not have a detrimental effect on ventricular function. Circulation 110(17) : 345–346.
    Singh B, Sapra R, Gupta RK et al. (2004) Pace mapping for the localization of focal atrial tachycardia arising near the mitral annulus. Indian Heart Journal 56(1) : 58–60.
    Stewart S, Hart CL, Hole DJ and McMurray JJ (2001) Population prevalence, incidence, and predictors of atrial fibrillation in the Renfrew/Paisley study. Heart 86(5) : 516–521.
    Ten Cate FEAU, Breur JMPJ, Cohen MI et al. (2001) Dilated cardiomyopathy in isolated congenital complete atrioventricular block: early and long-term risk in children. Journal of American College of Cardiology 37(4) : 1129–1134.
    Triedman J, Perry J and Van HG (2005) Risk stratification for prophylactic ablation in asymptomatic Wolff-Parkinson-White syndrome. New England Journal of Medicine 352(1) : 92–93.
    Tsang TS, Petty GW, Barnes ME et al. (2003) The prevalence of atrial fibrillation in incident stroke cases and matched population controls in Rochester, Minnesota: changes over three decades. Journal of American College of Cardiology 42(1) : 93–100.
    Yamada T, Allison JS, McElderry HT et al. (2008) Successful catheter ablation of premature ventricular contractions originating from the tricuspid annulus using a Halo-type catheter. Europace 10(10) : 1228–1229.
    Zareba W, Moss AJ, Daubert JP et al. (2003) Implantable cardioverter defibrillator in high-risk long QT syndrome patients. Journal of Cardiovascular Electrophysiology 14(4) : 337–341.
    Zipes DP, Camm AJ, Borggrefe M et al. (2006) ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Europace 8(9) : 746–837.
 Further Reading
    book Josephson ME (2008) Clinical Cardiac Electrophysiology: Techniques and Interpretations, 4th edn. Philadelphia: Lippincott Williams & Wilkins.
    book Kastor JA (2000) Arrhythmias, 2nd edn. Philadelphia: WB Saunders.

Related Sub-Topics:

Developmental Disorders
Contact Editor close
Submit a note to the editor about this article by filling in the form below.

* Required Field

Article Title: Cardiac Arrhythmias
 
How to Cite close
Kastor, John A, and Saba, Magdi M(Dec 2009) Cardiac Arrhythmias. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0002112.pub2]