Arrhythmia

Advanced care for AFib, tachycardia and irregular heartbeat

Two Scripps electrophysiologists study an image during an arrhythmia procedure.

Advanced care for AFib, tachycardia and irregular heartbeat

Every year, Scripps board-certified cardiac electrophysiologists diagnose and successfully treat thousands of patients with abnormal heart rhythms. Also known as heart arrhythmia, episodes of this dangerous condition often occur intermittently.


Scripps electrophysiologists work with your primary care physician, general cardiologist and medical colleagues across multiple specialties and sub-specialties to provide the best possible treatment options for all types of arrhythmias. Using the most advanced technology, we offer heart care services for you and your family throughout San Diego County — from Chula Vista to Oceanside — making our team of experts available where and when you need them.


Common arrhythmia types are: 



Learn more about arrhythmia symptoms, causes and treatment options below.

Understanding your heart and cardiac arrhythmia

A heart arrhythmia is an electrical system malfunction of the heart related to its rhythm. It is characterized by an abnormal heart rhythm, notably in the pace and number of heartbeats.


Because heart arrhythmias are complex and may have underlying or contributing causes related to lifestyle choices, Scripps physicians strongly encourage and support patient education as part of the overall approach to addressing their health needs.


Our physicians believe self-education about the foundations of heart disease is beneficial to patients during the treatment and healing processes.

The heart’s structure

The normal heart includes four chambers:


  • Atria are the two top (left and right) chambers.
  • Ventricles are the two lower (left and right) chambers.


Blood circulating from the body to the heart enters the top right chamber (right atrium) and is pumped through a valve into the lower right chamber (right ventricle). This blood is then pumped to the lungs where it is filled with oxygen, and carbon dioxide is released.


Freshly oxygenated blood returns from the lungs to the top left chamber (left atrium) through four pulmonary veins, one from each major segment of the lungs.


The blood in the left atrium is then pumped through a valve to the bottom left chamber (left ventricle). The left ventricle is the largest and strongest of the heart’s chambers because it must pump blood to all major organs.

The heart’s electrical system

A heart’s efficient pumping sequence is controlled by its electrical system that originates within a group of cells called the sinus node.


The sinus node (also known as sinoatrial node) is the group of cells in the upper right atrium that start a heartbeat. It’s your body’s natural pacemaker.


Depending on how active a person is (for example, sitting stationary or running at a full sprint), the sinus node sends anywhere between 50 to 160 impulses every 60 seconds that make the heart beat. These impulses cause the heart’s atria (top chambers) to contract and push blood into the heart’s ventricles (bottom chambers).


The atrioventricular node (AV node) is a small channel of heart tissue separating the heart’s atria (top chambers) and ventricles (bottom chambers). It helps regulate the heart rate.


The sinus node’s electrical impulses travel slowly through the atrioventricular node, allowing the ventricles to fill with blood. The impulses then spread across the ventricles, causing them to contract and pump blood from the right ventricle to the lungs, and from the left ventricle to the body.

Types of heart arrhythmia

There are two primary categories of irregular heartbeat:


  • Bradycardia is a very slow heart rhythm (under 50-60 beats per minute) with symptoms that can include lightheadedness, shortness of breath or fainting.
  • Tachycardia is a very fast heart rhythm (over 120 beats per minute) with symptoms that can include the sensation of a racing heart, as well as lightheadedness, shortness of breath, chest tightness and fainting.


An arrhythmia is defined by which chamber or chambers of the heart are affected and how the heart is beating differently than normal. The types of arrhythmia include:


Learn more about cardiac arrhythmia

Learn more about cardiac arrhythmia

Scripps electrophysiologist Douglas Gibson, MD, discusses common heart rhythm topics, such as atrial fibrillation (AFib), heart murmurs and more.

Supraventricular tachycardia

Supraventricular tachycardia (SVT) is a group of heart arrhythmias that involve the top chambers of the heart (atria) and cause your heart to beat too fast (tachycardia). “Supra” means “above,” so supraventricular means “above the ventricles.”


Symptoms of SVT may include palpitations (sensations of a racing heart), lightheadedness, chest tightness, shortness of breath and fainting.


Types of supraventricular tachycardia include:


Detection and diagnosis of supraventricular tachycardia

SVT is diagnosed primarily three ways through procedures or portable devices that allow physicians to evaluate patient heart rhythms:


Electrocardiogram, also known as ECG or EKG, involves an electrical tracing of your heart. An ECG reveals heartbeat rate, whether the heart’s rhythm is irregular and the strength and timing of the heart’s electrical signals as they pass through the upper and lower chambers.


An event monitor (also called mobile telemetry) can be worn by patients for continuous heart tracking when an ECG is not possible because SVTs usually happen intermittently and without warning and can’t always be recorded during a scheduled ECG appointment. Physicians are immediately notified when the cardiac monitor detects an abnormal heart rhythm. They review the recordings as part of making their diagnosis. Scripps physicians helped pioneer the use of a wireless 14-day heart monitor.


Electrophysiology study (also known as an EP study or EPS) is where catheters to record the heart’s electrical activity are inserted in a person’s veins in the upper leg and guided into the heart. Medications, pacing through the catheters, and the recording of the heart’s electrical signals help doctors identify heart arrhythmias.


Scripps has one of the region’s most advanced electrophysiology labs equipped with state-of-the-art diagnostics and testing equipment, and staffed by highly skilled physicians.

Supraventricular tachycardia treatment

Treatment for supraventricular tachycardia may include:


  • Antiarrhythmic medications can help suppress the abnormal rhythm.
  • Radiofrequency ablation uses a catheter emitting heat energy, advanced from the upper leg into the heart to cauterize the abnormal electrical circuit. Radiofrequency ablation is performed in conjunction with an electrophysiology study.
  • Cryoablation is a procedure like radiofrequency which uses cool energy instead of heat to treat arrhythmias

Atrial fibrillation

Atrial fibrillation, also called AFib, is a type of racing of the upper part of the heart (supraventricular tachycardia) caused by multiple abnormal electrical short circuits in the heart’s top left chamber (left atrium) just outside the pulmonary veins.


These abnormal electrical short circuits occur at a rate much faster than the sinus node rate, producing a heart rate of 100 or more beats per minute. Symptoms of atrial fibrillation may include heart palpitations (sensations of a racing heart), lightheadedness, chest tightness, shortness of breath and fainting.

Detection and diagnosis of atrial fibrillation

Atrial fibrillation is primarily detected and diagnosed through a non-invasive electrocardiogram (also called ECG or EKG) that provides physicians an electrical tracing of your heart.


Not all patients are the same, and your atrial fibrillation may be intermittent (paroxysmal). In such cases, you’ll be asked to wear a heart monitor (also known as mobile telemetry or event monitor) that records your heart activity continuously. Through the heart monitor, the abnormal heart rhythms are tracked remotely and recorded to help your physician make a diagnosis.

Atrial fibrillation treatment

Treatment for AFib may include:


Heart medications

Antiarrhythmic medications suppress abnormal heart rhythm.


Anticoagulation medications reduce the risk of blood clots. Many patients with AFib have an increased risk of stroke and other problems requiring blood-thinning medications.


Minimally invasive procedures

Radiofrequency (RF) ablation for atrial fibrillation uses a catheter that emits heat energy, guided into the heart to cauterize the abnormal electrical circuit. The procedure is performed in conjunction with an electrophysiology study (also known as an EP study or EPS).


In AV node ablation and pacemaker insertion, the AV node is cauterized, disconnecting the electrical connections between the heart’s top and lower chambers. A heart pacemaker is implanted to set the heart rate of the bottom chambers to correct the heart arrhythmia.


In pulsed field ablation, a catheter enters a small puncture in the patient’s groin and is threaded through a vein. Once the device reaches the heart, targeted cells are disrupted with micro-second bursts of electrical energy.


Heart surgery

Left atrial appendage closure is the removal of the left atrial appendage from the left atrium with the goal of reducing the risk of stroke, while potentially eliminating the need for anticoagulation (blood thinning) medication.


The Maze procedure is an open heart surgical procedure to eliminate the abnormal electrical circuits of AFib. Because RF ablation has become more common, the Maze procedure is now mostly reserved for patients who already need open heart surgery for other reasons, such as a valve repair or replacement, or coronary artery bypass graft.

Atrial flutter

Atrial flutter (heart flutter) is a type of arrhythmia. More specifically, it’s a type of supraventricular tachycardia caused by an abnormal electrical short circuit in the top chambers of the heart (atria). The short-circuiting results in a continual loop of electrical activation at a rate much faster than that of the sinus node (the body’s natural pacemaker), producing a heart rate often as fast as 150 beats per minute.


Symptoms may include heart palpitations (sensations of a racing heart), lightheadedness, chest tightness, shortness of breath and fainting.

Detection and diagnosis of atrial flutter

Atrial flutter is primarily diagnosed by an electrical tracing of your heart, known as an electrocardiogram (also known as ECG or EKG).


Not all patients are the same, and your atrial flutter may be intermittent (paroxysmal). In such cases, you’ll be asked to wear a heart monitor (also known as mobile telemetry or event monitor) that records your electrocardiogram continuously. Abnormal heart rhythms (arrhythmias) can be tracked remotely and recorded through an electrocardiogram that is used by your physician to help make a diagnosis.


Heart flutter can’t always be detected separately from other types of supraventricular tachycardia, such as atrial fibrillation, by an electrocardiogram or a heart monitor alone. They may require an electrophysiology study for specific determination.


Electrophysiology study (also known as EP study or EPS), is a procedure in which catheters to record the heart’s electrical activity are inserted into the upper leg and guided into the heart. Medications, pacing through the catheters and the recording of the heart’s electrical signals help doctors identify cardiac arrhythmias.


Patients commonly receive sedation and anesthesia to ensure they are comfortable and pain-free during an electrophysiology study. Scripps uses the latest 3-D mapping equipment for EP studies for diagnosis and treatment of atrial flutter.

Atrial flutter treatment

Treatment for atrial flutter may include:


Heart medications

Antiarrhythmic medications help suppress the abnormal heart rhythm. Anticoagulation medication helps reduce the risk of blood clots.


Minimally invasive procedures

Radiofrequency (RF) ablation for atrial flutter uses a catheter that emits heat energy, guided into the heart to cauterize the abnormal electrical circuit. The procedure is performed in conjunction with an electrophysiology study (also known as an EP study or EPS).


In AV node ablation and pacemaker insertion, the AV node is cauterized, disconnecting the electrical connections between the heart’s top and lower chambers. A heart pacemaker is implanted to set the heart rate of the bottom chambers to correct the heart arrhythmia.


Surgery

Left atrial appendage closure is the removal of the left atrial appendage (LAA) from the left atrium with the goal of reducing the risk of stroke while potentially eliminating the need for anticoagulation (blood thinning) medication.

Atrial tachycardia

Atrial tachycardia is a type of supraventricular tachycardia caused by the abnormal firing of a group of cells in one of the top chambers of the heart (atria). These cells fire at a higher rate than normal. The result is an unhealthy resting heartbeat of 100 beats per minute or higher. Symptoms may include heart palpitations (sensations of a racing heart), lightheadedness, chest tightness, shortness of breath and fainting.

Detection and diagnosis of atrial tachycardia

Doctors perform an electrocardiogram (ECG or EKG) to detect and diagnose atrial tachycardia. An electrocardiogram is an electrical tracing of the heart. It tells doctors your heart rate, whether the heart rhythm is irregular and the strength and timing of electrical signals as they pass through each part of the heart.


Because most atrial tachycardia episodes happen intermittently, patients may be required to wear a heart monitor (also known as mobile telemetry or event monitor). The monitor records heart activity around the clock and can detect abnormal rhythms, which are recorded and provided to your physician for review in making a diagnosis.


Atrial tachycardia can’t always be detected separate from other types of supraventricular tachycardia by an electrocardiogram or a heart monitor alone. An electrophysiology study may be necessary for specific determination. The newest 3-D mapping equipment is available at Scripps for proper diagnosis and treatment of atrial tachycardia and SVT.


An electrophysiology study (also known as EP study) is another way to diagnose atrial tachycardia. Doctors insert catheters into the upper leg to reach the heart and record electrical activity. Doctors also send signals to make the heart beat at different rates as part of the procedure. Patients commonly receive sedation and anesthesia to ensure they are comfortable and pain-free during an electrophysiology study.

Atrial tachycardia treatment

Treatment for atrial tachycardia may include:


Heart medication

Antiarrhythmic medications help suppress abnormal rhythm.


Minimally invasive procedure

Radiofrequency ablation uses a catheter emitting heat energy, advanced from the upper leg into the heart to cauterize the abnormal electrical circuit. Radiofrequency ablation is performed in conjunction with an electrophysiology study.

Other types of atrial tachycardia

Atrial ventricular nodal reentrant tachycardia (AVNRT)

Atrial ventricular nodal reentrant tachycardia is another type of supraventricular tachycardia caused by an abnormal electrical short circuit between one of the top chambers of the heart (atria) and the channel connecting the top and bottom chambers of the heart (atrioventricular node or AV node). The short circuit results in a continual loop of electrical activation at a rate much faster than the rate of the sinus node. The result is an unhealthy resting heart rate of 100 beats per minute or higher.


Atrial ventricular reentrant tachycardia (AVRT)

Atrial ventricular reentrant tachycardia — also known as Wolff-Parkinson-White syndrome — is a type of atrial tachycardia caused by an abnormal electrical short circuit between one of the top chambers of the heart (atria) and the bottom chambers of the heart (ventricles). It is due to an extra pathway called a bypass tract, in addition to the atrioventricular node (AV node). The result: an unhealthy resting heart rate of 100 beats per minute or higher.

Ventricular tachycardia

Ventricular tachycardia (VT) is a type of cardiac arrhythmia caused by abnormal firing of a group of cells in one of the bottom chambers of the heart (ventricles). The cells fire at a higher rate than that of the sinus node in the top right chamber (atria), which causes the heart rate of 100 beats per minute or higher.

Idiopathic ventricular tachycardia

“Idiopathic” ventricular tachycardia conveys that the heart is functioning normally, other than an abnormal heart rhythm (arrhythmia), and is caused by an electrical short circuit in the heart. Non-idiopathic ventricular tachycardia is associated with cardiomyopathy (heart disease).

Ventricular tachycardia associated with cardiomyopathy

Ventricular tachycardia associated with cardiomyopathy is caused by an electrical short circuit in one of the heart’s bottom chambers (ventricles). Symptoms can include lightheadedness, sensations that the heart is racing, chest tightness, shortness of breath and fainting. This dangerous condition can result in sudden cardiac death.


When the heart muscle weakens, scar tissue can form, creating a place for electrical short circuits to occur. The short circuits can result in a rapid heart rhythm that weakens the heart’s already compromised pumping function, causing a near-complete lack of blood flow to the body.


Immediate defibrillation (shock from a defibrillator) is commonly required to stop the abnormal rhythm. Cardiomyopathy associated with ventricular tachycardia is even more serious than idiopathic ventricular tachycardia that occurs in patients with otherwise normal heart muscle function.

VT caused by long QT syndrome and Brugada syndrome

Q and T are points on a standard heart rhythm and QT is the time between them. Long QT syndrome is a genetic condition in which the heart’s abnormal electrical system may short circuit spontaneously, causing dangerous ventricular tachycardia.


Brugada syndrome is a related genetic condition of a heart’s abnormal electrical system. These both can result in dizziness, fainting or death. Symptoms may also include lightheadedness, sensations that the heart is racing, chest tightness and shortness of breath.

Detection and diagnosis of ventricular tachycardia

Doctors use an electrocardiogram (ECG or EKG) to detect and diagnose ventricular tachycardia. An electrocardiogram is an electrical tracing of the heart.


Because most VT episodes happen intermittently, patients may be required to wear a heart monitor (also known as an event monitor or mobile telemetry). The monitor records heart activity around the clock and can detect abnormal heart rhythms, which are recorded and provided to your physician for review in making a diagnosis.


An electrophysiology study (also known as EP study or EPS) is another way to diagnose VT. Doctors insert a catheter into the upper leg to reach the heart and record electrical activity. Doctors also send signals to make the heart beat at different rates as part of the procedure. Patients commonly receive sedation and anesthesia to ensure they are comfortable and pain-free during an electrophysiology study.


For VT associated with cardiomyopathy, the newest 3-D mapping equipment is available at Scripps for proper diagnosis and treatment.


Patients may also be asked to provide a blood sample so genes can be screened for inherited abnormalities.

Ventricular tachycardia treatment

Treatment for ventricular tachycardia may include:


Heart medication

Antiarrhythmic medications that help suppress the abnormal rhythm.


Minimally invasive procedure

Radiofrequency ablation uses a catheter emitting heat energy, advanced from the upper leg into the heart to cauterize the abnormal electrical circuit. Radiofrequency ablation is performed in conjunction with an electrophysiology study.


Heart surgery

An implantable cardioverter defibrillator (ICD) keeps the heart beating at a healthy rate. The device is implanted under the skin, delivering silent pacing treatment or a shock to stop abnormal heart rhythms.

Premature ventricular contractions

Premature ventricular contractions (PVC) occur when the heart’s ventricles disrupt the normal heart rhythm and beat out of sync: a normal heart beat, an extra beat, followed by a pause and then a strong beat. PVCs can happen randomly or at regular intervals.


PVCs can occur in healthy people and pose no risk. But those that happen frequently or over a prolonged period require care and attention from physicians who specialize in diagnosing and treating premature ventricular contractions, which can be caused by heart disease. They can also be related to a heart injury, chemical imbalances in the body, some asthma medications, alcohol, caffeine, exercise or a spike in adrenaline due to stress or anxiety.


Symptoms of PVCs may include palpitations, the feeling of a “skipped” heartbeat, fluttering sensations in the chest or neck, lightheadedness, shortness of breath and fainting if an episode is prolonged.

Detection and diagnosis of premature ventricular contractions

Tests and procedures for premature ventricular contractions may include:


  • Electrocardiogram (ECG)
  • Holter monitor, a portable ECG device
  • Exercise ECG
  • Cardiac MRI scan
  • Cardiac CT scan
  • Electrophysiology study (EPS)
  • Coronary angiography

Premature ventricular contractions treatment

Infrequent PVCs for people with no other symptoms and no existing heart disease or heart problems typically do not require medical treatment. They can usually be addressed with changes such as a curtailing or eliminating caffeine or alcohol, reducing anxiety and stress or modifying routine medications that may contribute to PVCs.


PVCs related to heart disease or a structural heart abnormality may include the following treatments:


  • Heart medications, such as a beta blocker or calcium channel blockers
  • Radiofrequency ablation or cryoablation
  • Angioplasty
  • Coronary bypass graft surgery

Ventricular fibrillation

Ventricular fibrillation is the most serious type of heart arrhythmia and can result in sudden cardiac arrest, a life-threatening emergency that requires immediate medical attention.


During ventricular fibrillation (also known as V-Fib or VF) the heart’s electrical system becomes chaotic and disordered, causing the lower chambers (ventricles) to “flutter” instead of beating normally and pumping blood to the body.


Symptoms of VF may include palpitations (sensations of a racing heart), lightheadedness, chest tightness, shortness of breath, nausea and fainting.

Detection and diagnosis of ventricular fibrillation

Ventricular fibrillation can occur suddenly and may be brought on by a heart attack or preceded by ventricular tachycardia (rapid heart rate). It’s important to get immediate help and dial 911 if you suspect possible heart problems like ventricular fibrillation.


Restoring a regular heartbeat is the first priority for preventing potential brain damage, heart damage and possibly death.


During a ventricular fibrillation occurrence, emergency medical personnel may:


  • Listen to the chest for evidence of a heart beat
  • Check blood vessels of the wrist or neck for a pulse
  • View heart activity and heart rhythm on a cardiac monitor

Ventricular fibrillation treatment

Emergency treatment for ventricular fibrillation usually includes:


  • Cardiopulmonary resuscitation (CPR)
  • Use of an automated external defibrillator to deliver shocks to the heart
  • Immediate transport to a hospital emergency room for comprehensive heart diagnosis and medical treatment

Heart block and bradycardia

Bradycardia (slow heart rate) is when the heart beats slower than it should. For many people (excluding those who are very physically fit), this can be fewer than 50-60 beats per minute and pose a danger of insufficient oxygen delivery to the body. Symptoms may include lightheadedness, chest tightness, shortness of breath and fainting.


Bradycardia can be related to two primary conditions:


  • Sick sinus syndrome (or sinus node dysfunction) occurs when the heart’s group of cells (sinus node) that determines the heart rate becomes sluggish.
  • Heart block is when the atrioventricular node (AV node) malfunctions and fails to provide a pathway for electrical impulses from the top chamber to bottom chamber.

Detection and diagnosis of bradycardia and heart block

Physicians use an electrocardiogram to detect and diagnose bradycardia and heart block. An electrocardiogram is an electrical tracing of the heart.


Because many episodes of bradycardia and heart block happen intermittently, patients may be required to wear a heart monitor (also known as an event monitor or mobile telemetry). The monitor records heart activity around the clock and can detect abnormal rhythms, which are recorded and provided to your physician for review in making a diagnosis for cardiac arrhythmia.

Bradycardia and heart block treatment

Treatment options for bradycardia and heart block may include:


Heart pacemaker surgery

Bradycardia and heart block arrhythmias are typically treated with implantation of a device called a pacemaker. This is often performed as outpatient surgery with patients discharged the same day of surgery or the following day. Scripps cardiac surgeons work with the newest pacemaker technologies, including devices that do not require lead wires.


The pacemaker implantation typically involves local anesthetic and a small incision through which the artificial pacemaker is placed. Pacemaker implantation usually requires an overnight stay in the hospital. A pacemaker increases the heart rate when required and ensures that electrical impulses from the top chamber are transmitted to the bottom chamber.