By Susan J. White
NorthShore University HealthSystem

Our hearts beat an average of 60 to 100 beats per minute – all day, every day – and generally we’re not conscious of the steady rhythm. When the heart is pumping normally it adjusts the rate of beats per minute according to the appropriate needs of the body and can change in response to rest, exertion or changes in emotional state.

However, some people experience palpitations, or an awareness of an abnormal heart rhythm, which can be caused by arrhythmia, says NorthShore University HealthSystem (NorthShore) Associate Director of Cardiac Electrophysiology Jose Nazari, MD. There are two main categories of sustained or persistent arrhythmias of the upper chambers – atrial flutter and atrial fibrillation – the latter being far more common and complex, explains Dr. Nazari.

Atrial flutter can occur in older people or individuals with a cardiac related abnormality, even mild high blood pressure. Today, physicians have a very high success rate in treating atrial flutter with radio frequency catheter ablation procedures, says Dr. Nazari. The flutter is the result of a unique short circuit in the heart, and in catheter ablation a thin catheter is inserted through a vein to a highly targeted section of the heart muscle and a burst of energy is used to destroy the precise area of tissue causing the abnormal heart beat.

Atrial fibrillation is the most common heart arrhythmia and affects more than 10 percent of people over the age of 70, with risk increasing as we age, Dr. Nazari says. The disease increases the risk of mortality and is the most common cause of stroke, he adds. Those suffering with atrial fibrillation can feel sick, short of breath and have significant palpitations. The condition can also be asymptomatic.

Atrial fibrillation is often treated with medication to suppress the abnormal rhythm so it happens less frequently, decreasing discomfort to the patients. Other approaches to control the heart rate are also used frequently. Viable treatment options include catheter ablation and surgical ablation procedures to destroy the sections of heart tissue causing the short circuits involved in atrial fibrillation, explains Dr. Nazari. Minimally invasive surgical ablation procedures are done at NorthShore and offer patients the opportunity for a dramatically quicker and easier recovery than traditional open heart surgery.

Surgeons like NorthShore’s Cardiac Surgery Division Head Paul Pearson, MD, and cardiac electrophysiologists like Dr. Nazari, Westby Fisher, MD, and Alex Ro, MD, are working collaboratively to advance technology and technique for both catheter and surgical ablation procedures. Both may be required to maximize the success rate of atrial fibrillation control. Success rates of these procedures continue to improve, adds Dr. Nazari.

The single most common cause of atrial fibrillation is hypertension, says Dr. Nazari, so prevention is critical and comes with the standard prescription to exercise and eat right to lose weight, manage stress and quit smoking. “If you are the model citizen and follow those rules, but still have the arrhythmia, then genetics may well be the cause and treating atrial fibrillation with a surgical or catheter procedure may be necessary to control heart rate and offer stroke prevention,” he says.

Another cause of unduly fast heart beats causing palpitations is supraventricular tachycardia (SVT), a typically congenital electrical defect that does not manifest for many years and which often occurs in young, otherwise healthy people. SVTs are by and large successfully treated with ablation procedures as the short circuit is typically very discrete.

A sense of a fluttering heart should never be ignored, Dr. Nazari warns, urging anyone with this feeling to see their physician. Doctors have the ability to monitor heart rate for various lengths of time from days to months, to determine the cause and extent of arrhythmias and offer appropriate treatments.