Health Chats
Arrhythmias: Different Types and Available Treatment Options
Tuesday Jun 28, 2011, 01:00PM - 02:00PM (EST)
Peter Borek, MDBlank
There are many different types of cardiac arrhythmias. Many arrhythmias are benign and do not require any specific treatment. However there are some arrhythmias that need to be controlled with the use of medications, electric cardioversion, implantable devices such as defibrillators or pacemakers and catheter ablation. Join us with Dr. Borek, a Cleveland Clinic electrophysiologist who will provide answers to your questions about the different types of arrhythmias and their available treatment options.<br><br> Peter Borek, MD is a Staff Cardiologist in the Section of Cardiac Electrophysiology and Pacing in the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at Cleveland Clinic. He is board-certified in cardiac electrophysiology, cardiovascular disease and internal medicine. Dr. Borek is trained in all aspects of clinical cardiac electrophysiology and pacing, including catheter ablation of various arrhythmias.
Hello everyone and welcome to today's health chat with Dr. Peter Borek. We will be starting in a few minutes, but please feel free to submit your questions now.
Welcome Dr. Borek!  We are so excited to have you here today.
Peter Borek, MD:
Thanks for having me here.  Lets begin the questions.  
What are the causes of malignant arrhythmia's and how are they diagnosed? How rare are they in the setting of a "normally" structurally heart?
Peter Borek, MD:
In the settting of a normal heart the malignant arrhythmias are usually caused by various channel abnormalities or congenital heart disorders such as Hypertrophic cardiomyopathy, ARVD.  the common channelopathies include long QT syndrome and Brugada's syndrome.
I have nsvt, svt, pac, pvcs, and aivr. Had three eps with hope of ablation. They couldnt induce it any of the three times. Meds made the nsvt worse. Had loop recorder implanted so we got recordings of it. Otherwise my heart is normal healthy all the cardios dont seemed worried but I am. Now after a radioactive dye from hida scan my resting heart rate wont go below 90. Normal for me is 58-65. Wore a 24 hr this last friday for my heart rate and while wearing it I had an episode of nsvt or svt not sure thought I was going down. waiting for results. Help!
Peter Borek, MD:
In the setting of a normal heart and a relatively normal ECG your prognosis is fairly good.  I would only be aggressive in terms of ablation if you were very symptomatic or were having signs of worsening heart function.  I assume that you have never passed out before and that workup has been unrevealing of any cardiac abnormalities.  
I get pvcs.  Some days just a handful, some days they come in clusters in up to 8 a minute for a couple of hours.  I also get short runs of supraventricular tachycardia.  I think the longest was 12 or 24 beats.  I wear holters, have echos, and stress tests every year and everything is always normal except for the pvcs.  What is the limit in the amount of pvcs that exceeds normal.  Also, pvcs during exercise cool down I have read can be fatal.  Is this true?
Peter Borek, MD:
Everyone has PVCs but no everyone feels them.  In terms of symptoms, if they are severe or debilitating we offer medical therapy regardless of the PVC burden.  We don't get concerned with the PVC until they reach about 10% of the total number of beats over a 24 hour period.  At that point there is a risk of developing whats known as PVC induced cardiomyopathy.  We typically recommend aggressive medical therapy or an ablation based on patient's preferences.  
Peter Borek, MD:
PVC's during cool down typically aren't fatal.  The ones that occur during maximal exertion are more worrisome.  
I  had an ablation for AVNRT 3 weeks ago and I have several questions. 1. The slow pathway was ablated. Is there a chance that scar tissue will grow to effect the fast pathway causing a need for a pacemaker? 2. What are the functions of both  pathways? Is the heart affected by having the slow pathway ablated? 3. When I walk on the treadmill, my heart hurts. Am I exercising too soon and if so what is a reasonable amount of time to start exercising again?  Thank you.
Peter Borek, MD:
1.  Very unlikley this far out.
Peter Borek, MD:
2.  We arent' certain, potentially when one gets disease the other one takes over.  Also, at night we probably use the slow pathway predominantly.  Certainly, your longevity isn't affected by not having the slow pathway because of the ablation.  Not everyone has a slow pathway.
Peter Borek, MD:
3.  I usually tell my patients to take it easy for about a month or so.  I am, however, not concenred about your chest pain.  I don't think that it means that there is anything wrong going on after your procedure.  
I have "skipped beats" which can be sporadic or frequent.  My doctor says it may be due to a mild mitral valve prolapse.  Is there a specific test to determine the cause and is this condition considered dangerous?
Peter Borek, MD:
Patient with mitral valve prolapse tend to suffer from palpitations.  These are typically caused by PAC's or PVC's which are basically extra heart beats which come from the upper and the lower chambers, respectively.  The test that provides the accurate diagnosis is called a 24 hour Holter.  You could also wear an arrhythmia monitor in case the symptoms are very sporatic and aren't likely to be captured on a 24 hour arrhythmia monitor.  These typically have a favorable prognosis as long as heart function is preserved (EF >55%)
I suffer from various arrhythmias, which occur at night during the early morning hours. These include periods of bradycardia, short periods of tachycardia, periods of skipped beats, and, occasionally, several hours of heart beats that are all irregularly spaced (some faster, some slower, some after a pause). They also seem to occur more frequently when I am lying on my left side. What is the possible diagnosis and treatment?
Peter Borek, MD:
It sounds like your symptoms are very frequent therefore I would recommend wearing a holter monitor for 24 hours.  These most likely represent PAC's or PVC's.  they are generally benign.
Peter Borek, MD:
Depending on the nature of this arrhythmia further therapy may inlcude medications versus an ablation procedure.  In the setting of a normal heart these rhythms carry a low overall risk but certainly can cause quite a bit of symptoms.  I would recommend getting a second opinion.
Is there a relationship between weight loss pills and arythmias
Peter Borek, MD:
Absolutely.  Caffeine is the most common one, however, pseudoephedrine and other stimulants have been linked to causing arrhythmias as well.  
Hello, my dad has arrhythmias, and I may have also. My dad's are much more serious. Sometimes his heart has started racing so fast that he has to go to the emergency room. They have tried to do a procedure at a hospital in Honolulu Hawaii, where the nearest well known specialist was, where they cauterize the area of the heart causing it, but said it was too difficult to find and too many places as he has multiple arrhythmias of different kinds as I understand it, so it failed. During the procedure his heart started racing so bad they had to defib. while he was awake. They said they won't put in a pace maker because his heart is otherwise healthy, he does not have heart disease. This is really concerning to us because it seems there are no treatments, some meds help but do not control, so is scary to live with. Are there any new treatments or procedures that you know of for this situation? They do live part of the year here in Seattle if there is a recommended specialist here also.  
Peter Borek, MD:
Depending on the nature of this arrhythmia further therapy may inlcude medications versus an ablation procedure.  In the setting of a normal heart these rhythms carry a low overall risk but certainly can cause quite a bit of symptoms.  I would recommend getting a second opinion.
I have skipped beats.  I went for a stress test and they said there was 2 mm depression (I think it was something like that but can't quite remember if that was exact). They wanted me to go for an IV stress test to see if there were blockages.  The test showed no blockages.  They said not to worry about this 2mm depression.  Would you agree with that?  Would that be the cause of my skipped beats and bouts of irregular heartbeats?
Peter Borek, MD:
Yes, the nuclear stress tests has a better accuracy.  You should wear an arrhythmia monitor such as a holter or an event recorder to sort this out.  typically, extra heart beats are caused by PAC's or PVC's.  
I have mitral valve prolapse, and live with some extra heartbeats.  I'm currently 60.  How can I determine if I can safely do aerobic activity?
Peter Borek, MD:
You should follow up with your general cardiologist regaring that.  Certainly from the extra heart beat stand point, I would recommend proceeding with an arrhythmia monitor to identify the causse of your symptoms.  
Hi - I am a 41 yr. old athletic female who works out frequently and plays competitive tennis.  I have been diagnosed with svt with av nodal reentry.  I am on metoprolol but now have been diagnosed with bradycardia with beats around 47ish and 37ish at night.  I have svt events approx. once a month but my rate only goes up to about 150. It is accomp. with chest pain, shortness of breath, and flu like symptoms where my muscles seem to have extreme fatigue.  Ablation has been recommended.  My question is - is the metoprolol causing the bradycardia and is it ok to have a slow rate all of the time because it does make me feel very tired all of the time and is that bad for the heart?  If I was to have the ablation would that bring me back to a normal rate and fix my tiredness??  Also when I work out I can tell when I have reached a point where it's like I need to get my heart to beat faster but the meds are not allowing me to do so. Will this put unnecessary strain on my heart? Thank U
Peter Borek, MD:
The metoprolol is responsible for the bradycardia.  the nocturnal bradycardia is of no concern, however, daytime fatigue obviously is becuase you can't go on like this forever.  If I were you I would go with the ablation route.  It is curative in greater than 95% of patients and no further therapy is needed at that point.  The risk of serious complications is less than 1%.  your symptoms are very common.  Most young patients don't tolerate beta blockers very well.
If I have Atrial Fibrillation, does that increase my risk of stroke?  If so by how much and is there anything I can do to reduce that risk?
Peter Borek, MD:
AF increases the risk of stroke.  The risk depends on other factors such as your age, history of hypertension, heart failure, diabetes, valvular heart disease and history of prior stokes.  Most patients who are young without any of the above risk can be treated with aspirin alone.  Once any of the above risk factors are present treatment with coumadin is most optimal.  
navapavithra: father is suffering from low vt...he is implanted with an ICD in 2008, earlier cabg was done in 1999 and angioplasty in 2008,severe left lv dysfunction,left nephrotomy was his past past one month he suffers from recurrant vt..... two weeks back he was admitted for af..then discharged...then last week with vt which was controlled with cardarone in iv....later after 3 days he had an episode which was later reverted by 20j of during the hospital stay itself he had three recurrant episodes was reverted only in the 3rd episode with has suggested for ep ablation ....which wil be performed day after can u please suggest me is it safe and wat r the later effects