Many arrhythmias have no clear cause; these idiopathic cases arise without identifiable triggers, while for others, the causes may be congenital or acquired.
Many arrhythmias have no clear cause; these idiopathic cases arise without identifiable triggers, while for others, the causes may be congenital or acquired.
ARRHYTHMIA, or an abnormal heart rhythm, occurs when the heart beats too fast, too slow, or in an abnormal manner. Sunway Medical Centre, Sunway City consultant cardiologist and electrophysiologist Dr Gary Lee Chin Keong says arrhythmias are common in clinical practice and present in various forms, including atrial fibrillation (AF), supraventricular tachycardia (SVT), premature beats and potentially fatal ventricular arrhythmias. These arise from abnormalities in the heart’s electrical conduction system. While many are mild, others may signal underlying heart disease or lead to serious complications.
“Slow heart rate, or bradyarrhythmia, often go unnoticed or manifest subtly without obvious symptoms. Fast heart rate, called tachyarrhythmia, is felt more intensely and are often frightening. When the heart rate remains consistently elevated, patients usually seek help quickly,” says Dr Lee.
Not every arrhythmia is dangerous. Determining the severity depends on the type of arrhythmia, duration, symptoms and whether the irregular rhythm affects the heart’s ability to pump blood.
“We assess these factors to differentiate benign rhythm disturbances from those malignant rhythms that carry potential risks of complications such as stroke and heart failure,” he adds.
Arrhythmias affect an estimated 1 to 5% of the global population, depending on the various factors including age and presence of comorbidities. While Malaysia lacks official figures, Dr Lee believes the incidence is fairly similar. He notes that cases are being detected more frequently today – not necessarily because they are more common, but because awareness has significantly improved. The widespread use of smart devices like smart watches and personal electrocardiogram (ECG) devices has also contributed to more people seeking medical advice after receiving abnormal rhythm alerts.
Many arrhythmias have no clear cause; these idiopathic cases arise without identifiable causative factors. For others, the causes may be congenital or acquired.
“Congenital causes can be related to certain inheritable genes. Conditions such as Brugada syndrome and Long QT syndrome increase the risk of dangerous irregular fast heartbeats and can be inherited,” says Dr Lee.
In some arrhythmias, however, arise from factors encountered after birth. Structural heart disease and coronary artery disease are the major causes, but lifestyle-related triggers are becoming increasingly common. Lifestyle factors, alcohol and smoking can predispose one to the risk of arrhythmia. “We also see arrhythmias resulting from obesity, hypertension, poorly controlled diabetes and thyroid disorders. Another commonly undiagnosed condition known as obstructive sleep apnoea, which manifests in various ways such as snoring, can increase the long-term risk of atrial fibrillation (AF),” he explains.
A concerning trend is that arrhythmias are now occurring in younger patients. “My youngest patient seen in my practice is a 12-year-old,” shares Dr Lee. More individuals in their 20s, 30s and 40s now also present with AF or other heart rhythm disturbances, often linked to early-onset obesity, diabetes and untreated sleep apnoea. Sedentary lifestyles and modern dietary patterns have accelerated the rise of metabolic diseases once seen only in older populations, shifting the patient profile for arrhythmia.
Recognising early warning signs is crucial – though sometimes, Dr Lee cautions, the first symptom may be your last. “One very important red flag is unexplained sudden death in the family. This could be the result of a catastrophic rhythm disturbance,” he says. Other symptoms include chest discomfort, breathlessness, dizziness, fainting spells, sudden fatigue, exercise intolerance, or palpitations. “Some describe a sensation of fluttering, skipped beats, or a racing heart. Don’t dismiss these. Seek medical advice as soon as possible.”
Diagnosis relies on tools both at home and in the hospital. Smartwatches can alert wearers to possible arrhythmias and prompt medical evaluation. In clinical settings, the electrocardiogram (ECG) remains the first-line test. For intermittent episodes, Holter monitors track heart rhythms over an extended period from 24 hours to weeks. An implantable loop recorder can monitor heart rhythms for an even longer period up to three years. Electrophysiology study can allow cardiac electrophysiologist to assess the heart’s electrical pathways and pinpoint the type of arrhythmia, while tilt-table tests help evaluate patients with fainting spells.
Fortunately, treatment options today are highly effective and tailored to individual needs. “There is no one-size-fits-all approach,” says Dr Lee. Patients with very slow heart rates may need a pacemaker. Those with fast heart rhythms may require catheter ablation to target abnormal electrical circuits. Others may rely on long-term medications to control symptoms. Some patients with life-threatening arrhythmias may require an implantable cardioverter-defibrillator (ICD).
Recovery times vary, but Dr Lee notes that most patients recover quicker today, especially those undergoing catheter ablation. In addition, with the advancement in the field of cardiac electrophysiology, the procedure can be carried out in safer manner and with higher success rate.
Ultimately, early diagnosis is key. Maintaining a healthy lifestyle and balanced dietary intake are important, but listening to your body remains most important. Timely medical evaluation and treatment can prevent serious complications, improve quality of life and even save lives.
