Diagnosing heart rhythm disorders
To diagnose an arrhythmia, your health care provider will take your medical history, perform a physical exam and suggest certain tests. You may be referred to an electrophysiologist, which is a doctor who specializes in treating heart rhythm disorders.
Medical history
Your providers will ask about your symptoms, duration, frequency and triggers, as well as your other medical conditions, family history of heart disease, medications and lifestyle.
Physical exam
Your provider will check your vital signs, listen to your heart and lungs, and examine your legs for signs of swelling. They may also check for an enlarged thyroid or other body changes to see what might be causing the arrhythmia.
Diagnostic tests
You might need one or more of these tests to diagnose an arrhythmia:
- Electrocardiogram (ECG or EKG): This non-invasive test records your heart’s electrical activity. It can detect atrial fibrillation, bradycardia or ventricular tachycardia. You will probably be at rest for an ECG, but you may also have one when you’re exercising (stress test) or over a longer period (Holter monitoring).
- Holter monitor: A Holter monitor is a portable device you wear for 24 to 48 hours. It may spot arrhythmias that don’t appear during a standard ECG. You may be asked to keep a diary of symptoms and activities while wearing the monitor to help spot possible triggers.
- Event recorder: Like a Holter monitor, an event recorder tracks your heart’s electrical activity. But you wear it for up to 30 days and turn it on when you notice symptoms. Event recorders are helpful if your symptoms don’t happen often.
- Echocardiogram: An echocardiogram is a non-invasive test that uses sound waves to create a detailed picture of your heart. It shows the size and function of the heart chambers, heart valves and blood flow. Echocardiograms help spot structural problems or heart conditions that could make you more likely to have arrhythmias.
- Electrophysiology study (EPS): An electrophysiology study is a procedure performed in a cardiac catheterization laboratory. During an EPS, thin, flexible tubes (catheters) are inserted into the heart through your blood vessels. They map the heart’s electrical pathways and trigger arrhythmias. This test helps identify the cause and location of arrhythmias. It can guide treatment decisions, such as catheter ablation or implantable device placement.
Treating heart rhythm disorders
Your health care provider may recommend one or more of these options to treat your arrhythmia:
Lifestyle changes
Lifestyle changes may include:
- Choosing a heart-healthy diet rich in fruits, vegetables, whole grains, lean proteins and low-fat dairy products to help control blood pressure, cholesterol levels and weight.
- Regular physical activity can improve cardiovascular fitness, lower blood pressure and reduce stress.
- Quitting smoking.
- Limiting alcohol and caffeine, which may help symptoms be less frequent and severe.
- Practicing stress-reduction techniques such as deep breathing, meditation, yoga or mindfulness, which may reduce stress-induced arrhythmias.
Healthy lifestyle changes may also help prevent arrhythmias from developing.
Medications
Medications can control heart rate, rhythm and underlying conditions. Commonly used prescription medications include:
- Antiarrhythmic drugs: These medications help stabilize your heart rhythm and stop arrhythmias. They include beta-blockers, calcium channel blockers, sodium channel blockers and potassium channel blockers.
- Anticoagulants (blood thinners): Medications like warfarin or direct oral anticoagulants (DOACs) may reduce the risk of blood clots and stroke in people with atrial fibrillation or other arrhythmias.
- Heart rate control medications: Beta-blockers or calcium channel blockers may slow heart rate in people with tachyarrhythmias (fast heart rates).
- Medications for other conditions: Medications to treat high blood pressure, heart failure or thyroid disorders may improve cardiovascular health and reduce the risk of arrhythmias.
Heart procedures
In addition to lifestyle changes and medication, your doctor may recommend one of the following minimally invasive procedures.
Cardioversion
This procedure may return your heart rhythm to normal if you have certain arrhythmias such as atrial fibrillation or atrial flutter.
With electrical cardioversion, a health care provider places electrodes on the chest and delivers an electrical shock to the heart. The shock interrupts abnormal electrical impulses so your heart can beat normally again.
Catheter ablation
Catheter ablation is a minimally invasive procedure that can treat certain arrhythmias by destroying (ablating) abnormal electrical pathways or tissue causing the arrhythmia.
During the procedure, a health care provider guides a thin, flexible catheter into the heart through blood vessels and eliminates the abnormal tissue. It may be a good choice if you have atrial fibrillation, atrial flutter or certain types of ventricular tachycardia.
Your provider may recommend pulsed field ablation or stereotaxis genesis. These innovative options may improve safety and reduce the risk of complications.
Learn more about the different types of catheter ablations and how the procedures work.
ICDs and pacemakers
Most of the time, non-invasive or minimally invasive procedures can treat your heart rhythm disorder. In some cases, your health care provider may recommend a surgical treatment like:
- Implantable cardioverter-defibrillator: This device is placed in your chest and delivers an electric shock when your heartbeat is irregular.
- Pacemaker: This device is placed in your chest or abdomen to control your heart rate.
Learn more about these and other outpatient heart procedures.
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