Off The Beat

Specialized cardiologists can treat arrhythmia

If you’re watching a live band and the drummer is not in time with the rest of the players, you know it. You don’t have to be a musician to hear the problem. Something is just off.

Guess what? Your heart is your body’s drummer. If it doesn’t keep the beat properly, it can’t pump blood the way it should. If the blood doesn’t get pumped to the brain, lungs and other organs at the right time, they get damaged.

“The initiation of it all is an electrical signal to direct the timing of the heart muscle’s contraction,” explains cardiologist Michael B. Chisner, MD, of Cardiology Associates of Savannah. Dr. Chisner is also an electrophysiologist, a physician who’s an expert in diagnosing and treating problems with the heart’s electrical system.

If the signal causes the heart to beat too quickly, too slowly or erratically, it is known as an arrhythmia.

“Disorganized, multiple impulses coming from different areas of the atrium, and bearing down on the ventricles, can cause the heartbeat to be erratic and therefore less effective,” adds cardiologist and electrophysiologist Daniel Cobb, MD, who also practices at Cardiology Associates of Savannah.

Depending on its severity, an arrhythmia could require medication and possibly a procedure called radiofrequency ablation.

Why The Rhythm Matters

We all know what happens when a heart stops beating—cardiac arrest, which can be fatal in minutes if not treated immediately. So as long as it has a beat, the heart should be healthy, right?

Not quite. The heart has four chambers that must beat in rhythm in order for the blood to pump effectively. While some arrhythmias are brief and make little difference, longer lasting arrhythmias could put your health at risk. Some common types include:

• Tachycardia – In adults, a heart rate of more than 100 beats per minute. The heart’s chambers don’t fill completely between contractions, affecting blood flow to your other organs.
• Bradycardia – In adults, a heart rate of fewer than 60 beats per minute (exceptions include deep sleep or physically-active adults at rest). The slow rate causes insufficient blood flow.
• Atrial fibrillation (AFib) – An irregular heartbeat. Without a steady, regular beat, blood that is not pumped out can pool and become clotted. Blood clots can block the blood supply to the brain, causing a stroke. 
  

“AFIb is one of the most common arrhythmias that we see,” Dr. Cobb says.

People with AFib may experience palpitations, which is the fluttering or pounding of the heartbeat that can be felt, as well as symptoms of dizziness, fatigue and shortness of breath.

Some people, however, experience no symptoms.

“The difference can be quite striking sometimes—how folks are asymptomatic while others are incredibly symptomatic and know every minute of the day that they are in AFib,” Dr. Cobb says.

Both types of patients could have an increased risk for stroke. Blood not completely pumped out of the heart can pool there and potentially form a blood clot. If the clot is later pumped out to an artery leading to the brain, it could end up blocking that artery and cause a stroke.

If you feel a fluttering in your chest, feel dizzy or light-headed, or if your heartbeat feels to fast or too slow when you’re not exerting yourself, talk with your doctor.

“It may not be a medically-concerning problem,” Dr. Chisner says. “But you won’t know unless you get it checked out.”

Dr. Cobb agrees, and he urges people not to put off a workup.

“When you have a patient who has consistently had AFib for many years versus a patient who is early in their diagnosis, the conversation about success rates changes,” he says. “That doesn’t mean it’s an emergency where I have to treat you the next day. But early referral and evaluation for people who have symptoms has shown to lead to better outcomes.”

Targeting The Signals

If your arrhythmia does require treatment, there are variety of medications that work in tandem to inhibit or correct abnormal electrical signals. Patients may also need to take anticoagulants (sometimes known as blood thinners) to reduce the risk of blood clots. Medication therapy for arrhythmia is typically long-term, perhaps even for the rest of your life.

If medication doesn’t work, or the side effects are too severe, certain patients may be candidates for a radiofrequency ablation. This procedure uses radiofrequency energy to target and destroy the heart cells creating the abnormal signal.

For the ablation procedure, your doctor will guide a catheter through a blood vessel (typically from the groin) to your heart using live X-ray imaging. Once there, he sends electric impulses to the heart, which activates the abnormal cells and lets him know their location. He will then send radiofrequency energy through the catheter to that site. The energy ablates, or destroys, the cells causing the arrhythmia, while the rest of the heart remains undamaged.

Patients can often go home on the same day, and most can return to their normal activities within a few days. You may still experience irregular heartbeats occasionally after the procedure as the tissue heals.

“It may be gradual, but it will correct the problem,” Dr. Chisner says. “Your heart will beat in the rhythm that is right for you.”