DR MILES DALBY

Although atrial fibrillation is the commonest important heart rhythm abnormality a number of other rhythm problems can cause concern. There are complicated classifications and names for these problems which can be difficult to understand however it can be helpful to differentiate between single extra (ectopic) beats and continuous abnormal beats-which may be very shortlived, more sutained, come and go (paroxysmal) or be permanent.

Ectopic beats can come from the atria (atrial ectoics) or the ventricles (ventricular ectopics, VEs). These ectopic beats are common and often asymptomatic however they can sometimes causes an awareness of the heart beat, particularly VEs. Depending on their characteristics, frequency, and the underlying condition of the heart these ectopic beats can be harmless or can cause a significant cardiac problem. Treatment of ectopic beats can include conservative management and avoidance of precipitating factors (eg caffeine), drug therapy and sometimes catheter ablation.

Sustained rhythm abnormalities can be helpfully divided into those arising in the atria of the heart and those arising in the ventricles of the heart.

In addition to atrial fibrillation (AF) other atrial arrhythmias include atrial flutter, atrial tachycardia and re-entrant tachycardias sometimes called ‘supraventricular tachycardias’ or SVT. These problems can often be managed conservatively with no specific treatments but sometimes drug treatment or catheter ablation will be recommended.

Ventricular tachycardia or VT is a potentially serious rhythm abnormality and always requires careful evaluation often including scans of the heart and a coronary angiogram. VT often requires drug therapy and sometimes an implantable defibrillator (ICD) will be recommended to protect the patient from a dangerous rhythm. Sometimes catheter ablation may be recommended.

When investigating rhythm disturbances in the clinic your cardiologist will need to take a history and perform a physical examination. In addition they will want to perform some tests which will often include blood tests, a chest x-ray, ECG and echocardiogram as well as a holter monitor. The length of monitoring will usually depend on how frequently the abnormal rhythm is occurring. Sometimes a patient activated monitor or implantable monitor may be necessary Sometimes a catheter electrophysiological study (EPS) will be necessary.

Dr Dalby will discuss these tests, their implications and any subsequent tests, treatment or follow up with you so that you may reach a mutually agreeable management plan.