The heart’s rhythm is caused by electrical signals generated in the sinus node, the heart’s normal pacemaker located in the right atrium of the heart. Normally the heart at rest works at 60 to 100 beats per minute.

Arrhythmias are disturbances in the frequency or regularity of the heart rhythm that cause the heart to beat, either faster (tachycardia), or slower (bradycardia) or sometimes completely irregularly such as e.g. in atrial fibrillation.

Arrhythmias are diagnosed with simple tests such as history and clinical examination, electrocardiogram, Holter rhythm and ultrasound (Triplex) of the heart. Sometimes a stress test, other cardiac imaging tests, or mildly invasive diagnostic methods (implantable Holter, electrophysiological study) may be needed.

Extraordinary contractions

Arrhythmias often occur in people with normal hearts.
The most common rhythm disorder in people with a normal heart is ectopic contractions, that is, early – before the expected time – contractions that interfere with the normal rhythm resulting in small, momentary interruptions, and most of us have experienced them.

Abnormal contractions may cause no symptoms and be found on a random medical examination, but they can be extremely bothersome, create a feeling that the heart has missed a beat (skipped beat), an “empty” feeling in the chest or stomach, or they give the feeling that some pulses are stronger. They are often caused by strong emotions or factors such as excessive consumption of alcohol, coffee or nicotine although most of the time there is no clear trigger.

Abnormal contractions in a normal heart have an excellent prognosis and subjects should be reassured and explained that they have an innocent condition from which they are not at risk. Many times this is enough to relieve the discomfort. Only when the extraordinary contractions are very frequent (constantly more than ten thousand per 24/hour) may treatment with drugs or ablation be necessary.

Sinus Tachycardia

An also innocent rhythm disorder in a normal heart is Sinus Tachycardia where electrical signals are produced normally, in the sinus node, but with a frequency greater than 100 beats per minute. It is usually caused by stress, tension, fever or exercise and is essentially a normal function of the heart and not a true arrhythmia.

The Sinus Bradycardia that we see in athletes is also completely innocent and is indicative of good physical condition.

Paroxysmal Supraventricular Tachycardia

Another group of arrhythmias that occur in a normal heart are Paroxysmal Supraventricular Tachycardias. They are caused by a circular movement of the electrical stimulus in the upper part of the heart in people predisposed to such tachycardias, resulting in a rapid heart rate. The tachycardia stops abruptly either by itself, or with the so-called vagotonic manipulations (tightening, pressure of the carotid arteries, coughing, etc.) or with drugs. Often these tachycardias are very symptomatic and cause palpitations (fluttering) in the chest, dizziness or a tendency to faint. They have a good prognosis and, although they can be controlled to an extent with drugs, they are usually treated with ablation with very high success rates.

Atrial Fibrillation

Atrial Fibrillation is a chaotic atrial rhythm that causes an irregular tachyarrhythmia. This condition can be transient or persistent. Atrial fibrillation in a normal heart is relatively harmless although it can cause very distressing symptoms. Ablation tends to become the treatment of first choice with high safety and fairly high success rates.

Ventricular Tachycardia

Ventricular Tachycardia is a rhythmic tachycardia in which the electrical signals start in the ventricles of the heart and, in people without heart disease, is not dangerous. It usually occurs in short bursts and may cause palpitations, dizziness or a tendency to faint. Medicines have moderate success while ablation offers a more permanent solution with high efficiency.

Primary Electrical Heart Disease

Of course, there are cases of ventricular tachycardia that inspire concern, without structural heart disease. Such conditions are Primary Electrical Heart Disease, such as Long QT Syndrome, Arrhythmogenic Right Ventricular Dysplasia, Brugada Syndrome and Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT). People with such conditions usually report episodes of syncope, while there is often a positive family history as these conditions are genetic and are usually inherited. In these cases, extensive diagnostic investigation and aggressive treatment, pharmaceutical or even invasive, are required.

in conclusion

Arrhythmias in people with a normal heart are generally innocuous. If the symptoms are tolerable, no treatment may be required, as in the case of sudden contractions. In cases of supraventricular and ventricular tachyarrhythmias, antiarrhythmic drugs may be partially effective but only suppress the arrhythmia and do not cure it definitively, while the occurrence of unwanted actions is possible.

On the contrary, ablation performed with special catheters inserted inside the heart can offer a permanent treatment of tachyarrhythmias with safety and high success rates. Hospitalization is usually 24 hours, the patient is mobilized a few hours after the end of the operation and is discharged the next day. For these reasons, Ablation can be used as a treatment of first choice, i.e. before drugs are even administered, as it is a radical treatment of arrhythmias with high efficiency and safety.

“Arrhythmias in a normal heart generally have a very good prognosis. In the case of sudden contractions, it is usually sufficient to inform and reassure the examinee, while for persistent arrhythmias (paroxysmal supraventricular tachycardias, atrial fibrillation, ventricular tachycardia) drugs and especially invasive ablation (ablation) offer an effective way of treatment”