Most people can count on a steady heartbeat. Sure, it beats faster when they run or pounds a little when they’re scared. It may even skip a beat when they fall in love. But then it returns to normal.

Some people can have a heartbeat that is too fast, too slow, or erratic, without returning to normal. These irregular heartbeats are known as arrhythmias.

Understanding arrhythmias
“Normally, the heart rhythm comes from the sinus node, the normal pacemaker of the heart,” explains Laurent Lewkowiez, MD, a board-certified cardiac electrophysiologist at Kaiser Permanente Colorado. “Arrhythmia is basically any heart rhythm that is not normal.”

Usually the heart’s electrical impulses travel in an orderly manner and maintain a steady heartbeat. Arrhythmias occur when these impulses somehow become disordered and misfire, causing the heart to beat irregularly and pump ineffectively.

The heart has four chambers – two on top and two on the bottom. There are different kinds of arrhythmias, depending on where they occur. Atrial fibrillation – one of the more common arrhythmias – starts in the heart’s upper chambers, called the atria.

Symptoms
People with this condition may notice palpitations – an uncomfortable feeling that the heart is racing or pounding. They may also experience shortness of breath, dizziness, or feel faint. These symptoms often start and stop abruptly, and often are triggered by exertion. For people who have no history of heart disease, fleeting changes in heart rhythm are normal and not a cause for worry.

In some cases, however, arrhythmias are severe and do not correct themselves, causing people to go to an emergency room for an IV medication to stop the condition. If that’s not successful, they may be given a brief electric shock, known as an electrical cardioversion, to reset the heart’s rhythm. Some people also try to avoid arrhythmias by curtailing activities.

“If left unmonitored and untreated, atrial fibrillation can lead to heart failure, caused by the heart’s reduced pumping ability,” Dr. Lewkowiez explains. “It can also cause blood clots to form, increasing a person’s stroke risk. Blood thinner medications are often prescribed to reduce this possibility.”

Ventricular tachycardia, another type of arrhythmia, involves the heart’s bottom chambers. “Arrhythmias in the heart’s bottom chambers are more likely to be life threatening and make it difficult for the heart to pump enough blood to the brain and body,” Dr. Lewkowiez continues. “They often are associated with a weakness of the heart muscle, due to congenital abnormalities, heart weakness of unknown cause, or damage from a previous heart attack.”

Curing arrhythmias
Arrhythmias are initially treated with medication. When that proves ineffective, patients at Kaiser Permanente have the option to be treated with ablations. “Ablations are a relatively new procedure that completely cures many common arrhythmias – without requiring medication afterward,” Dr. Lewkowiez explains. “When performed in the best of hands, these procedures have a very high success rate.”

During an ablation, a cardiologist guides a catheter, a thin, flexible tube from the groin into the heart. Electrodes at the end of the catheter deliver a high-frequency energy, causing scar tissue or lesions to form, which blocks the heart’s erratic impulses. Depending on the type of arrhythmia, the lesions can prevent erratic impulses from starting or continuing.

“Ablations are very satisfying procedures to perform because they can cure arrhythmias for life and significantly improve a person’s quality of life,” Dr. Lewkowiez says. “However, because they require special training and technology, they are not offered everywhere.”

Dr. Lewkowiez is recognized as one of Denver’s leading cardiologists and a 5280 Magazine “Top Doc.” “I was inspired to come to Kaiser Permanente because of its integrated health system, which keeps track of patients and makes sure they have appropriate preventive therapy. This group also allows me to practice medicine to meet the best interests of my patients.”

To learn more about heart arrhythmias, visit kaiserpermanente.org.

Dr. Lewkowiez received his medical degree from the Medical University of South Carolina and completed his residency and fellowship training at the University of Colorado Health Sciences Center. He also completed an advanced ablation fellowship at the University of Pennsylvania. He is board certified in cardiology, with subspecialties in cardiovascular disease and clinical cardiac electrophysiology.