Ventricular Arrhythmias

Is it time to see a heart rhythm specialist?

Ventricular arrhythmias (ven-TRI-kyuh-lar uh-RITH-mee-uhs) are problems with the electrical signals in your heart. These conditions make your heart beat too fast or cause the heart’s rhythm to become out of sync. Arrhythmia means a change in the heart’s rhythm or force.

A healthy heart at rest beats at a steady rhythm of 60 to 100 times per minute. Ventricular arrhythmias cause problems with the heart’s electrical system, leading it to beat too fast, or sometimes, chaotically.

Your heart has four rooms, or chambers. The lower two chambers are called ventricles (VEN-tri-kulls). When an arrhythmia occurs in the ventricles, the heart has a hard time pumping enough blood to the body.

Left untreated, some types of ventricular arrhythmias may lead to fainting, dizziness, lightheadedness, a loss of consciousness and sudden cardiac arrest or death.

There are several types of ventricular arrhythmias, including:

  • Premature ventricular contractions
  • Ventricular tachycardia
  • Ventricular fibrillation

Types of Ventricular Arrhythmias

Arrhythmias are caused when the electrical signals in the heart don’t fire as they should. If the heart does not squeeze and release in a certain way at a certain time, blood can’t move through the body. This can cause symptoms such as lightheadedness, dizziness, shortness of breath and fatigue. There are different types of arrhythmias, depending on where the arrhythmia starts from and how the muscles move. Ventricular arrhythmias only affect the lower two chambers of your heart.

Premature ventricular contractions

Premature ventricular contractions (PVC) are extra heartbeats that start in the ventricles. It may feel as if your heart has skipped a beat and then beats very hard for one or two beats. This feeling is caused by an electrical impulse sent too soon to the heart’s ventricles, so that extra beat occurs before a normal heartbeat would.

After a PVC, blood begins to fill the ventricle. The additional amount of blood in the heart gives the next beat extra force, making it feel stronger. Symptoms include heart palpitations that feel like a fluttering or flip-flopping in the chest.

This arrhythmia is not dangerous in healthy people because it usually doesn’t affect the heart. But in people with heart problems, such as a heart valve disease, or those who have had a heart attack, PVC can trigger more dangerous arrhythmias. These can include ventricular tachycardia or ventricular fibrillation.

Premature ventricular contractions can be caused by:

  • Alcohol intake
  • Stimulants such as caffeine or pseudoephedrine, which can make the heart beat faster
  • Emotional or physical stress

Ventricular tachycardia

Ventricular tachycardia (VT) is when your heart beats very fast – more than 100 beats per minute. A healthy heart rate is about 60 to 100 beats a minute while you are at rest.

During VT, the chambers can’t fill up with enough blood. When the heart muscle squeezes and pushes out what little blood there is. This means the body isn’t getting enough oxygen, which leads to very serious problems. VT requires immediate medical attention.

Causes of ventricular tachycardia:

  • A previous heart attack, which can create scar tissue that interferes with the heart’s electrical signals
  • Cardiomyopathy (car-dee-oh-mahy-AH-puh-thee), a condition in which the heart enlarges, thickens or stiffens, reducing its ability to pump blood to the body
  • Idiopathic (id-ee-oh-PATH-ik) ventricular tachycardia, which is an electrical disorder that can occur in patients who do not have heart disease
  • Using recreational drugs such as cocaine, which is a stimulant

Symptoms of ventricular tachycardia:

  • Heart palpitations (pal-pit-TAY-shunz), which is when you feel like your heart is beating too fast or too hard, fluttering or skipping beats
  • Chest pain
  • Lightheadedness or dizziness
  • Shortness of breath
  • Fainting or passing out

Treatment for ventricular tachycardia

            Some types of VT require an implantable cardioverter-defibrillator, which checks your heart rhythms and sends an electrical signal to bring your heart back into a normal rhythm as needed.

            Your health care provider may recommend you have a ventricular catheter ablation. This is a minimally invasive procedure that uses hot or cold energy to scar the part of the heart that causes the misfiring.

            There are also some medications that might help correct your arrhythmia.

Ventricular fibrillation

Ventricular fibrillation is a life-threatening condition. The heart’s electrical signals become irregular. The ventricles then quiver, rather than squeezing and releasing. Blood gets trapped in the heart and cannot circulate to the body. Left untreated, VT can lead to sudden cardiac arrest, and in severe cases, death.

A heart attack is the most common cause of VT. Other causes of ventricular tachycardia include:

Symptoms of ventricular tachycardia include:

  • Heart palpitations
  • Chest pain
  • Lightheadedness or dizziness
  • Nausea
  • Shortness of breath
  • Fainting or loss of consciousness

Survival is possible with immediate treatment, using either an automated external defibrillator (AED) found in public places or a defibrillator in an emergency department.

Causes and Risk Factors

Besides some of the causes listed above, ventricular arrhythmias can also be caused or affected by:

  • Coronary artery disease, other heart problems and previous heart surgery. Narrowed heart arteries, a heart attack, enlarged or smaller than average heart valves, prior heart surgery, heart failure, cardiomyopathy and other heart damage are risk factors for almost any kind of arrhythmia.
  • High blood pressure. This condition increases the risk of developing coronary artery disease. It may also cause the walls of the left lower heart chamber (left ventricle) to become stiff and thick, which can change how electrical signals travel through the heart.
  • Congenital (cuhn-JEN-it-all) heart disease. Being born with a heart condition may affect the heart’s rhythm.
  • Thyroid disease. Having an overactive or underactive thyroid gland can raise the risk of irregular heartbeats.
  • Obstructive sleep apnea. This condition causes pauses in breathing during sleep. It can lead to a slow heartbeat (bradycardia) and irregular heartbeats, including atrial fibrillation.
  • Electrolyte imbalance. Substances in the blood called electrolytes — such as potassium, sodium, calcium and magnesium — help the heart send electrical impulses. An imbalance in electrolytes — for example, if they are too low or too high — can interfere with heart signaling and lead to irregular heartbeats.
  • Certain drugs or medicines. Some prescription drugs and certain over-the-counter cough and cold medications can cause arrhythmias.
  • Excessive alcohol. Drinking too much alcohol can affect the electrical impulses in your heart and can increase the chance of developing an arrhythmia.
  • Caffeine, nicotine or illegal drug use. Stimulants can cause your heart to beat faster and may lead to the development of a more serious arrhythmia. Illegal drugs, such as amphetamines and cocaine, may greatly affect the heart and cause many types of arrhythmias or sudden death due to ventricular fibrillation.

Diagnosis of Ventricular Arrhythmias

If you have symptoms of ventricular tachycardia, your health care provider will start with a physical examination and ask questions about your symptoms, your family and personal medical history, and your lifestyle habits such as diet and exercise.

Tests

If you have signs or symptoms of tachycardia, tests can be done to evaluate the heart and help confirm the diagnosis. Tests can also help determine if another health problem is contributing to ventricular tachycardia. There are many types of test your physician may order.

Electrocardiogram (EKG)

An electrocardiogram (e-LEK-troh-CAR-dee-oh-gram) is the most common test used to diagnose tachycardia. This painless exam detects and records the heart’s electrical activity using small sensors on to the chest and arms.

An EKG records the timing and strength of electrical signals as they travel through the heart. Patterns in the signals help physicians see where the problem might be coming from.

There are also many types of portable heart rhythm machines you can use at home to get more information about your heart rate. These devices include:

  • Holter monitor This is worn for a day or more to record your heart rate during daily activities. It may be recommended if a traditional EKG doesn’t give your care provider enough information about your heart’s condition.
  • Event monitor This can be worn for up to 30 days or until you have an irregular heart rhythm (arrhythmia) or symptoms. You typically press a button when symptoms occur. However, some monitors automatically sense arrhythmias and then start recording.
  • Implantable loop recorder This implantable device has no wires and can sit underneath the skin for up to three years to continuously monitor the heart rhythm.

Heart (cardiac) imaging

  • Chest X-ray can show the condition of the heart and lungs and can help diagnose an enlarged heart.
  • Echocardiogram uses sound waves to create a picture of the heart in motion. It can identify areas of poor blood flow and heart valve problems.
  • MRI provides still or moving pictures of how blood flows through the heart.
  • CT scan combines several X‑ray images to provide a more detailed cross-sectional view of the heart.
  • Coronary angiogram is a test that checks for blockages in the heart’s arteries. It uses a contrast dye and special X-rays to show the inside of the arteries around the heart.

Treatment for Ventricular Arrhythmias

Like many other things in life, ventricular fibrillation will affect you differently than it affects someone else. It’s important that you see your own health care team to get a personalized treatment plan.

There are many kinds of treatment for ventricular arrythmia.

Ventricular fibrillation that lasts longer than 30 seconds usually requires urgent medical treatment, as this condition may sometimes lead to sudden cardiac death. If you or a loved one is experiencing an abnormal heartbeat for longer than 30 seconds, seek immediate care.

Since VT is a condition based on abnormal heartbeats, the goal of treatment is to slow a fast heartbeat and to stop episodes from happening. This can be done with medications, lifestyle modifications and surgical procedures. Or it may be done by figuring out if there is an underlying condition causing the arrhythmia.

VT can be treated with medication, but there are some reasons why a ventricular ablation is right for you. You will talk to an electrophysiologist (eh-LEK-troh-fi-zee-AHLL-uh-just), who has an expertise in understanding your heart’s electrical signals. Before recommending ablation, the physician will check:

  • If your VT cannot be treated well with medication
  • How well medication works for you
  • If you have or have had heart failure
  • If you have reduced ejection fraction (low EF), which is the amount of blood the lower left chamber (ventricle) of your heart pushes out with each heartbeat

Your physician will also take into consideration your age.

If you have a device that sends electrical signals to your heart to get it to beat correctly, called an implantable cardioverter-defibrillator, ablation can reduce the number of times this device needs to send signals to your heart to get it to beat correctly.

The ablation procedure typically has a higher success rate than medication alone, which means there is less risk of symptoms returning. There is a low risk of complications with this procedure, as well as a quick recovery time.

Treatment for ventricular tachycardia involves managing any diseases that causes the condition, as well as the symptoms of VT. Common treatments for ventricular tachycardia include:

  • Radiofrequency catheter ablation (RCA): After locating the point where an irregular rhythm starts in the heart, your health care provider will destroy tissue in that area with an electrical current.
  • Implantable cardioverter-defibrillator (ICD): This small machine monitors and controls your heart’s rhythm. A battery is inserted below the collarbone, usually on the left side just underneath the skin. It is connected to leads, which are passed through the blood vessel to the heart. The ICD monitors and controls your heart’s rhythm. If it detects an episode of ventricular tachycardia, it quickly sends an electrical signal to get your heart back to a normal rhythm.

Medications: These can slow heart rate and may help your heart to maintain a safe rhythm. Your health care provider can help you understand the pros and cons of medications. Sometimes medicines called anti-arrhythmics can help with irregular abnormal heart rates. Your physician may also prescribe calcium channel blockers or beta blockers. These improve your heart’s ability to relax, pump blood and maintain a normal heart rate. Examples of beta blockers are carvedilol (Coreg) and metoprolol succinate (Toprol-XL).

Cardioversion

This medical procedure is generally used when emergency care is needed for a rapid heart rate, such as that seen with sustained ventricular tachycardia. Cardioversion sends electrical signals to the heart through sensors (electrodes) placed on the chest. This affects the heart’s electrical signals and restores a regular heartbeat. It’s also possible to do cardioversion with medications.

When appropriate, a shock can also be delivered to the heart using an automated external defibrillator (AED).

Preventing Ventricular Arrhythmia

As we know, everyone is affected differently by their ventricular arrhythmia. Most of the time, the best thing you can do is take your medication as instructed and see your provider regularly. You should also pay attention to your symptoms and report any changes to your provider, especially if symptoms suddenly change or get worse.

There are a few lifestyle habits that can help reduce the number and severity of an episode, including:

  • Limit alcohol and caffeine. Caffeine can increase heart rate and alcohol can cause electrolyte imbalances, which may make you more likely to have an abnormal heart rhythm.
  • Avoid using recreational drugs like cocaine and methamphetamine. These are stimulants which make your heart beat faster and harder.
  • Avoid certain over-the-counter medicines that contain pseudoephedrine, which is a stimulant.
  • While it’s important to exercise, limit any strenuous or extreme physical activity. Discuss which types of exercise are safe with your provider.
  • Manage any underlying conditions such as diabetes, heart disease, hyperthyroidism and other diseases can help reduce episodes of arrhythmia.
  • Avoid any form of tobacco use – including smokeless tobacco products.
  • Maintain a healthy weight and eating a heart-healthy diet can also reduce the number of episodes you might have.
  • Manage your mental health. Stress and anxiety can cause physical problems.

Living With Ventricular Arrhythmia

The outlook is good for people who get an early diagnosis and prompt treatment, and who follow the health care provider’s recommendations. You should also:

  • Take all medicines exactly as prescribed.
  • Never stop taking any prescription medication without consulting your health care professional.
  • Tell your health care professional about any side effects you have.
  • Tell your health care professional about all your other drugs and supplements, including over-the-counter medications and vitamins. 

Follow your treatment plan, ask your provider when you have questions and make the lifestyle changes you need to stay healthy. Tell your family and friends about your treatment plan. Often, people with ventricular arrythmias don’t look sick, and others can assume you’re healthy. Educate them on your condition and ask for support. The experts at the Norton Healthcare Heart Rhythm Center can help you do all this and more.

Heart and Vascular Care for the Whole Person

Norton Heart & Vascular Institute offers patient resources to support you and your family, including free classes for people of all ages who are seeking to improve cardiovascular health or living with a heart condition.

Cardiac Rehabilitation Program

Our cardiac rehabilitation providers are leaders in developing and applying innovative techniques that can help you recover and resume your life.

Connecting Hearts Support Group

The group provides education and support to individuals who have had a heart attack, are living with a heart condition or are at risk for cardiovascular disease.

Heart Health Screenings

Prevention is the best way to manage heart disease, and screenings are available to detect early signs of cardiac and vascular disease and identify risk factors.

About Norton Heart & Vascular Institute

Every year, more than 137,000 people in Louisville and Southern Indiana choose Norton Heart & Vascular Institute specialists for their heart and vascular care. That’s more than any other health care provider.

  • Norton Healthcare’s adult-service hospitals in Louisville all have received Chest Pain Center accreditation from the American College of Cardiology (ACC). This is the seventh consecutive accreditation for all four hospitals, which ensures quality for the treatment of heart attack.
  • Norton Audubon Hospital, Norton Brownsboro Hospital and Norton Hospital all are recognized as having ACC Chest Pain Center with Primary PCI accreditation.
  • Norton Healthcare has the most facilities across the city of Louisville with the ability treat a life-threatening heart attack.
  • You have access to more than 100 physicians and advanced practice providers with specialized training and experience in a comprehensive range of conditions and treatments.
  • Patients can make appointments at 28 locations in Louisville and Southern Indiana. Telecardiology is offered at more than 30 sites in the region.
  • Norton Audubon Hospital, a key location for Norton Heart & Vascular Institute services, has been recognized with a HeartCare Center National Distinction of Excellence year after year by the American College of Cardiology. This is the only hospital in Louisville to be recognized for this distinction.
  • U.S. News & World Report 2023-24 Best Hospitals ranked Norton Healthcare’s adult-service hospitals in Louisville as high performing in heart attack, heart failure, aortic valve surgery and heart bypass surgery.
  • Norton Audubon Hospital earned ventricular assist device (VAD) accreditation from DNV – Healthcare and the Centers for Medicare & Medicaid Services.
  • Communicate with your health care provider, renew prescriptions, get lab results and more through your free Norton MyChart account.

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