Question: What is the difference between atrial fibrillation and cardiac arrhythmia? I have had an irregular heart beat since I was 16, and now I am 70. I have had ECGs, Holters, ultrasound, etc. The diagnosis is always the same—cardiac arrhythmia. I’ve taken Inderal for over 40 years. Do you have any suggestions?
Dr. Hibberd's Answer:
An arrhythmia refers to any irregularity in the rate of contraction (slow or fast) of the heart’s upper or lower chambers, and includes continuous and intermittent conditions including atrial fibrillation. Atrial fibrillation (AF) is a specific arrhythmia of the upper chambers (atria).
In AF, the atria don’t contract effectively, the atrial activity becomes an unsynchronized contraction associated with increased stroke risk as well as occasional rapid ventricular rates. Atrial arrhythmias are most often controlled—and are occasionally cured—by ablation therapy.
AF often requires anticoagulant therapy until it is controlled, converted to normal rhythm for a period of time, or erratic pathways are surgically ablated in the cath lab. Atrial fibrillations are usually nuisance problems.
Ventricular arrhythmias are more serious. They often result in loss of consciousness and death, since ventricular arrhythmias are more likely to interrupt the pumping of blood or impair the heart’s ability to supply the body with oxygenated arterial blood.
While medications are available to control minor ventricular problems (such as occasional PVCs), the best solution is usually to correct the underlying disorder that causes the arrhythmia. If not easily corrected, or if long term treatment is felt to be risky, many patients may be cured with a visit to an EP (electrophysiology) lab where surgical ablation therapy will be performed via a catheter inserted through blood vessels.
There are risks, of course, and some atrial conditions—and occasionally a ventricular arrhythmia—are mild enough that occasional meds may provide adequate control.
The EP lab has revolutionized the long-term management of arrhythmia. Though it appears you may not be an EP lab candidate, ask your physician if you are a candidate for this curative procedure as opposed to using medications.
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