A thorough assessment is needed to establish the cause of your heart rhythm problem and allow for an appropriate management plan.
How you describe your symptoms will often help narrow down the possibilities. However, correlation of your symptoms with an electrocardiogram (ECG) recording is essential to an accurate diagnosis. If you already have an ECG during symptoms, please bring a copy with you to your initial consultation.
A resting ECG can often provide a clue to the diagnosis even when recorded in the absence of any symptoms. Patients with a normal resting ECG are unlikely to have a dangerous rhythm abnormality. The likelihood of this is even less if the heart is normal. A simple ultrasound scan of the heart (echocardiogram) can detect many structural abnormalities.
Continuous or intermittent ambulatory ECG monitoring can help capture symptoms that are intermittent. If that is unsuccessful, insertion of an implantable loop recorder under the skin can help with symptoms that only occur occasionally. If symptom-rhythm correlation still remains elusive a diagnostic electrophysiology study can be performed.
Diagnostic electrophysiology study
This invasive test is performed in a catheter laboratory at the hospital which is similar to an operating room. You are required to lie flat during the study during which fine wires are inserted into the heart with x-ray guidance through the vein at the top of your leg. These wires are used to record the signals from within your heart and can be used to stimulate it in order to diagnose the problem. This should not be painful but you may experience symptoms similar to your usual palpitations.
I returned to the UK in 2002 to complete specialist training in cardiology and cardiac rhythm management at the internationally respected Freeman Hospital in Newcastle.
Depending on the results of the assessment, treatment options will range from management with medicines, catheter ablation or insertion of a cardiovascular implantable electornic device such as a pacemaker or cardioverter-defibrillator.
This can be carried out at the same time as the diagnostic electrophysiology study or at a later stage. Energy is delivered through one of the wires in your heart to damage the abnormal electrical circuits responsible for your symptoms.
Pacemakers are small electronic devices that are implanted under the skin below the collar bone. They are attached to a variable number of wires (leads) which are inserted through a vein to the heart and prevent it from going to slowly.
Implantable cardioverter defibrillators (ICD) are needed in patients who are at risk of dangerous fast heart rhythms. In addition to providing pacing they deliver a small electric shock to the heart to restore normal heart rhythm when needed.
If you have experienced symptoms you might think are related to heart rhythm disturbance or have been diagnosed with an arrhythmia please discuss with your general practitioner whether referral is appropriate.