Arrhythmia

What is arrhythmia?

Arrhythmia is a disorder of the heart rate (heart rhythm) in which the heart can beat too fast, too slow or just irregularly (the heart skips a beat or races fast). Arrhythmias are categorised by which part of the heart they affect (atria or ventricles) and by their impact on heart rhythm.

Tachycardia (fast heart beat)

Tachycardia is a fast heart beat, of more than 100 beats per minute, which is not normal. There are a few different types of tachycardia:

• Long QT syndrome – this is a rare congenital (inherited) heart condition which is associated with a long pause in the QT interval which is the time it takes for the heart muscles to contract and then recover. The long QT interval increases the risk for life threatening ventricular tachycardia. People with long QT syndrome often experience tachycardia arrhythmia symptoms during exercise or with intense emotions. Long QT syndrome is one of the main causes of sudden death in young people. Long QT syndrome may be acquired through other means (certain medications mainly)
• Multifocal atrial tachycardia – this type of tachycardia occurs when multiple electrical impulses fire off at the same time in the heart which causes the heart to beat too fast (100-250 beats per minute). This tachycardia is most common in people over 50 and those with lung conditions
• Supraventricular tachycardia (SVT) – this is a condition which involves both the ventricles and atria (all four chambers of the heart) and involves episodes of very fast heart beats that start and end without any reason. The SVTs may be due to extra electrical connections between the atria and ventricles and can be difficult to control without surgery
• Ventricular tachycardia – a condition which involves rapid heart beat originating in the ventricles (the lower chambers of the heart) and is the cause of most heart failure as it is usual fatal if it happens to a person – this is a serious and life threatening condition
• Wolff-Parkinson-White syndrome – this is a special type of supraventricular tachycardia and is one of the most common causes of tachycardia (fast heart beat) in children and infants. In people with this type of tachycardia, there is an extra connection between the atria and ventricles, which causes a specific electrical impulse which can be viewed on an electrocardiogram

Bradycardia (slow heart beat)

Bradycardia is an abnormally slow heart heat, of less than 60 beats per minute. There are a few different types of bradycardia:

• Heart block (or A-V block) – in this bradycardia arrhythmia there is a dysfunction in the way the heartbeat is triggered from the sinus node to the ventricles. There are three degrees of heart (A-V) block, ranging from a slowed electrical response to no response at all. The heart may beat irregularly or more slowly depending on the degree of the heart (A-V) block
• Sinus node dysfunction – this occurs when the sinus node is impaired, which causes a heat rate of 50 beats per minute or less. The sinus node is the heart’s natural pacemaker, responsible for controlling heart rhythm, so if it is impaired in any way, it may not be able to fire its signal for the heartbeat, so it could cause this condition. Sometimes the dysfunction of the sinus node can cause heart rate to speed up and alternate between slow and fast heart beat The most common cause of sinus node dysfunction is scar tissue that has developed in the area of the sinus node, which may eventually replace the sinus node. This condition is also known as sick sinus syndrome

Fibrillation (irregular heart beat)

Fibrillation is an irregular heart beat and is the most common arrhythmia in people over 75. There are a few different types of fibrillation:

• Atrial fibrillation – this causes a very fast and irregular heartbeat, which causes the atria (upper chambers of the heart) to contract abnormally or not at all. The atria quiver or fibrillate (like worms jiggling around) during atrial fibrillation. In this condition, the heartbeat is triggered in different parts of the atria instead of the sinus node (where it should be triggered). Atrial fibrillation is very common in people with heart disease and older people. The abnormal and irregular heartbeat that occurs in atrial fibrillation causes the blood to be unable to be pumped out of the heart properly, which means blood clots can form inside the heart
• Atrial flutter – causes a “fluttering” effect on heart beat, due to overactive electrical activity in the atria to make the heart beat too fast for a short time. This type of arrhythmia happens due to an abnormal loop of electricity in the atria
• Ventricular fibrillation – this type of fibrillation causes electrical signals in the heart to fire off very erratically and this causes the ventricles to quiver and to stop pumping blood. This is a life threatening condition. If the person with this condition does not receive medical attention immediately, they could die

Abnormal, but not dangerous arrhythmias

Some arrhythmias are just an occasional abnormal heart beat which occur in normal, healthy adults, do not signify an underlying problem with the heart and are not serious. These types of arrhythmias do not have any serious health implications nor do they have an impact on the ability of a person to have a normal life.

• Premature ventricular contraction – in this condition, an electrical impulse originating in the the ventricles triggers an early heartbeat and then the heart seems to pause before it beats normally again. This type of arrhythmia is commonly seen in normal and healthy adults without any underlying heart disease
• Sinus tachycardia – the sinus node sends out an electrical impulse to make the heart beat fast. This type of fast heartbeat happens during physical exertion such as exercise and is considered normal
• Premature supraventricular (or atria) contraction – this occurs when there are extra or premature beats that cause an irregular heartbeat. The irregular heartbeats can start in the atria (upper chamber of the heart) and are called premature atrial contractions (PAC) and the irregular heartbeats that start in the ventricles are called premature supraventricular contractions (PSC). This type of irregular heartbeat are quite common and are considered to be a benign condition

Facts about arrhythmia

• Ventricular arrhythmias are caused by heart disease and can be very serious
• Arrhythmias can occur in normal, healthy adults and have no serious underlying conditions and are considered to be benign
• Some arrhythmias are so serious and life threatening, that they can be fatal
• Arrhythmias are generally associated with other types of heart disease
• To reduce risk of heart disease, people are recommended to eat properly, exercise, stop smoking, maintain healthy body weight and take medication as prescribed
• Some arrhythmias, are a signal of a serious heart problem and should be thoroughly investigated before they cause further serious health problems
• Wolff-Parkinson-White syndrome occurs in about four out of every 100,000 people and is one of the most common causes of fast heart rate (tachycardia) in infants and children

Symptoms of arrhythmia

Main arrhythmia symptoms

The main symptoms of arrhythmia are palpitations which present in any of the following ways:

• Faster than normal heartbeat
• Heart flutter
• Rapid heartbeat that lasts a short time
• Missed heartbeat
• Skipped heartbeat
• Slower than normal heartbeat
• Thumping heartbeats

Other general symptoms

In addition to the main heart palpitation symptoms, other symptoms can also be present, depending on the type of arrhythmia:

• Chest pain
• Dizziness
• Fainting
• Fatigue
• Light-headed
• Shortness of breath
• Sweating
• Weak or racing pulse
• Weakness

Causes of arrhythmia

Arrhythmia can be caused by a whole range of reasons, but sometimes the cause is never found (especially in those arrhythmias that do not have any basis in heart disease and are not serious).

Some of the most common causes of arrthymias are:

Abnormal blood chemistry

If certain substances in the blood are unbalanced, it could cause arrhythmia. The most common reasons are due to an imbalance (usually deficiency) of:

• Calcium – a lack of calcium may cause abnormal heart rhythm. Calcium is needed to regulate heart beat to normal levels. Calcium also helps to control blood pressure
• Magnesium – a lack of magnesium can cause abnormal heart rhythm. Magnesium is needed to ensure the heart muscle is healthy and beats properly and regularly, so it vital for healthy heart rhythm. Magnesium is also needed to control blood pressure
• Vitamin B1 – a lack of vitamin B1 (thiamin) can cause abnormal heart rhythm. The body needs adequate levels of vitamin B1 (thiamin) to enable the heart to beat strong and healthy and to ensure the heart muscle is elastic and functions properly

Anxiety or intense emotions

Anxiety or very intense emotions can often cause a “flutter” type of heart beat or to feel that the heart is racing, or skipping a beat. This type of arrhythmia is usually not serious, but if it continues unabated, it should be investigate by a doctor to rule out any underlying serious heart problems. Several recent studies are showing that depression, anger, prolonged stress and intense emotions may cause arrhythmia and also heart disease.

Certain illicit and prescription drugs

Certain illicit drugs may cause an increased heart rate, palpitations and arrhythmias which can range from benign to life threatening. The most common drugs to cause this type of symptom are: speed and cocaine (or any drugs that are derivatives of either).

Certain prescription medications can also cause arrhythmia as a side effect. The most common medications to cause this type of side effect are:

• Allergy and sinus medications that contain pseudoephedrine
• Appetite suppressants
• Beta-blockers
• Psychotropics (anti-depressants)
• Thyroid medications

Caffeine

A high intake (or even moderate intake for some people) is enough to cause arrhythmias. The arrhythmias normally occur due to the stimulatory effect of caffeine on the heart. People who are concerned should cut down on their caffeine intake.

There are some guidelines for maximum caffeine intake for children and adults (from the Canadian government):

• Children aged 4-6 : 46mg caffeine per day
• Children aged 7-9 : 62.5 mg caffeine per day
• Children aged 10-12 : 85 mg caffeine per day
• Children aged 13-18 : 100mg caffeine per day
• Adults over 18 : 400mg caffeine per day
• Women 18-50 : 300 mg caffeine per day

The most common sources of caffeine are:

• Chocolate: 4-30 mg per 40g
• Coffee: 70-120 mg per cup
• Cola: 34-50 mg per can
• Energy drinks:- 20-40 mg per can
• Fizzy drinks: 20-40 mg per can
• Black (non-herbal) tea: 15-45 mg per cup

Exercise

In some people exercise can precipitate arrhythmia in certain circumstance, some of which are completely normal and others which may be serious, or potentially life threatening.

Fever

Sometimes a fever can cause an arrhythmia. This type of arrhythmia is normally benign and does not usually signify a underlying problem with the heart.

Heart disease

Many diseases of the heart can cause abnormal heart beats and very serious heart disorders can cause tachycardia (very fast heartbeats).

Stress

Sometimes being under prolonged stress can cause the heart to beat a little bit fast or skip a beat. This is because of the effect that the stress hormones (adrenaline and noradrenaline) have on the heart. People concerned about stress should engage in some meditation or other types of relaxation therapy.

Thyroid disorder

An overactive thyroid gland (hyperthyroidism) can cause the heart beat to increase as one of the symptoms of this disorder. Sometimes the medications for an underactive thyroid can cause arrhythmia if they over-stimulate the thyroid.

Prevention of arrhythmia

Non-preventable risk factors

Arrhythmia may be unpreventable in certain circumstances:

• Genetics – long QT syndrome is an arrhythmia which is inherited mainly (but can also be due to taking certain medications). There is very little which can be done to reduce the risk factors associated with this arrhythmia
• Overactive thyroid – people who have an overactive thyroid gland (hyperthyroidism) often also experience a fast heart rate due to their condition. This is not preventable as it is part of the thyroid disorder. The only way people with hyperthyroidism can reduce their heart rate to become more normal is through the medications they are prescribed for their condition, which reduces the action of their thyroid gland to become somewhat more normal
• Underactive thyroid – people who have an underactive thyroid (hypothyroidism) are often prescribed medication to increase the function of the thyroid. One of the side effects of this medication is to increase heart rate as the thyroid gland starts to function more. People with this problem should consult their doctor to determine if they can reduce their dosage, or take a different type of medication to reduce the arrhythmia symptoms

Preventable risk factors

There are though, many ways to prevent arrhythmia from occurring:

• Alcohol intake – excessive intake of alcohol is a risk factor for any type of arrhythmia, from the benign to the more serious types
• Anxiety and stress – recent studies suggest that intense emotions, anxiety, grief, depression and chronic stress may be associated with arrhythmia, even without any underlying heart disease. There are a number of relaxation strategies that can be used to reduce depression, intense emotions, anxiety and/or stress so that the abnormal heart beats are at least abated or do not happen at all. Some good relaxation strategies are: meditation, tai chi, yoga, visualisation
• Caffeine – people who drink too much coffee, could reduce their caffeine intake by trying an alternate drink, such as roasted dandelion root, which has a very similar, bitter taste to coffee. The dandelion not only does not contain any caffeine, but it is actually really good for the liver, as it helps to detoxify the liver. Tea drinkers can try to decrease intake and drink herbal teas (such as peppermint or rose hip) which contain no caffeine and also have a beneficial effect on the body. People who eat a lot of chocolate can try to eat only a small amount of organic, dark chocolate, which is packed full of antioxidants and is actually beneficial for the heart. Those people who drink energy drinks packed with caffeine should swap these with plain water or juice instead to immediately reduce their caffeine intake to prevent further arrhythmia
• Intense emotions and stress – recent research suggests that experiencing intense grief, depression, anger or chronic stress can all contribute to a risk of developing an arrhythmia, even without any underlying heart disease
• Medications – certain over-the-counter (OTC) and prescription can cause arrhythmias, especially if taken over a longer term. If any medications are causing arrhythmia as a side effect, this should be discussed with the treating doctor to find an alternative medication that is not going to cause these symptoms. People taking illicit drugs (speed or cocaine) should cut down on their intake to reduce their symptoms and to prevent any future heart problems
• Nutrient deficiencies – a diet that includes high intake of processed foods, very little fresh and healthy foods (fruits and vegetables especially) may be increasing their risk of nutritional deficiencies associated with arrhythmias from a lack of certain nutrients. The only way to determine if the arrhythmia (palpitations, fast heart beat) are caused by a nutrient deficiency (omega-3 fatty acids, calcium, magnesium, vitamin B1), is to have a blood test.  Once confirmed, then the only way to prevent this is to eat more foods rich in these nutrients and/or use some supplements (as advised)
• Obesity – people who are overweight and obese significantly increase their risk of developing any type of arrhythmia due to the increased pressure on the heart
• Smoking – cigarette smoke is a well known risk factor for any type of heart disorder, including arrhythmia. Not only are people who smoke at risk, but also people who are exposed to second-hand smoke from other people. Cigarettes contribute to as much as one third of all cardiovascular disease cases

Complications of arrhythmia

Arrhythmia can cause a some serious and life threatening complications.

• Heart failure – the risk of heart failure significantly increases with some types of arrhythmia (long QT syndrome, ventricular fibrillation, ventricular tachycardia) and is associated with the other serious arrhythmias. Heart failure can happen if the heart is beating ineffectively for a long period due to an arrhythmia and finally the heart is unable to function and heart failure ensues, which can be fatal if there is no immediate medical attention
• Stroke – the risk of stroke is quite common in some types of arrhythmia more than in others and especially in atrial fibrillation. When the heart is unable to pump blood through the arteries properly, this can cause the blood to pool in the arteries, which may increase the risk of blood clots to form. If a blood clot breaks away, it can travel to one of the arteries in the neck which supply the heart and cause stroke. A stroke may damage some or all of the brain and can even cause death

Immediately life threatening complications

Certain arrhythmias need really urgent medical attention to prevent a fatal outcome:

• Long QT syndrome – this is the most common cause of sudden death in younger people, who are seemingly healthy
• Ventricular fibrillation – a type of fibrillation that can be fatal without immediate and urgent medical attention (defibrillation)
• Ventricular tachycardia – most common cause of heart failure and needs immediate and urgent medical attention to prevent death

When to see a doctor about arrhythmia

People who have any arrhythmia symptoms, even just minor palpitations, should consult their doctor to diagnose their condition. If there are no underlying heart problems (which can usually be diagnosed with blood tests), no underlying structural heart problems and no underlying fault with the electrical activity of the heart, the arrhythmia is usually considered benign.

People who have been diagnosed with arrhythmia need to ensure they visit their doctor on a regular basis, to monitor their symptoms and any underlying heart disease, to monitor their medication and adjust it if necessary and to provide advice on surgical options (if warranted).

Diagnosis of arrhythmia

Arrhythmia is diagnosed through a series of tests to determine the cause and type of the arrhythmia and to work out if it is serious (and life threatening) or just an abnormality that is not going to cause adverse health effects.

Electrocardiography (ECG)

The most common (and main) test for arrhythmia is the electrocardiography (ECG). The ECG shows how the electrical impulses in the heart are working; during an ECG, small patches are places on various parts of the chest, arms and legs, to which electrical leads (from an ECG machine) are attached; this records the electrical activity of the heart over a specific period to determine arrhythmia activity.

There are three types of ECG tests that can be performed:

• Resting ECG – this ECG test is usually performed when a person is resting and lasts only a few minutes. A number of attachments from an ECG machine are put on various parts of the body to do a quick, preliminary test of the electrical activity of the heart
• Holter ECG monitor – a special ECG monitor which has electrical leads that are attached (glued) to various parts of the body is worn under clothing for 24 hours to record heart rhythm while a person just goes about their normal daily acclivities. The person also needs to record their activities of the day. This is one of the best ways to determine the cause of arrhythmia as it gives a very good indication on any triggers of the arrhythmia
• Stress ECG – an ECG machine is used to determine the heart’s activity during exercise (usually while a person is on a tread mill or exercise bike). A set of leads are attached to certain part of the body and the person is required to run on a treadmill (or ride an exercise bike) for a specified amount of time to increase heart rate by putting pressure on it through exercise, to determine if there are any problems with the heart and if these problems can be viewed on the electrical activity of the heart on the ECG

Echocardiogram

This is basically an ultrasound of the heart and is the next most common diagnostic test to rule out structural problems with the heart that may be causing the arrhythmia.

A special ultrasound machine called an echocardiogram is used in a similar way as a regular ultrasound machine. A special rod (covered in some gel to help it roll over the chest area) is used to get a picture of the heart – the atria, ventricles and other parts – to determine if there are any structural problems of the heart, including blockages, that may be causing the arrhythmia.

Electrophysiology studies

This is done to work out what is going on in the heart to cause the arrhythmias; during this test, special thin tubes are inserted into a large vein (usually in the legs) and taken up to the heart in order to record the heart’s electrical impulses and test the heart’s response to stimulus.

Tilt table studies

This test is done to determine if there are sudden drops in blood pressure or slow pulse rates when the person is strapped to a table, hooked up to an electrocardiogram and blood pressure monitor and tilted at different angle in quick succession. The electrocardiogram will provide electrical activity of the heart and the blood pressure monitor will provide blood pressure results at the different tilts.

Conventional treatment of arrhythmia

The treatments for the various types of arrhythmias depend on the type of arrhythmia the person has. Treatment can either be of the form of medication or surgical intervention or a combination of both.

If the arrhythmia is caused from a non-serious reason, there is no treatment other than to observe symptoms and seek medical attention if they worsen.

Medication

There are a number of different medications that are used to treat arrhythmia, depending on the cause of the arrhythmia. Some of these medications may be used in combination:

Anti-arrhythmic medications

These medications are used to control the rhythm of the heart rate, to bring it back to normal. There are a number of different types of anti-arrhythmic medications and they are prescribed depending on the nature, frequency and severity of the abnormal heart rhythm and whether the arrhythmia starts in the upper (atria) or lower chambers (ventricles) of the heart. The different types of anti-arrhythmic medications are:

• Sodium channel blockers – these medications block sodium channels in the heart cells to decrease the conduction of electrical signals from cell to cell in the heart and reduce fast heartbeat
• Beta-adrenergic antagonists (beta- blockers) – these medications are normally used to treat high blood pressure, angina and reduce incidence of further heart attacks in people who have already had a heart attack. Beta-blockers are also used for some types of arrhythmia, as they decrease the heart’s requirement for blood and oxygen and so reduce its workload, which helps the heart to beat regularly
• Potassium channel blockers – these medications help to slow nerve impulses in the heart tissue, without affecting the heart’s normal electrical activity. The potassium channel blockers have less adverse affects on the heart’s pumping ability and act on both the upper (atria) and lower (ventricles) chambers of the heart
• Calcium channel blockers (calcium antagonists) – these drugs help to dilate the blood vessels which reduces the pressure on the heart. Calcium channel blockers are most often used to treat hypertension (high blood pressure) as well as for treating coronary artery disease associated with atherosclerosis, but are not prescribed for people with heart failure or any type of structural damage to the heart
• Anti-clotting medications – these medications are used to prevent blood clots that can cause heart attack and stroke. Certain types of arrhythmia have a high risk for blood clots (atrial fibrillation) and this type of medication can reduce the risk of blood clots. The anti-clotting medications are also used to treat stable angina and protect against heart attacks from occurring. These medications have to be carefully monitored because they may cause internal bleeding that may not be stopped, if there is an internal injury
• Anti-hypertensive medications – there are a number of medications which can be used to treat any underlying high blood pressure (hypertension) that may be the cause of the arrhythmia. The most common medications used for hypertension are: Angiotensin Converting Enzyme (ACE) Inhibitors, Angiotensin Receptor Blockers (ARBs), Alpha-Adrenergic Blockers (or alpha blockers), Beta-blockers, Diuretics and Hydralazine
• Cholesterol lowering medications – these medications help to reduce or prevent the accumulation of high levels of cholesterol or triglycerides (fat) in the blood. The cholesterol lowering medications may help improve blood flow in the arteries, even when taken for only a short time
• Diuretics – these medications help to reduce the amount of water and sodium (salt) in the body and are often recommended to treat high blood pressure. Diuretics are also used to treat heart failure and preventing stroke
• Inotropic and cardiotonic drugs – these medications are used to stimulate and increase the strength of the muscle contractions that pump blood from the heart and are used in people who are at risk (or have experienced) heart failure
• Pain relief medications – these medications may be prescribed after a heart attack to treat pain or relieve angina pain. These medications act on blood vessels and dilate them by relaxing smooth muscle in the vessel wall, they produce an increase in diameter, which in turn increases the volume of blood flowing through the coronary arteries and stop chest pain
• Thrombolytic therapy (clot breaking medications) – these medications are used in the early stages of heart attack or stroke to break up a blood clot and restore blood flow by helping to open up the arteries to normal levels to enable better blood flow and oxygenisation

Heart surgery

There are a number of surgical procedures which are used to treat arrhythmias. The type of surgery depends on the type of arrhythmia condition:

• Ablation – this is a surgical procedure conducted with a catheter, where abnormal electrical tissue of the heart is removed. The defunct electrical tissue is identified during an electrophysiology study. This procedure works to resolve many types of arrhythmias, including: atrial fibrillation, atrial flutter, ventricular tachycardia, atrial tachycardia, supraventricular tachycardia
• CryoMaze procedure – this is a special procedure in which certain areas of the heart are frozen to help restores normal heartbeat in people with fibrillation which doesn’t respond to other treatment (medication or ablation). The CryoMaze procedure can restore proper and normal pumping from the upper chambers of the heart and this can restore the heartbeat back to normal and resolve the atrial fibrillation symptoms

Other medical procedures

There are a number of minor surgical procedures in which certain devices are implanted in the skin near the heart and which are used to treat some types of arrhythmia:

• Implantable cardioverter-defibrillator (ICD) – this type of battery-powered device is usually recommended for people at high risk of serious forms of either ventricular fibrillation (VF) or ventricular tachycardia (VT), which cause dangerously fast or quivering heartbeats that can cause death. An ICD is implanted near the left collarbone and one or more electrode-tipped wires are inserted into the veins to run to the heart. The ICD monitors the heart rhythm and if it detects slow heartbeat, it functions as a pacemaker (sends electrical signals to fire up the rhythm of the heart to increase heart rate so that it becomes normal). If the ICD detects VF or VT, it sends out some electrical shocks to the heart to re-sets the rhythm back to normal. An ICD may significantly decrease the risk of experiencing a fatal arrhythmia (especially when compared to using medication). There are also ICDs which can be used in people with serious forms of atrial fibrillation too
• Pacemaker – this is an artificial battery device which is inserted under the skin near the collarbone in a minor surgical procedure to make a slow heart beat normally. A pacemaker has an insulated wire which is attached to the right side of the heart. When the pacemaker detects a heart rate that is too slow (or no heart rate at all), it emits small electrical impulses to stimulate the heart to start the heartbeat again or to speed up the heartbeat. A pacemaker is also used for those people with life-threatening ventricular arrhythmias. This minor surgical procedure usually requires an overnight (up to two night) stay in hospital

Emergency defibrillation

This is the application of an electrical shock to the chest area to return heart beat back to normal. This is performed when the heart suddenly stops, so is used in an emergency where life is at risk.

Vagal manoeuvres

Certain ventricular arrhythmias (supraventricular tachycardia, or SVT) may be able to be stopped by using a certain maneouvre – holding the breath and straining, putting your face in icy water or coughing. The reason these maneouvres work to stop certain ventricular arrhythmias is because they affect the vagal nerves, a part of the sympathetic nervous system which control heartbeat and may cause the heart to slow down back to normal. The cardiologist will show you how to do the vagal maneouvres.

Alternative / complementary treatment of arrhythmia

People who have been diagnosed with any type of arrhythmia must seek their doctors advice before trying any of the alternative / complementary strategies advised here

Some alternative / complementary treatments could seriously and adversely affect you if they are taken in combination with certain medications

These treatment strategies are advised as part of a heart healthy lifestyle and should not be used as a way of self-treatment.

Herbs

There are some herbs which have heart-protective benefits, but they need to be individually prescribed by a qualified herbalist to ensure the best benefit. Always seek your doctors advice before trying any herbs for your arrhythmia as it could have serious and life threatening consequences.

Vitamins

The antioxidant vitamins may be especially beneficial for people with arrhythmia (but do not take these in supplement form unless you have approval from your medical specialist to do so):

• Betacarotene – the antioxidant betacarotene is required for the health of the arteries, as it helps to reduce oxidative damage that free radicals or any inflammation may cause. Since betacarotene is less toxic and is the precursor to vitamin A, it has been most often recommended instead of vitamin A in supplements. Recent studies suggest that betacarotene supplements must not be used by people who are current or former smokers or who currently drink excessive amounts of alcohol, as it may increase their risk of a number of cancers. It is recommended to get your betacarotene from the food in your diet (orange and dark green coloured fruits and vegetables have the highest amounts of betacarotene)
• Bioflavonoids – the bioflavonoids, together with vitamin C help to ensure the walls of arteries and other blood vessels are strong and healthy
• Folic acid – the B vitamin, folic acid has vasodilation properties, which helps to ensure the blood vessels and arteries are not narrowed to allow proper blood flow
• Vitamin A – the antioxidant vitamin A is vital for the reducing oxidative damage from free radicals and ensure the cells in the heart are healthy. Vitamin A recommended intakes must not be exceeded in supplements, as they can produce toxic side effects
• Vitamin C – the antioxidant vitamin C, together with the bioflavonoids, help to ensure the walls of arteries and other blood vessels are strong and healthy. One large study of people who had coronary artery bypass surgery, and who were also taking beta-blocker medications were divided into two groups: one group were supplemented with vitamin C and the other was not. The study found that the people who were taking the vitamin C as well as their beta-blocker medications were significantly less likely to experience atrial fibrillation than the people who were just taking the beta-blocker medications
• Vitamin E – the antioxidant vitamin E is vital for the health of the arteries, as it helps to reduce oxidative damage that free radicals and inflammation may cause to the arteries. In addition to this, vitamin E helps to thin the blood, which may significantly decrease the risk of blood clots forming. People taking any type of blood thinning medications must talk to their doctor about using any vitamin E supplements in combination with their medications, as it may not be advised to do so

Minerals

There are a few minerals which may be beneficial for people with arrhythmia (but do not take these in supplement form unless you have approval from your medical specialist to do so):

• Magnesium – the mineral magnesium is really beneficial for the heart, as it helps to ensure the heart muscle is able to be relaxed (after contractions), functioning properly and that the heart rate is normal, which reduces the risk of arrhythmia. Adequate levels of magnesium are also necessary to reduce any calcium deposits in the arteries, which may cause blockages. Several studies also show that intravenous magnesium, compared with placebo or control, is effective in preventing atrial fibrillation in people who have had any type of heart surgery (such as coronary by-pass surgery), if the magnesium is administered post-operatively
• Selenium – some studies show that the antioxidant mineral selenium may help to protect the heart against oxidative damage and heart disease. A severe lack of selenium in the diet may cause a type of heart disease called Keshan’s disease

Other nutrients

There are a few nutrients which may be beneficial for people with arrhythmia (but do not take these in supplement form unless you have approval from your medical specialist to do so):

• Arginine – studies show that the amino acid arginine is a vasodilator, which helps to keep the arteries and other blood vessels open, preventing narrowing and enabling proper blood flow. Studies show the effect of arginine on the arteries is greatly enhanced when vitamin C is also supplemented together
• Carnitine – the amino acid carnitine is very beneficial for improving the function of the heart. Research shows that carnitine is a key regulator of fatty acid metabolism, which helps to ensure that cholesterol levels are normal (by eliminating excess levels of cholesterol so that they do not circulate in the blood and risk plaque build-up in the arteries) which may help to reduce risk of atherosclerosis. One study showed that combining carnitine with simvastatin (a cholesterol-lowering drug) in people with diabetes helped to reduce their cholesterol levels better than just with simvastatin alone. Studies also show that carnitine helps to reduce inflammation which is associated with atherosclerosis
• Co-enzyme Q10 – studies show that coenzyme Q10 may prevent blood clots from forming and may boost the function of the other antioxidant nutrients in the body, as well as boosting the mitochondria of the heart, enabling it to function better. Other studies suggest that there is evidence to support the therapeutic value of CoQ10 as an adjunct to standard medical therapy in congestive heart failure. Several other studies show that people who take statins (a medication for lowering LDL (“bad”) cholesterol levels) have lowered levels of coenzyme Q10. People taking statins need to seek their doctor’s advice about trying some coenzyme Q10 supplements
• Lipoic acid – several studies show that alpha-lipoic acid has anti-inflammatory, antioxidant properties, which help to reduce fatty plaque build-up in the artery walls. The studies also showed that alpha-lipoic acid helps to reduce triglycerides (fat) levels in the blood
• Omega-3 fatty acids – many studies have shown that omega-3 fatty acids (DHA and EPA found in fish oil can help prevent atherosclerosis from worsening or even prevent it from developing, by stopping the development of plaque and blood clots in the arteries. Many studies have also shown that omega-3 fatty acids may help to prevent heart disease, lower blood pressure and reduce the level of triglycerides (fats) in the blood. The Australian Heart Foundation recommends people eat at least two servings of oily fish (mackerel, salmon, sardines, trout, tuna) per week to reduce the risk of heart disease. In addition to this, several studies have shown that adequate intake of omega-3 fatty acids may prevent sudden cardiac death associated with life threatening arrhythmia. People with existing arrhythmia and who want to reduce their blood pressure or triglycerides levels can try an omega-3 fatty acid supplement, but need to talk to their doctor before doing so, because many medications may not work well in combination with omega-3 supplements and increase the risk of internal bleeding (especially blood thinning medications)
• Quercetin – the flavonoid quercetin is a part of the bioflavonoids, so it has the same protective effects on the artery walls, strengthening the walls and reducing the risk of atherosclerosis from developing and since quercetin has antioxidant properties it reduces oxidative damage to the arteries and may prevent oxidation of cholesterol which reduces the risk of plaque build-up in the artery walls
• Taurine – several studies on animal hearts show that the amino acid taurine has a protective effect on the heart by stabilising irregular heartbeat (arrhythmia), which is accomplished by taurines’ ability to stabilise cell membranes and through its properties as an antioxidant, by scavenging for free radicals and reducing oxidative damage to the heart. The studies with taurine suggested that certain arrhythmias could be prevented with taurine supplementation. The arrhythmia studies and prevented were: premature atrial contractions (PACs), premature ventricular contractions (PVCs), atrial fibrillation and related sinus pauses

Dietary modifications

There are a number of dietary modifications which may be beneficial in maintaining good heart health:

• Eat enough legumes and wholegrains – the diet needs to include adequate amounts of legumes (chickpeas, peas, beans and soya beans) as well as wholegrains to ensure that the diet has adequate fibre, as well as the various nutrients that the legumes and wholegrains provide. Adequate fibre intake can help to reduce the amount of LDL (“bad”) cholesterol in the blood
• Eat enough “good” fats – you need to ensure the diet includes adequate amounts of the “good” fats which are the polyunsaturated fats, from foods such as olive oil, safflower oil, sunflower oil, olives (but take care that they are not too salty), avocado, as well as all types of nuts and seeds
• Eat more fruit and vegetables – intake of fresh fruit and vegetables needs to be increased so that the diet includes about 2-3 portions of fruit and 5-7 portions of vegetables every day. The vitamins, minerals and especially the antioxidants in the fruit and vegetables can help the heart function more effectively and reduce the risk of blockages in the coronary arteries and may reduce risk of oxidative damage to the heart
• Eat more garlic and onions – both garlic and onions, but especially garlic have blood thinning effects, which may help to prevent stickiness and blood clots, as well as reduce the risk of artery blockages. Fresh garlic and onions, are best, but they can be cooked in meals. People who cannot tolerate garlic can try supplements, but always seek the advice of a medical doctor before trying supplements as they may not be recommended in conjunction to your other medication
• Eat more ginger – fresh ginger is highly recommended as it helps to reduce inflammation in the body. Fresh ginger can be finely grated into smoothies and fruit juice and it can also be cooked in meals
• Eat more oily fish – research suggests that people at risk of any type of heart disease should eat more oily fish (mackerel, salmon, sardines, trout, tuna). Heart foundations around the world recommends eating these types of fish around 2-3 times a week in order to provide adequate levels of the heart-healthy, anti-inflammatory omega-3 fatty acids from the fish
• Increase fibre intake – fibre is essential for ensuring good digestive health and good heart health, as adequate fibre intake reduces the amount of cholesterol in the blood and this may be helpful in reducing the risk of blockages by the cholesterol in the arteries
• Increase intake of potassium-rich foods – the mineral potassium is needed to counter the effects of sodium, especially in people with high blood pressure, whose heart may not be functioning properly and may be causing the angina. Foods high in potassium include: bananas, apricots, treacle, sultanas, raisins, wheat bran, figs, currants, unsalted nuts, baked potato and most fruits and vegetables. People taking certain medications should talk to their doctor about their potassium intake
• Increase intake of magnesium-rich foods – the mineral magnesium is so beneficial for the heart, as it helps to ensure the heart muscle is relaxed, functioning properly and heart rate is normal. Foods high in magnesium include: beans, spinach, wholegrain bread and cereals, wholemeal flour, yeast, seafood, almonds, brazil nuts, peanuts, walnuts and treacle. People taking certain medications should talk to their doctor about their magnesium intake
• Limit intake of saturated fat – foods that are high in saturated fat (full cream milk, cheese, butter, sour cream, as well as red meat, any fried foods, any processed foods, any take-away or junk foods) need to be limited in the diet, to help reduce levels of cholesterol and triglycerides as well as reduce risk of possible blockage build-up in the arteries

Lifestyle modifications

There are a number of lifestyle modifications which may be beneficial in maintaining good heart health:

• Antibiotics – always use the antibiotics you have been prescribed around one hour before and also six hours after a dental procedure, to reduce risk of any bacterial infection of the heart
• Exercise – regular physical activity is recommended to help reduce the pressure on the heart and enable it to function better. Since some arrhythmias can be induced by exercise, always seek your doctor (or cardiac specialists) advice about the type and duration of exercise you are allowed to do
• Stop smoking – people who smoke are recommended to stop because the chemicals inside cigarettes can damage the walls of arteries and make them more susceptible to blockages and narrowing, as well
• Stress reduction – there are a number of stress reduction therapies available for people who experience prolonged stress, as it is not healthy for the heart and could be the reason for the arrhythmia. Stress reduction therapies include: meditation, tai chi and yoga
• Weight reduction – people who are very overweight and obese will be advised to lose weight, because their excess weight may be causing the arrhythmia and the heart disease

Alternative treatments

There are no other alternative treatments recommended for arrhythmia.

Always ensure that you notify your medical practitioner of any supplements that you want to take as they may interfere with other medication or conditions you have. Confirm with your doctor it is safe to take before you try it.

Living with arrhythmia

If you have any seriously fast (over 100 beats a minute for more than a few minutes) or very slowed heart rate (less than 60 beats per minute for more than a few minutes), you need to seek immediate emergency medical attention – call an ambulance 000

Management of arrhythmia consists of a number of factors relating mainly to lifestyle and dietary modifications:

• Avoid cigarette smoke – smoking cigarettes can damage the artery walls and lead to atherosclerosis, which can cause arrhythmia. In addition to this, smoking depletes the body of many of the antioxidants, especially vitamin C, which is required to ensure the artery walls are strong and healthy. Not only should you not smoke, but you should also not be around other people who smoke, because when you breath their unfiltered cigarette smoke it has exactly the same effect on your arteries as if you smoked yourself
• Avoid recreational drugs – there are a number of recreational drugs which can exacerbate arrhythmia or even cause it in the first place. Certain drugs (speed, cocaine, amphetamines) are stimulants which increase heart rate and should be avoided by people who have been diagnosed with arrhythmia
• Exercise regularly – in order to help condition the heart and improve circulation, a regular exercise program is required. Your doctor will advise you on the type of exercises you may be able to engage in, depending on your condition and the severity of your symptoms. If you can exercise, you should try to do so for at least 30-45 minutes every day (but only with your doctor’s approval). Some people with certain types of arrhythmia may need to be careful when exercising, as any form of physical activity may initiate (sometimes life threatening) arrhythmia. Always seeks your doctors advice about exercise
• Increase intake of fruit – you need to make sure you eat at least 2-3 portions of fruit every day, ensuring that you have at least a few servings of cherries and berries each week. Fruit contains a number of vitamins and minerals and the cherries and berries contain the potent antioxidants anthocyanins, which may be useful in preventing oxidative damage to the artery walls, plus the fruit helps to reduce risk of high cholesterol, triglycerides, blood pressure levels
• Increase intake of vegetables – you need to ensue that you have at least 5-7 portions of vegetables every day, with at least 1-2 of those portions being leafy green vegetables, which are packed full of folic acid, fibre, vitamins and minerals. The folic acid may help to reduce homocysteine levels which is implicated in atherosclerosis, plus the vegetables help to reduce cholesterol, blood pressure and triglycerides levels
• Limit alcohol intake – alcohol puts a lot of stress on the arteries and the heart and is implicated in the worsening of atherosclerosis. Women should have no more than one drink and men should have no more than two drinks per day, with at least two days of the week being alcohol free
• Limit caffeine intake – caffeine is a stimulant, which increases heart rate and may cause some forms of arrhythmia to occur (usually the benign forms, but also can be the more serious ones). Caffeine intake should be limited to no more than two cups of coffee on most days, with some days to be caffeine free
• Medications – if you experience any palpitations, fast or irregular heartbeat from any medications you are taking (especially over-the-counter cold and sinus medications), you must talk to your doctor about it. Your doctor will advise you on how to reduce your reliance on this type of medication and offer advice on alternatives
• More oily fish in the diet – you need to make sure you eat at least two portions of oily fish each week, to increase your intake of the omega-3 fatty acids, which reduce inflammation and are vital for heart health. The best types of oily fish are: mackerel, salmon, sardines, trout, tuna and should be wild and fresh (canned fish should be eaten less regularly)
• Reduce stress – prolonged amounts of stress can increase the amount of the stress hormone cortisol, which creates a great deal of inflammation everywhere in the body and it can also damage the artery walls and the heart. Reducing stress is vital to ensuring better heart, artery and cardiovascular health. There are a number of excellent stress-reduction strategies: dancing, having a bath, meditation, tai chi, visualisation, yoga
• Regular doctor visits – you need to see your doctor on a regular basis, in order to monitor your symptoms, the progression of your condition and to adjust medications (if you are getting any side effects). You can also ask your doctor’s advice about any supplements you want to take in addition to your medications (if you are taking any) to make sure that it is safe to do so. Your doctor may request regular blood tests to monitor your cholesterol, triglycerides and blood pressure

Caring for someone with arrhythmia

Partner

People who have a partner with arrhythmia, can help them with a number of strategies:

• Don’t smoke – if you smoke, only do so outside the house (and car) and never smoking near your partner as the second hand some for your cigarettes can damage their artery walls and exacerbate their symptoms
• Emergency – if your partner is experiencing very fast heartbeat (over 100 beats a minute, for longer than a few minutes without any exertion), or very slowed heartbeat (less than 60 beats a minute without being asleep or relaxing) you must seek immediate emergency medical advice and they have the symptoms of arrhythmia – call an ambulance 000
• Exercise program – encourage your partner to engage in some type of exercise program which has been recommended by your doctor, who will advise the best types of exercise for your partner. Walking will most likely be advised, so go for regular walks with your partner, when your schedule permits. Your partner needs to make sure they are allowed to exercise and have advice on the type of exercise they can do, because some arrhythmia’s may be brought about by exercise
• Healthy diet – you need to ensure to cook healthy and fresh foods with your partner and remove (or limit) processed foods, junk foods and saturated fats from your diet to help reduce their temptation to eat these types of foods. Always have lots of fresh fruit and vegetables, as well as nuts and seeds for healthy snacks
• Limit alcohol – your partner should not be indulging in large amounts of alcohol as it can worsen their condition, so try to make sure that there is less alcohol in your evening meals at home and when you go out socially

Friends

People who have a partner with friends, can help them with a number of strategies:

• Don’t smoke – if you smoke, only do so outside the house (and car) and never smoking near your partner as the second hand some for your cigarettes can damage their artery walls and exacerbate their symptoms
• Emergency – if your friend is experiencing very fast heartbeat (over 100 beats a minute, for longer than a few minutes without any exertion), or very slowed heartbeat (less than 60 beats a minute without being asleep or relaxing) you must seek immediate emergency medical advice and they have the symptoms of arrhythmia – call an ambulance 000

Parents

Parents who have a child with arrhythmia, can help them with a number of strategies:

• Antibiotics before and after dental work – either ensure you give your child the antibiotics or remind them to take them before (1 hour) and after (6 hours) any dental work, to prevent any possible infection in the tooth from affecting the heart
• Emergency – if your child is experiencing very fast heartbeat (over 100 beats a minute, for longer than a few minutes without any exertion), or very slowed heartbeat (less than 60 beats a minute without being asleep or relaxing) you must seek immediate emergency medical advice and they have the symptoms of arrhythmia – call an ambulance 000
• Exercise program – encourage your child to engage in some type of exercise program which has been recommended by your doctor, who will advise the best types of exercise for your child. Your child needs to make sure they are allowed to exercise and have advice on the type of exercise they can do, because some arrhythmia’s may be brought about by exercise
• Healthy diet – ensure to cook healthy and fresh food, provide healthy lunches and snacks for your child, remove (or limit) processed foods and junk foods and saturated fats from the diet
• Oily fish every week – oily fish such as mackerel, salmon, sardines, trout or tuna should be part of your child’s diet at least two times a week. The fish can be steamed, grilled, baked or even fried, but only with good quality cold pressed, extra virgin olive oil
• Stop smoking near your child – if you smoke, only do so outside the house (and car) and never smoking near your child as the second hand some for your cigarettes can damage their artery walls and exacerbate their symptoms

References

Last reviewed and updated: 5 May 2025