Did you know that every heart has an electrical system? It sends electrical signals that tell the different parts of the heart muscle when it is time to activate, like a conductor of an orchestra.
Palpitation is the term we use to describe awareness or sensation of the beating of their heart. This sensation can last seconds, minutes, hours or days, and can reflect fast or slow heartbeats. Sometimes people feel a skipped or absent beat, a fast or hard heartbeat, a “flip” or a thud. While many different electrical irregularities can happen with the heart, they are often not dangerous.
Slow heartbeats, especially if they are creating fatigue or lightheadedness, are often treated with pacemaker devices. These prevent the heart from going below a programmed number, usually 60 beats per minute. Overactive rhythms from the bottom chambers of your heart—the ventricles—may require installing a defibrillator, which shocks rapid heartbeats to slow them down. Extra or skipped heartbeats are typically treated if they happen often enough to be a bother, sometimes with medicine, other times with procedures. Sudden unexpected racing heartbeats may be an electrical “short circuit” in the heart, probably affecting 1 in 200 people, which can also be treated if bothersome, with medication and/or procedure. One of the most common abnormal heart rhythms is atrial fibrillation, an irregular, usually fast and overactive electrical condition from the top chambers of the heart. This affects between 3 and 5 million Americans in 2017, can increase risk of stroke and can create symptoms that limit quality of life.
There are several questions your doctor will want to ask to help make a proper diagnosis. It is useful to know when the palpitation first took place in your life, how often it happens, what it feels like, how long episodes tend to last and if there is anything you have experienced that triggers the spells or makes them go away when they take place. Fainting or passing out is always something to take seriously.
The best way to diagnose an abnormal heart rhythm is to get an electrical recording at the time you have your symptoms. If episodes last long enough, coming to the office or an urgent care center or emergency room for an ECG is particularly helpful. There are also heart rhythm monitors that can be worn at home that can help for episodes that can come on at any time. Your doctor may refer you to a cardiologist or an electrophysiologist for further evaluation.
Many abnormal heart rhythms, especially if they cause bothersome symptoms, can be treated with a procedure called cardiac ablation. The goal is to pinpoint where the irregularity is coming from in the heart and stop it from happening. Precise ablation can be a permanent fix for heart rhythms, often not requiring ongoing medication treatment for the arrhythmia. The procedures are quite safe and are done with an anesthesia team for patient comfort.