Cardiac Arrhythmia Services

The Brown University Health Cardiovascular Institute (LCVI) is the most experienced and comprehensive center for arrhythmia services in Rhode Island, and one of the busiest centers in New England. Our electrophysiologists and cardiologists provide advanced consultation and therapies that span the spectrum of heart rhythm disorders.

Our experienced team of board-certified electrophysiologists, pacemaker and defibrillator implant physicians, nurses, and advanced electrophysiology fellows work together with your physician to ensure the most complete care in an evidence-based and patient-centered approach. All of our heart rhythm physicians are also faculty of The Warren Alpert Medical School of Brown University.

What Is Cardiac Arrhythmia?

A cardiac arrhythmia—often called a heart arrhythmia—is simply an irregular heartbeat.

Because the severity of arrhythmias can range from an emergency to harmless, it’s important to seek medical help right away if you notice something unusual occurring with your heartbeat.

Symptoms of cardiac arrhythmias can include:

• Fluttering or palpitations in the chest
• Chest pain
• Unusually fast or slow heartbeat
• Lightheadedness or fatigue
• Anxiety

It is important to note that an arrhythmia can also cause no symptoms.

What Are the Different Types of Arrhythmia?

In most cases, arrhythmias are grouped according to where they occur.

Supraventricular arrhythmias begin in the upper chambers of the heart, also called the atria.

Types of supraventricular arrhythmias include:

• Paroxysmal supraventricular tachycardia (PSVT): A regular, rapid heart rhythm that starts in the atria and begins and ends abruptly.
• Atrial fibrillation (AFib): A very common arrhythmia in which abnormal impulses spread throughout the atria, resulting in a disorganized, irregular heart rhythm. Learn more about AFib.
• Atrial flutter: An arrhythmia caused by rapid, irregular impulses. Atrial flutter is common in people with heart disease, and often switches to AFib.
• AV nodal reentrant tachycardia (AVNRT): A fast heart rhythm that occurs when the AV node—a small structure near the coronary sinus—contains an extra pathway.

Ventricular arrhythmias occur in the heart’s ventricles, or lower chambers.

Types of ventricular arrhythmias include:

• Premature ventricular contractions (PVCs): A common arrhythmia characterized by a skipped heartbeat. PVCs can be caused by exercise, stress, or too much caffeine.
• Ventricular fibrillation (V-fib): Occurs when the ventricles quiver, preventing them from contracting properly and delivering blood to the body. V-fib is a medical emergency that must be treated with defibrillation and CPR.
• Ventricular tachycardia (V-tach): Characterized by a fast heartbeat that prevents the heart from filling with enough blood. V-tach may be linked to other symptoms of heart disease and should be evaluated by a cardiologist.
• Long QT syndrome (LQTS): While not technically an arrhythmia, LQTS is a heart signaling disorder in which the lower chambers of the heart contract and release too slowly. LQTS can increase the risk of a life-threatening ventricular tachycardia and may require a surgical device.

Bradyarrhythmias are characterized by abnormally slow heart rhythms that may be caused by an issue in the heart’s electrical system or certain medications. The two major types of bradyarrhythmias are sinus node dysfunction—an issue with the heart’s natural pacemaker—and heart block, a delay or stoppage of the electrical impulse moving from the sinus nodes to the ventricles.

What Causes Arrhythmias?

There are a variety of conditions and factors which can increase the risk of an arrhythmia. If you experience arrhythmia symptoms, make an appointment with a heart rhythm specialist.

Medical conditions that can cause an arrhythmia include:

• High blood pressure (hypertension), or the force of the blood against the artery walls
• Heart valve disorders such as stenosis, regurgitation, or atresia
• Coronary artery disease or other cardiovascular issues like previous heart failure or cardiomyopathy
• Obstructive sleep apnea, which causes breaks in breathing during sleep
• Imbalances of electrolytes, including sodium and potassium imbalances
• Thyroid disease, or having an underactive or overactive thyroid

In addition to medical conditions, arrhythmias have a variety of risk factors including:

• Heavy alcohol use
• Use of caffeine, nicotine, and other stimulants
• Obesity
• Genetic predisposition
• Anxiety or stress

Lifestyle changes such as healthy diet, exercise, and lowering stress levels can reduce your risk of arrhythmias and other cardiovascular issues.

Learn more about the connection between weight and your heart.

What Does an Arrhythmia Specialist Do?

An arrhythmia specialist is called an electrophysiologist, or EP, and specializes in monitoring and treating heart rhythm disorders. EPs can perform specialized test to examine the heart’s electrical system, and may prescribe medication or perform a procedure to treat an arrhythmia.

Arrhythmia specialists utilize a variety of tests to diagnose arrhythmias, including:

• EKG: An EKG, or electrocardiogram, is a test that records the electrical activity of the heart. It’s a common, non-invasive test employed to detect cardiovascular issues.
• Stress Test: Stress tests record how much activity your heart can handle before an abnormal rhythm occurs. Common types of stress tests include the exercise test (exercise electrocardiogram), graded exercise test, and treadmill test.
• Holter monitor: Also called an ambulatory electrocardiogram or portable EKG, a Holter monitor is a wearable device used to detect arrhythmias. It’s often employed when a standard EKG doesn’t provide enough information, or when long-term monitoring is recommended by a specialist.
• Cardiac catheterization: A procedure in which a doctor inserts a long, narrow tube (a catheter) into a blood vessel to the heart to detect arrhythmias or diagnose heart conditions. The catheter’s tip can be placed in different parts of the heart to take blood samples or measure oxygen levels.
• Electrophysiology study: A test that creates a recording of your heart’s electrical system to check for abnormalities. Specialists may also map the spread of the heart’s impulses during each beat.

What Is the Most Common Treatment for Arrhythmia?

Common treatment for arrhythmias includes prescription medications, cardiovascular treatments, or a combination of the two.

Brown University Health’s range of treatments includes:

• Implantable devices to control heart rhythm—such as pacemakers and defibrillators—and cardiac resynchronization therapy for heart failure
• Radiofrequency catheter ablation for atrial fibrillation, supraventricular tachycardia, and ventricular tachycardia
• Novel cryoballoon technology and advanced hybrid ablation for atrial fibrillation
• Lead extractions performed using laser technology to remove damaged or infected leads
• Noninvasive electrophysiology procedures such as cardioversions and tilt table testing

Some common medicines prescribed to treat arrhythmias include:

• Calcium channel blockers (CCBs): Also referred to as “calcium antagonists,” CCBs interrupt the flow of calcium into the heart and tissue, lowering blood pressure.
• Anticoagulants (blood thinners): Anticoagulants simply make it more difficult for the blood to coagulate, or clot. Patients with atrial fibrillation or those with artificial heart valves are at higher risk for blood clots.
• Beta-blockers: Beta-blockers slow down the heart by reducing cardiac output and slowing the heart rate. They work by blocking the effects of hormones like adrenaline.

Learn more about the arrhythmia treatment procedures we offer for atrial fibrillation.

Do Cardiologists Treat Arrhythmia?

Cardiologists are heart specialists trained to diagnose and treat the full range of cardiovascular issues—including arrhythmia, high blood pressure, heart valve issues, blood clots, and heart abnormalities, among others.

But your cardiologist or primary care physician may recommend an appointment with an electrophysiologist, or a cardiologist with specialized training in arrhythmias and heart rhythm disorders.