Why arrhythmia develops and how it is managed
Arrhythmias arise from two broad origins: congenital and acquired. Congenital arrhythmias form in the womb due to genetic factors and are relatively rare. Acquired arrhythmias develop during life under a mix of influences, including past viral illnesses, a sedentary lifestyle, excess weight, and the emergence of chronic diseases affecting the endocrine system, kidneys, or lungs. Over time these factors accumulate and can exhaust the heart’s reserve, leading to rhythm disturbances. Overall, arrhythmias account for about 15% of heart diseases. They can occur sporadically in a healthy person and may not be dangerous, but they still warrant attention.
Some arrhythmias stem from scar tissue in the heart after a heart attack or surgical procedures. This is tied to anatomical changes within the heart. When a portion of heart muscle dies during a myocardial infarction, a scar forms where tissue structure becomes heterogeneous. Cells die in places while some survive, creating a disrupted electrical environment that can generate abnormal rhythms.
To illustrate, a simple analogy helps patients picture the problem. A smooth lake receives a single stone, producing clean, expanding waves that travel across and back. The heart normally conducts an electrical impulse, the chambers contract in a coordinated way, and blood circulates. Now imagine a lake with uneven, rugged stones. The waves collide with obstacles, break into irregular patterns, and whirlpools form. In the heart, scar tissue disrupts the normal wave of contraction, sometimes causing dangerous vortexes of electrical activity that can trigger ventricular tachycardia or ventricular fibrillation, potentially leading to cardiac arrest in susceptible individuals.
Is ventricular tachycardia the most dangerous form of arrhythmia? It is essential to view all arrhythmias as potentially serious. When the heart beats irregularly, the cause should be investigated and addressed. Treating the underlying trigger protects the heart from wear and gradual loss of pumping ability. Some arrhythmias, however, do not threaten life. The risk depends on where the focus sits in the heart. For example, sinus tachyarrhythmia may produce rapid heart rates around 120 beats per minute or more. It can be uncomfortable and limiting but may be manageable with breath control, hydration, and sometimes medication. If this rhythm significantly reduces quality of life or causes anxiety, more definitive treatment may be considered.
Do life-threatening rhythm disorders exist? Yes. Ventricular arrhythmias can be lethal if not controlled. The heart has four chambers, with the ventricles playing the main role in pumping blood. Ventricular tachycardia or ventricular fibrillation can quickly lead to cardiac arrest and death if not treated promptly.
Every rhythm nuance requires individual assessment to determine how to live with the condition and what interventions are appropriate. In some cases, a calm, watchful approach suffices, while others call for medication, and in many situations, surgical intervention is considered. The decision is shared with the patient, respecting fear of surgery or a desire for rapid, lasting results. When necessary, long-term medical therapy is offered, or a surgical option may be pursued.
Can arrhythmia be detected by the patient alone? If someone notices irregular heartbeats, sudden sensations of racing, or pauses in contraction they should see a cardiologist. It is important to know that some arrhythmias are asymptomatic at first. Regular medical checkups, including an electrocardiogram, are essential for timely detection. An EKG identifies the rhythm type, and Holter monitoring, lasting a day, may be needed in some cases. In rare situations, an electrophysiological study in an operating room helps map and pinpoint the arrhythmia focus for targeted treatment.
What approaches are used to treat arrhythmias in Russia? The initial step typically involves drug therapy. If necessary, radiofrequency catheter ablation becomes an option. This minimally invasive procedure uses a catheter to reach the heart, guided by ultrasound and X-ray imaging to reconstruct a three-dimensional model of the heart. The goal is to locate and eliminate tissue regions that generate dangerous rhythms. In some cases, a pacemaker is implanted. These procedures are now performed in many regional centers, with national centers advancing the most complex ablations. The Meshalkin National Center for Medical Research is a leading facility, performing a high volume of ablations annually.
What are the expectations after ablation regarding activity? While any heart intervention leaves some scarring, the aim is to create a stable electrical landscape. The goal is a reliable contraction pattern that allows a mobile, active lifestyle, typically with guidance from a cardiologist. Friends and neighbors need not know the patient has a life-threatening condition, because the recovery can be discreet. As technology progresses, new methods are explored, including pulsed field ablation, which uses electric fields to block electrical conduction rather than destroying tissue. This may reduce collateral damage and shorten procedure times.
Has this novel approach reached clinical practice in Russia? Internationally, early work focused on radiofrequency ablation and cryoablation. The idea behind pulsed field ablation emerged later, with researchers in Russia and the United States exploring electroporation as a parallel development. In Siberia, a concentrated program, led by a major research center, has conducted several procedures. Early experiences show promise: reduced trauma, minimized risk to nearby organs such as the esophagus, and shorter operative times. Ongoing trials will determine its place in routine care.