It then receives the blood returning from the veins and pushes it towards the lungs. This is a cycle that repeats itself continuously throughout our lifetime, and for it to occur normally, the heart must contract in sync via the electrical impulse conduction system. If there is a disturbance in this cycle, then we are led to the appearance of arrhythmias.

“The word arrhythmia means that the functioning of the heart lacks rhythm, that is, it beats too fast or too slowly or in an irregular manner. As a term it is quite general and includes a large group of heart rhythm disorders, from fairly innocent to life-threatening arrhythmias if left untreated,” emphasizes Mr. Theoni Messiskli MD, Cardiologist – Arrhythmologist Department of Electrophysiology and Pacing Metropolitan Hospital and continues, “as an electrophysiologist (arrhythmiologist), i.e. a cardiologist specializing in arrhythmias, I deal with many patients every day who complain of an irregular heart rhythm.”

How is a regular or irregular pulse created and what are the symptoms?

The heartbeat is generated by an electrical impulse generated in its normal “battery” known as the sinus node. This changes continuously during the 24 hours depending on the needs of our organization. When this impulse is not produced or transmitted properly, or there is another center that produces impulses in an unnatural way, an arrhythmia is created. This does not allow the blood to be properly pushed by the heart pump throughout our body.

Common symptoms can be: a “fluttering”, “pounding” feeling in the chest (called palpitations), weakness, dizziness, fainting, restlessness, discomfort or even shortness of breath, chest pain or syncope. However, some patients with arrhythmias have few or no symptoms and these arrhythmias may be discovered by chance during a routine examination or because some other medical problem has arisen,” the expert points out.

The most common arrhythmias

The extraordinary contractions, i.e. the “extraordinary” contractions (pulses) that sometimes affect the normal rhythm of the heart and may have been felt by many of us. A sudden contraction can create the feeling that the heart misses a beat. They are often caused by strong emotions (joy or sadness) or some external factors such as alcohol, coffee or nicotine. These contractions are usually not worrisome. Rarely, it can be a harbinger of a more serious condition and especially in patients with heart disease.


As tachycardia we define, when the pulses at rest are more than 100 per minute. Normal pulses are not the same for every person, as they depend on the age and general state of the person’s health. So in fact, any increase in the number of pulses from our normal, and especially if accompanied by symptoms, can be a sign of arrhythmia. Among them, we find:

  • Sinus tachycardia: Usually caused by stress, tension, fever or exercise. This is generally a normal function of the heart under certain conditions and is usually not an arrhythmia.
  • Supraventricular tachycardia: The condition in which electrical impulses from the top of the heart create a rapid heartbeat that is usually intolerable to the patient, but not life-threatening.
  • Atrial Fibrillation: This is a chaotic supraventricular rhythm that causes a rapid and asynchronous heartbeat. This condition may be transient or may not go away without treatment and eventually cause serious complications, such as stroke.
  • Atrial flutter: Similar tachycardia to atrial fibrillation, but the heartbeats are more organized and is also associated with strokes.
  • Ventricular tachycardia: A rhythmic tachycardia that does not allow the ventricles of the heart to fill with blood sufficiently, resulting in an inability to send an adequate amount of blood to the body. It may not be dangerous in people without heart disease, but in those with heart problems it is an emergency that requires immediate treatment.
  • Ventricular fibrillation: The chaotic ventricular rhythm that leads to death if not treated immediately.


We say that we have bradycardia when the pulses are less than 60 per minute. “Few pulses are not always a sign of an abnormal rhythm. Every day we meet young and even older people who exercise and eat right and have a heart rate of less than 60, with a healthy heart. If we feel well, the number is not a problem, explains the cardiologist.

What are pathological bradycardias?

If the normal pacemaker of the heart does not work properly – more often in elderly people – we may feel weakness, dizziness, fainting or tachycardia. This is called sinus disease. The treatment in these cases is the placement of a permanent pacemaker.
In addition, it can be caused by blocking the pulse at some point in the heart’s electrical system, with the most dangerous form being complete AV block. The treatment here too is the placement of a pacemaker.

How is arrhythmia diagnosed?

In order to diagnose the arrhythmia, we must record the abnormal pulse and find the cause of this “abnormality”.
“The patient’s history (both individual and hereditary) has a primary role. With the visit to the doctor, a detailed medical examination and an electrocardiogram follow. Blood tests, echocardiogram, fatigue test, Holter rhythm (24-hour or prolonged heart rate recording depending on symptoms), tilt-table test (reclining test to investigate fainting episodes) and in some cases genetic tests, imaging may also be requested of the heart with CT or MRI and an electrophysiological study (to measure the electrical activity of the heart),” he says.

How are arrhythmias treated?

Important is prevention. Although we cannot always prevent them, we can certainly reduce the risk if:

  • Ask for help from cardiologists and follow the therapeutic steps.
  • We exercise regularly
  • We avoid smoking and various drugs that trigger them
  • We limit alcohol consumption
  • We talk to our doctor before taking any medicine or dietary supplement
  • We watch our diet and maintain a normal weight
  • We control high blood pressure and treat apnea syndrome.

If the arrhythmia requires other treatment, then the following may be recommended:

  • Drugs depending on the type of arrhythmia
  • Procedures, such as ablation
  • Implantable devices such as pacemakers, defibrillators, resynchronization therapy.

What is the ablation that is increasingly used nowadays to treat arrhythmias?

“In a specially organized laboratory, the electrophysiological one, the operation is performed in which catheters are placed through the veins into the heart with local anesthesia. With the help of sensors on top of them, we locate the areas that produce abnormal electrical signals and block them with either cold (cryo-ablation) or heat (usually radio frequency current), restoring the heart’s normal rhythm.
For decades, this method has been the treatment of choice for drug-resistant supraventricular tachycardias, bundles, and ventricular tachycardias. Today, however, it is also chosen as a treatment for a more frequent arrhythmia, atrial fibrillation, which the earlier it is treated, the better the result will be”, he explains.

What are pacemakers?

When pulses are low without a cause that can be corrected, even with medication, the solution is a pacemaker. This is a small device, which is usually implanted under the skin in the chest, below the collarbone. This device has one, two or even three electrodes that are placed in different parts of the heart to restore the normal electrical system.
“These are small computers that record the heart’s rhythm, giving us information about other arrhythmias and about parameters that help us personalize the correct operation and treatment of our patient. Nowadays we also place pacemakers without electrodes (leadless pacemaker), directly in the heart. The correct choice of pacemaker is different for each person and must be decided with the help of a specialist electrophysiologist”, he adds.

What is different about defibrillators (or defibrillators)?

These pacemaker-like devices have the potential to treat life-threatening arrhythmias, either with rapid pacing or with a low- or high-energy shock that restores the normal rhythm. We recommend them to patients who are at increased risk for arrhythmic death and are one of cardiology’s greatest achievements.

When should we worry if we feel an abnormal pulse?

“There is no reason to worry if it is not accompanied by other discomforts, such as dizziness, pain, shortness of breath, etc. However, while most arrhythmias are harmless, some may be a sign of a more serious cardiac condition that requires treatment. That is why it is necessary to get the opinion of an expert, because knowledge is power and prevention is the cornerstone of health, concludes Ms. Mesiskli.