Everything you need to know about arrhythmia

Lynne Wallis

More than 2 million people in the UK experience heart rhythm problems—could you be one of them?

About five years ago, in my early fifties, I noticed a difference in my heartbeat. Sometimes it went a lot faster than normal, while on other occasions it felt as though it had stopped for a few seconds, and then came back to life with a huge "boom" inside my chest. It got worse and more frequent, until two years ago, when I became dizzy after my heart rhythm went out of sync.

After almost passing out at a friend’s wedding in July last year, I went back to my GP. I had gone before and been fitted with a heart monitor, but—of course—my heart never performed its irregular beat while I was wearing the equipment. However, in July my heart was beating so fast that I was sent urgently to A&E by taxi. My GP had hastily put a sticker on my coat lapel saying, "ECG Urgent. Arrhythmia." I felt like an ailing Paddington Bear.

"If you find your heartbeat is irregular, go and see your GP. It could save your life"

The results of my ECG showed a fast, irregular heartbeat and I was diagnosed with atrial flutter, one of several different forms of arrhythmia (irregular heartbeat) which is very similar to atrial fibrillation. Both conditions occur in the upper chambers of the heart (the atria) above its ventricles. The fast heartbeat in the upper part results in atrial muscle contractions that are faster than, and out of sync with, the lower chambers (the ventricles). I also had an "ectopic beat", which is an extra, premature beat in the upper chambers which is usually followed by a pause before the heart starts again—this explained my somewhat terrifying "boom" feeling.

Arrhythmia can be triggered by caffeine, alcohol or stress and occasional irregular beats aren't normally a cause for concern. But if it becomes a regular occurrence, it could be the sign of something more serious such as heart disease, or a fault in the heart’s "electrical circuit" which can be corrected by surgery.

Figures released by the British Heart Foundation (BHF) have shown that the numbers of people being diagnosed with arrhythmia are at an all-time high. An additional 55,000 people were diagnosed with the commonest form of arrhythmia, atrial fibrillation (AF), in the year to October 2018 compared to the previous 12 months, taking the UK total to 1.3 million. The BHF say another 500,000 people are suffering from heart rhythm abnormalities that are so far undiagnosed. The NHS estimate that 2 million people now suffer from all forms of arrhythmia.

This number is in part growing as a result of our ageing population—arrhythmia is more common in the over forties—and to increasing awareness among health professionals, but also in part thanks to the exponential growth in coffee drinking in recent years. Some experts also say that society's excessive use of energy drinks have seen arrhythmia being triggered in younger people, who use caffeine-laced beverages to stay awake for longer.

The most worrying aspect of arrhythmia is that it puts the sufferer at a significantly increased risk of stroke. That's because it causes the blood flow to slow down and "pool" around the heart, leaving it more prone to clotting. The BHF say those who have arrhythmia are five times more likely to have a stroke than non-sufferers. But that’s not the worst part—strokes that are linked to arrhythmia have been shown to be more disabling and debilitating than any other form of stroke.

Clot-busting drugs called anti-coagulants are preventing substantial numbers of strokes every year, according to research from the University of Leeds which was part funded by the BHF. Professor Chris Gale, an honorary consultant cardiologist at the university said, “Sudden strokes in people who have AF are unnecessarily common. Treatments which prevent AF-related strokes are saving lives, but there are still many thousands of people in the UK living with undiagnosed AF who are missing out.” The Leeds research team found that since 2009, the number of AF sufferers being treated with anti coagulants has more than doubled. Without this increase, there would have been 4,000 more strokes in patients with AF in England between 2015 and 2016.

"Stokes linked to arrhythmia are more disabling than any other form of stroke"

AF contributes to around one quarter of all strokes. Stroke is the fourth biggest killer in the UK and a leading cause of disability. In 2016 it killed almost twice as many women as breast cancer. Anti-coagulants slow the formation of clots by thinning the blood, and can cut the risk of stroke by two thirds. The AF Association say that one in four people over 40 will develop AF, and estimate that 12,000 people suffer AF-related strokes every year in the UK.

Richard Elgar, 46, from Dorset was diagnosed with atrial fibrillation in 2014. He had previously suffered a heart attack aged 36, which doctors put down to narrowed arteries due to smoking heavily for 20 years. Richard had made a remarkable recovery, given up cigarettes completely and returned to training in the gym. "It all began with a large cup of coffee," he recalled. "I'd just finished it when I noticed a butterfly feeling in my chest. I remember feeling very tired, and hot. It was like a cold sweat with a drum beating in my chest. I phoned 111 and they sent me straight to A&E, where they discovered my heart was beating between 170-200 beats a minute. When I looked at the door it said 'resuscitation' so I knew the situation was serious."

"It began with coffee. I'd just finished a cup when I noticed a butterfly feeling..."

Richard was kept in overnight, and his rhythm was "out" for 30 hours. A few weeks later, it came back. He was kept in overnight once more, after which he was put on anti-coagulants to thin his blood to protect against stroke. "The doctors wanted to do the ablation procedure but the wall on the left side of my heart had hardened as a result of the heart attack, which makes ablation impossible. Instead I underwent cardioversion, which is when doctors literally stop the heart then start it again with paddles to get it back into a normal rhythm. It lasted six weeks then it went out again, and it's been spasmodic ever since. I barely notice it now, except when I exercise hard. I've become used to it. I'm on anti-coagulants for life, but I'm relaxed about it as I'm unlikely to suffer a stroke. It's not a pleasant thing, but it's something I've learned to live with. And I still enjoy the occasional cup of coffee. I'm keen for people to know about heart arrhythmia and to get diagnosed, which is why I help the BHF to raise awareness." People similar to Richard, who have suffered heart attacks are at an increased risk of arrhythmia.

"I'm on anti-coagulants for life. It's not pleasant, but I've learned to live with it"

On prevention, Sir Nilesh Samani, the medical director at the BHF, said: “Spotting AF is surprisingly easy, all it takes is a simple pulse check. A normal heart beat will feel regular, but if you find yours is irregular or random, go and see your GP. It could save your life.”

A procedure known as catheter ablation is routinely used to correct arrhythmia. The patient will usually be put on anti-coagulants for several weeks beforehand to protect them against stroke both before and during surgery, which is performed using local anaesthetic with sedation. It involves going in through a vein in the groin, threading a catheter to go up into the heart, then removing the faulty electrical pathway within the heart’s electrical circuit that is causing the rhythm problems. The bad sections can either be frozen or killed using heat. Pace-makers can be used to correct abnormal heart rhythms, but ablation is by far the most common method. The success rate with ablation for atrial flutter is between 88-95 per cent, for atrial fibrillation it's around 75 per cent. Patients over 50 sometimes need the procedure to be repeated, as malfunctioning pathways are harder to correct the older we get.

By the time you're reading this feature, I will hopefully have undergone the ablation procedure, and I'm looking forward to living without the constant worry of an episode of arrhythmia every time my heart beats a little bit too fast, I'm under stress, or I have one cup of coffee or a glass of wine too many.

Arrhythmia can be very frightening, even with anti-coagulants to protect you against the risk of stroke.

If you notice your heart regularly beating too fast, or in a rhythm that feels different or unnatural, see your GP as soon as possible. Don’t delay it and suffer years of unnecessary risk and worry.