If you’ve ever felt as though your heart is beating too hard or fast, skipping a beat, or fluttering, you know it can be a scary experience. However, these sensations don’t automatically signal something serious or harmful, and often they go away on their own.
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Most of the time isolated skipped beats are related to stress or too many stimulants such as caffeine, nicotine or alcohol, says pediatric cardiologist Peter Aziz, MD. Though uncomfortable, these are often benign.
Why your heartbeat goes off-tempo
Palpitation refers to the sensation that the heart beat is faster than normal. Although some palpitations are considered benign, a carefully taken patient history typically exposes important clues that an abnormal heart rhythm, or arrhythmia, might be the culprit. Palpitations that sustain, and that appear and disappear abruptly, are an important clue that an arrhythmia is occurring.
Much like an orchestra maestro synchronizes complex sounds into symphony, electrical signals in the heart synchronize muscle contractions, which result in heart beats. The electrical system has to perform in a regulated fashion for the heart to function effectively and efficiently.
The electrical system runs on the equivalent of railroad tracks – a very specialized tissue that allows for efficient electrical conduction. Patients with arrhythmias often have extra electrical connections, and arrhythmias can occur when the electrical system uses these accessory connections.
Instead of the heart beating at a normal rate, these extra electrical connections can cause the heart rate to abruptly race at rates that exceed the normal capacity of the heart. When this occurs, patients will sense a rapid and uncomfortable increase in their heart rate referred to as palpitations.
Not all palpitations are considered abnormal. It’s common for the heart to skip for single beats, causing an unusual sensation. With rare exception, these single-skipped beats are considered normal.
In contrast, a patient who experiences an abrupt change in heart rate requires further investigation. Palpitations in these scenarios can often be accompanied by discomfort, chest pain, dizziness or even passing-out spells. These important clues serve as red flags that the patient’s palpitations represent an arrhythmia, and further evaluation is warranted.
During an evaluation, your physician will obtain a detailed history with particular attention to symptoms such as discomfort, chest pain, dizziness and fainting. An electrocardiogram (ECG) – a non-invasive study that assesses the electrical conduction of the heart in its resting state – likely will be performed during the initial evaluation. Occasionally, even at rest, the ECG can show subtle clues that an extra electrical connection exists.
If the ECG is normal and the details of the history suggest an arrhythmia, ambulatory monitoring may be employed. Ambulatory monitors are wearable devices that serve to capture the electrical activity in the heart during an episode. Your doctor will instruct you to record any symptomatic events with your device. This strategy provides a definitive diagnosis if an arrhythmia is in fact captured.
Prognosis and treatment
Depending on the underlying electrical problem, the prognosis and treatment of arrhythmias can vary. Most often, arrhythmias that occur in otherwise healthy children are referred to as supraventricular tachycardia (SVT).
“The prognosis for SVT is excellent and luckily, SVT is not considered a life-threatening condition,” he says.
Management for SVT is largely based on symptoms but can include observation, medical therapy or catheter ablation. Catheter ablation involves a procedure in which an electrophysiology doctor will use electrical wires placed inside the heart through the groin. These wires provide a map of the patient’s electrical system and can identify accessory electrical connections.
Typically, once the accessory tissue is identified, a special catheter called an ablation catheter can be used to deliver energy to the accessory tissue and destroy the electrical activity in that small area. Catheter ablation for SVT is considered quite safe and has outstanding success rates.
With the right prognosis and treatment, patients with arrhythmias are able to get their heartbeat back on track and live normal, healthy lives.