Signs and Symptoms of an Arrhythmia

Some arrhythmias are “silent,” causing no symptoms, while others cause bothersome symptoms that may be brief, long-lasting, or sudden and intense. Symptoms associated with arrhythmia may include:

  • palpitations, or skipping a beat
  • fluttering feeling in chest or neck
  • racing heart sensation
  • fatigue
  • weakness
  • dizziness or lightheadedness
  • fainting or almost fainting
  • shortness of breath
  • chest pain
  • suddenly rapid, chaotic heartbeat
  • Syncope, or fainting (or almost fainting), or feeling dizzy or lightheaded, can be caused by serious heart rhythm disorders and should be evaluated thoroughly.

Types of Arrhythmias

  • Supraventricular arrhythmias (begin in the atria, the upper chambers of the heart):
  • Atrial Fibrillation (AFib) - the most common arrhythmia, affecting about 5 million people in the United States. The heartbeat is irregular and fast, an AFib can lead to other rhythm disturbances.
  • Atrial Flutter - Like AFib, atrial flutter is characterized by a rapid heartbeat. Unlike AFib, which is caused by many disorganized electrical signals, atrial flutter is caused by a single electrical wave circulating very quickly.
  • Sick Sinus Syndrome (SSS) - group of symptoms indicating the heart’s natural electrical “trigger” – the sinoatrial node, where the electrical signal begins – is not working properly. The heartbeat can switch back and forth between too slow and too fast.
  • Sinus tachycardia - normal harmless elevation in heart rate due to excitement, exercise or fever. It rarely requires treatment.

Ventricular arrhythmias (begin in the ventricles, or lower chambers of the heart):

  • Ventricular tachycardia (VT) - extremely fast heart rate, typically associated with other heart disease, although it occasionally occurs in healthy hearts. Requires prompt treatment and aggressive monitoring because it can lead to ventricular fibrillation (see next item).
  • Ventricular fibrillation (VF) - occurs suddenly and without warning, and stops all heart function. VF causes sudden cardiac death, also known as cardiac arrest. The only effective treatment is defibrillation, and it must be performed quickly to save the patient's life.
  • Long QT Syndrome - an electrical system disorder that may be caused by genetics, medications or a combination of both. People with Long QT Syndrome are at a higher risk of ventricular arrhythmias.

Other arrhythmias:

  • Premature contractions - early, extra or "skipped" heartbeats are the most frequent cause of irregular rhythms. They may occur in the upper chambers, atria (PACs), or lower chambers, ventricles (PVCs).
  • Heart block - electrical signals created in the upper chambers don’t reach the lower chambers, causing the heart to beat too slowly.


In addition to gathering a medical history and performing a thorough physical exam, many tests and tools help determine the type of arrhythmia and its severity. Some common diagnostic tests include:

Measures the heart’s ability to respond to external stress, such as strenuous physical exercise.

External test in which ultrasound waves visualize the structures of the heart. An echocardiogram can be used to diagnose structural abnormalities of the heart, assess valvular function and look for clots in the atria prior to an ablation procedure. Intracardiac echocardiography (ICE) is also used to guide physicians during various electrophysiology procedures.

Provides physicians with important information about the heart’s rhythm by recording its electrical signals. In order to view the heart’s electrical signals, electrodes are placed in various places on the patient’s chest and limbs. An EKG is a non-invasive, painless and safe diagnostic tool in electrophysiology.

A minimally invasive procedure that involves placing specialized catheters in the heart through a patient’s blood vessels. The specialized catheters allow the physician to see the electrical conduction of the heart with much greater detail than the surface EKG can provide. During an EP study, a physician can provoke an arrhythmia using several methods. An EP study can provide a definitive diagnosis of an arrhythmia and information essential in selecting the appropriate treatment. An EP study is typically recommended for persons with symptoms of arrhythmia or those who are at risk for sudden cardiac death.

A special type of EKG worn by a patient for up to seven days. The results of a Holter monitor can be very useful in diagnosing arrhythmias that are intermittent. The arrhythmia may be detected even if symptoms are not present.

Continuously records the heart's electrical activity just like an electrocardiogram (ECG). It can store the pattern of activity that happens before, during and after an "event." By analyzing the stored data, your physician can determine whether the cause is an arrhythmia, and can monitor your heart accordingly.

Used to determine the cause of fainting, lightheadedness or dizziness, which involves tilting the patient upright at a 70 to 80 degree angle for 30 to 45 minutes while monitoring heart rate and blood pressure.

Internal Echo, during which an ultrasound transducer positioned on an endoscope is guided down the patient’s throat and into the esophagus, providing a view of the heart’s chambers and valves. TEE is typically recommended when the physician wants to examine the heart valves and chambers closely, check for blood clots in the heart, or visualize the left upper chambers of the heart.