Understanding your irregular heartbeat — and how to treat it

Alexander Turin, MD, and Douglas Moore, DO, are clinical cardiac electrophysiologists with Trinity Health Medical Group, Cardiology - Muskegon.

An irregular heartbeat can be unsettling and scary. It’s also very common, affecting millions of Americans.

Studies say about 5% of the population experience atrial fibrillation (AFib) — the most common type of irregular heartbeat. Many patients live with ongoing discomfort, worry — and possibly life-threatening risk — of unmanaged heart arrythmias. That’s why we are working to raise awareness about the growing number of options and greater access to treatment.

Whether you’re feeling palpitations, shortness of breath or simply know something isn’t right — Trinity Health’s cardiac electrophysiologists are here to listen and help.

What do cardiac electrophysiologists do?

An electrophysiologist is a cardiologist who has undergone specialized training focusing on the electrical system of the heart to address heart rhythm disorders. As one of the relatively newer fields of cardiology, the subspecialty has seen some remarkable advances in recent years.

Most patients who see a cardiac electrophysiologist have been referred by a primary care physician, cardiologist or, sometimes, emergency departments. Although patients may already have been tested with an electrocardiogram (ECG), the electrophysiologist will conduct a deeper exam.

“Electrophysiologists have some extra tools at our disposal, and step one for us is diagnosis because there's so many different reasons for symptoms like this — ranging from normal to very, very abnormal,” Dr. Turin said. “The first question I try to answer is whether not the patient is experiencing something dangerous.”

From there, the electrophysiologist will talk to patients about options, ranging from observation to medication to catheter ablation to devices like pacemakers and defibrillators.

What are the symptoms of arrythmia? When should I call the doctor?

Some patients describe it as palpitations, the heart racing or skipping beats, sometimes accompanied by shortness of breath or dizziness. In some cases, patients may not even be aware they are experiencing arrhythmia.

Patients need to be as specific as possible when describing these symptoms to their primary care doctor. 

That's a challenging thing when it comes to funny feelings in the chest. Awareness of fluttering or funny feelings in the throat, in the head, sometimes in the arm and sometimes even in the belly — in these cases having an electrical tracing will go a long way. For instance, we have patients who come in because their smart watch has detected atrial fibrillation.

Red flag symptoms include fainting or near-fainting, trouble breathing, chest pain, and swelling in the legs. These conditions need to be addressed relatively urgently.

What is AFib?

Fibrillation is the medical term for quivering. AFib is when the upper chambers of the heart — the atria — are in electrical chaos, beating in a very disorganized way and unable to pump enough blood out. Your heart is behaving like a turkey baster that doesn’t have the opportunity to fill back up.

Why does AFib increase the risk of stroke and heart failure?

When blood is not moving, it tends to clot. If a clot forms, it can eventually reach the brain, leading to stroke. The American Heart Association says AFib can double the risk of death and is linked with a fivefold increased risk of stroke. AFib also can contribute to heart failure by overworking the heart muscle.

Those are some of the reasons for early diagnosis and intervention, in addition to improving the opportunity for effective treatment. You get a better outcome, but patients also show benefit even up to five years or longer from their diagnosis of atrial fibrillation. 

What are options for managing arrythmia?

The first option to consider is to do nothing: In situations where there's not imminent danger or there's not long-term morbidity associated with problems, a lot of times we say, ‘Well, let's see what happens in six months.’

When waiting does not make sense, medication therapy is another option. While this is non-invasive, medications need to be considered with caution. 

Your antiarrhythmic drugs have their own set of potential complications and risks. In some cases, these could actually cause arrhythmias and those are usually dangerous arrhythmias that are potentially fatal.

Many cases call for catheter ablation — a minimally invasive procedure where doctors use very thin wires to deliver and electric impulse to parts of the heart. 

The general definition is you destroy heart tissue to help eliminate arrhythmias and there's different types of ways to go about it with. It's called radio frequency ablation where you burn areas of the heart. There is a type where you can freeze parts of the heart muscle. And then the new way is the pulsed field ablation (PFA), which delivers small electrical shocks to the heart.

PFA primarily is used to treat AFib, and its use is being explored with other arrythmias. While still evolving, efficacy of PFA for AFib appears to comparable to other strategies; additionally, it has a favorable safety profile and may be more efficient in certain cases.  The addition of PFA capability is part of Trinity Health’s continued investment in next-generation electrophysiology tools. 

What kind of devices can be used to manage heart rates?

Another area of advancement in the treatment of arrythmias are devices, such as pacemakers and defibrillators. Pacemakers, devices that are implanted to prevent a heart rate from going to slow, once were the size of a small book and needed new batteries every year. Modern pacemakers are about the size of a half-dollar and the batteries last 12 to 15 years.

Another innovation with pacemakers is wireless technology — including a dual-chamber leadless pacemaker system, pioneered last year at Trinity Health Muskegon as the first West Michigan hospital to implant AVEIR™ DR.

Defibrillators, meanwhile, are ‘life insurance policies that we implant in the chest’. These devices, which also have grown much smaller in recent years, are able to deliver a shock during life-threatening arrythmias. 

Are irregular heartbeats mainly a concern as you age?

Arrythmias can be seen in patients of any age, even at birth. Accessory electrical pathways such as in the Wolff-Parkinson-White syndrome are usually diagnosed in childhood, but Dr. Turin once found one in an 84-year-old, so you never know.

However, age does naturally increase the risk of some arrythmias. For example, over time, the atria — upper chambers of the heart — are more likely to see scarring, which can contribute to AFib, the most common type of arrythmia.

I heard someone once say, ‘It’s like gray hair — if we all live long enough, we’re going to get it’.

Can lifestyle changes reduce risk of arrythmias?

Despite the many advances in recent years, some of the most effective approaches to addressing irregular heartbeats are in the hands of patients themselves.

We’ll want to look at things like managing sleep apnea, tobacco and alcohol abuse, controlling high blood pressure and diabetes, sedentary lifestyle or morbid obesity and caffeine intake. It's an important part of the whole picture.

Moore emphasized the importance of patients talking to their primary care doctors about anything they feel is not right about their heart.

They almost have to be insistent on testing being done. If we don’t see the patient, then they may not get the optimal care that we’ve been talking about.

Take control of your heart health today. Request an appointment with an AFib specialist and learn about advanced treatments at TrinityHealthMI.org/AFib.