Every Day

Good News:
All Heart Rhythm Problems Are Treatable

James Roth, MD

Medical College of Wisconsin Cardiologist;
Director, Arrhythmia Management Program

Named one of the "Best Doctors in America®" 2004 by Best Doctors, Inc.


"Whereas for certain forms of heart disease, the best we can do is help you manage your condition, heart rhythm problems are all treatable in one way or another."

Racing heartbeat, slow heartbeat, irregular heartbeat — heart rhythm problems range from the benign to the life-threatening. James Roth, MD, talks about the causes of arrhythmia and the many successful treatments available.

The term refers in general to problems where the heart rhythm is abnormal, either too rapid or too slow or irregular. The various heart rhythm problems all exert their effects by making the heart either not pump fast enough to function correctly or pump too fast and hence not work efficiently. In other cases, it is simply bothersome to feel one's heart racing or skipping beats.

The heart is a peculiar organ. It has millions and millions of cells, and each cell has the potential for electrical activity. Unlike most organs in the body, all the cells in the heart are wired together so that if a single cell fires prematurely, the neighboring cells will be activated and a wave will travel over the heart.

Some people feel the loss of normal cadence of the heartbeat, and that's their primary complaint. It could be because it's uncomfortable, but often it's a complaint because the patient is concerned. They know their heart is critical to minute-to-minute survival. The good news is that when your heart appears normal by reasonable tests — electrocardiogram, physical examination, maybe an echo — then the rhythm problem is usually isolated and usually doesn't get any worse. It is what it is.

It's not unusual for somebody who has a rhythm disorder to be mislabeled as having panic attacks. Just because you've been told you have panic attacks, it doesn't mean that's necessarily the cause — you could have a rhythm disorder. We have "healed" some cases of panic attacks just by treating the rhythm — it turned out not to be panic attacks at all.

In the case of life-threatening problems that are not curable because the heart disease is significant, we would use an implantable defibrillator. A defibrillator does nothing most of the time except monitor the heart rhythm. If the heart rhythm should abruptly accelerate to a dangerous rate and not get better on its own, then the defibrillator will deliver a shock to the heart. It's a strong electrical kick and it hurts, but the shock converts what would have been a life-threatening or even lethal event into basically a non-event.

There are new techniques that use sophisticated equipment we now have at Froedtert & Medical College. It's called computerized electroanatomical mapping. It enables us to make three-dimensional models of cardiac function and cure rhythms with very advanced heart disease, and that's a major advance. We have a good bit of experience with it.

Rhythm problems that occur in heart disease occur in large part because of scar tissue. Whereas normal tissue conducts electrical impulses, scar tissue doesn't. So you have areas of blockage where impulses can't go through — they have to go around. And once an impulse travels around in a loop, it will keep looping around that area over and over and over again — perhaps at rates of several hundred beats per minute — and not stop.
 
With newer techniques, we locate where there is abnormal tissue and scar tissue. We can then deliver lesions — small burns — in critical areas between the scar tissue that interrupt rhythm problems.

One very reassuring thing for patients to understand is that whereas for certain forms of heart disease the best we can do is help you manage your condition, heart rhythm problems are all treatable in one way or another. And the success of treatment is very, very high. Many rhythm problems are either benign and don't need treatment, or are treatable easily with a simple medication, or are curable. It's very important for people not to be afraid that they may have something dangerous, because even if it is dangerous, it's almost always treatable — and that's not true with many conditions.

Author: James Roth, MD

Source: Every Day

Date: May-August 2004