As romantic as it seems, the phrase, “my heart skipped a beat” is definitely not something to gush about in the medical space.

In tandem with World Heart Day, let’s take a look at Heart Arrhythmia, a heart rhythm disorder that occurs when electrical signals that coordinate the heart's beats malfunction, causing the heart to beat either too fast or slow, or irregularly. 


ABOUT ARRHYTHMIA
A person with arrhythmia could experience symptoms such as fluttering in the heart, a racing heart, the heart beating too slowly, a skipped heartbeat, chest pains, faintness, fatigue etc. However, not all arrhythmias are indicative of heart disease and are deadly. 

Clinically, doctors classify the various types of arrhythmia by ascertaining its origin (in the heart) and also the patient’s heart rate. 

By its origin, we mean which part of the heart. There are 4 chambers in the heart. The 2 upper chambers are known as atria and the 2 lower chambers are known as ventricles. Normally, the contraction and relaxation of these 4 chambers are controlled by the electrical impulses travelling around the heart, which are in turn, controlled by the heart’s natural pacemaker,  the sinus node that is located in the right atrium. 

The normal heart rate of a healthy human heart is about 60 to 100 beats a minute. In anomalies, they are classified as such:

• Bradycardia: Slow heart rate, < 60 beats per minute
• Tachycardia: Fast heart rate, > 100 beats per minute
• Atrial flutter: Atria beats faster than usual and more often than the ventricles
• Atrial fibrillation: Atria beats irregularly

Atrial fibrillation (AF) is the most common kind of arrhythmia and if left untreated, increases the patient’s risks of heart failure, stroke and death. AF alone affects 16 million people in Asia Pacific and is expected to grow to 72 million people by 2050. An individual can increase his/her risks of developing AF due to many factors. This includes increasing age, high blood pressure, excessive alcohol intake and metabolic diseases such as obesity, diabetes and a history of a previous heart attack.


TREATING AF 
Depending on how long the patient has had AF, the severity of his/her symptoms and the cause behind it, AF can be treated using medication and interventional procedures. Usually, medication is the first line of treatment. These medications include:

• Beta-blockers to control heart rate
• Antiarrhythmics to control heart rhythm
• Anticoagulants or antiplatelet medication, to reduce risk of stroke
   

For patients who are unable to take anticoagulant medication, a Left Atrial Appendage  (LAA) closure device is used to prevent stroke risks in patients. This device is implanted permanently via a minimally invasive procedure in the LAA. The LAA is a little pouch-like structure in the left atrium. By permanently closing the LAA, blood is prevented from collecting and clotting internally, which could result in a stroke when these blood clots are pumped out of the heart. 

Sometimes, a more invasive interventional procedure is required. Such procedures usually occur after medication therapy has failed or if the patient is intolerant to the medication. Here are how these procedures and medical devices work:

• Pacemaker: A small battery-operated device that is usually implanted in the patient’s chest, below the collarbone in a minor surgical procedure under local anaesthesia.
  It helps the heart to beat regularly by sensing and sending small electrical signals to the heart muscles.
• Cardioverter-defibrillator: Monitors a patient’s heart rhythm, detects irregularities and corrects these irregularities with electrical impulses by shocking the heart to reset its rhythm
• Electrical Cardioversion: The patient is put under anaesthesia and the heart is reset to a normal and synchronised heartbeat by an electrical shock through patches placed on his chest wall.
• Catheter ablation: This is a minimally invasive procedure that restores normal heart rhythm by destroying the area of heart tissue that is causing the heart’s abnormal electrical signals.
  In this procedure, interventional cardiologists insert and advance catheters through the femoral vein to the problematic areas of the heart by using mapping systems. Either heat (radiofrequency) or extreme cold (cryoablation) is delivered to destroy the problematic heart tissues, thereby restoring normal electrical signals.

Through our platform and network, we are placing such medical devices in the hands of more healthcare practitioners, empowering them to save more lives and safeguard patient health.