5 things to know about heart rhythm disorders

Heart rhythm disorders are one of the most common cardiac problems. Arrhythmias cause the heart to beat too fast, too slow or irregularly. Consultant cardiologist Elijah R. Behr, M.D., shares five developments in the prevention, detection and treatment of arrhythmias.

Arrhythmias and COVID-19

"We know that COVID-19 appears to worsen arrhythmias in patients who have them, and that it may provoke arrhythmia. For patients who have a risk of arrhythmia, prevention is the best treatment, and that's vaccination," Dr. Behr says. "The more unwell a patient is with COVID, the more likely they are to develop arrhythmias."

Atrial fibrillation is common in people with severe COVID-19, Dr. Behr says. Defined as an irregular beating of the heart's upper chambers, the condition increases the risk of heart failure and stroke.

As health care providers treat heart rhythm disorders in people with COVID-19, they also address the underlying infection and any accompanying complications, Dr. Behr says. Patients with COVID-19 and heart arrhythmia may need ongoing care, such as cardiac rehabilitation, after the COVID-19 infection clears up.

"It depends how persistent and severe the damage to the heart muscle," Dr. Behr says. "If it is managed, simple rehabilitation should be sufficient. If there is permanent damage, they may need treatment to prevent future problems or underlying heart failure. They might need medication and/or implantable heart rhythm devices."

Genetic testing can predict, even prevent, sudden cardiac death

"Genetic testing has reached quite an advanced stage for groups at high risk of arrhythmias, such as people with a family history of heart rhythm disorders or unexpected sudden cardiac deaths," Dr. Behr says. "Where genetic testing is now moving is to identify risk in a number of different ways."

For instance, researchers are identifying genetic risk of sudden cardiac death from acquired causes, such as coronary artery problems, rather than genetic causes, Dr. Behr says. Researchers are also examining if it's possible to predict sudden cardiac death risk in the general population.

"There are no data currently to support doing predictive genetic testing for sudden cardiac death risk in the general population. So the people we are focusing on now are those where we know there is a family history of genetic heart problems or there is an unexpected sudden cardiac death in a family that, particularly in young people, is more likely to have a genetic basis," Dr. Behr says.

Dr. Behr envisions that genetic testing would occur alongside heart tests with results provided through genetic counseling. Your risk would determine any needed preventive steps, such as medications, surgery or implantable devices, Dr. Behr says.

Helping athletes stay in the game if they have heart rhythm disorders

"It depends on the condition and its severity and whether the person has had symptoms or consequences of it already," Dr. Behr says. "There will be athletes who have suffered palpitations caused by non-life-threatening heart rhythm problems such as supraventricular tachycardia, or SVT, an abnormally fast heartbeat. These are often very amenable to 'curative' treatments such as ablation therapy, where a minimally invasive approach is used to block abnormal heart signals. They can then return to normal activities."

For instance, people with Wolff-Parkinson-White syndrome are born with an extra electrical pathway between the lower and upper chambers of the heart. The extra pathway causes a rapid heartbeat. But radiofrequency ablation can destroy the extra pathway and permanently correct the rhythm issues.

For other athletes with electrical issues in the heart or long-standing heart muscle problems, continuing sports can be more challenging. These athletes often require a personalized approach, Dr. Behr says.

"For example, defibrillators used to protect patients at risk of life-threatening heart problems are not usually considered conducive to continuing elite sports," especially contact sports, such as American football or rugby, he says. And while it’s generally safe for older people with pacemakers to play golf, that may not be the case at the elite level, as strong golf swings can place too much stress on implanted medical devices.

"In the end, it is the athlete's decision," Dr. Behr says. "There has been a lot of progress made, especially by Mayo Clinic, in studying athletes who have these conditions and making us realize that more can return to sports than we thought possible, because the risks may be not quite as high as we thought."

Arrhythmia symptoms to be aware of

Tell your health care provider if you have a family history of arrhythmias, heart disease or sudden cardiac deaths. If you experience unexplained blackout faints (not attributed to a drop in blood pressure or shock from seeing blood), seek immediate attention, Dr. Behr says.

"When there is a very sudden loss of consciousness, that's a quite serious symptom to have and requires urgent evaluation at a hospital," he says.

Heart palpitations are generally not worrisome. However, if you feel discomfort or have a family history of heart conditions, you should be evaluated by a cardiac specialist. If you experience palpitations while exercising or feel lightheaded, seek emergency care, Dr. Behr says.

"In general, if people have worrying symptoms such as palpitations that do not cause more serious side effects, those still deserve to be checked out," he says. "That can involve simple cardiac tests such as an electrocardiogram or Holter monitor to record heart rhythm."

To reduce arrhythmia risk, Dr. Behr suggests:

  • Controlling your cholesterol, blood pressure and weight
  • Keeping a healthy diet
  • Avoiding overconsumption of alcohol
  • Avoiding smoking

Pharmacogenomics and preventing drug-induced arrhythmias

Because genetic makeup is unique, not every drug or every dose works for every patient. Through pharmacogenomics, health care providers can examine a person's genes to deliver the right medicine at the right dose, thereby increasing effectiveness and reducing side effects.

"Pharmacogenomics is a promising and rapidly developing area," he says.

It's especially important in cardiology. More than 200 common medications, such as mental health drugs, antibiotics and heart-related drugs, can cause arrhythmia, including long QT syndrome, Dr. Behr says.