Heart rhythm disorders, also called arrhythmias, affect how fast, slowly or regularly the heart beats. An accurate diagnosis helps your care team identify the type of arrhythmia, understand what may be causing it and determine whether treatment is needed.
Your evaluation may begin with a primary care provider or cardiologist. Depending on your symptoms, test results and the complexity of your condition, you may be referred to a cardiac electrophysiologist. These cardiologists specialize in diagnosing and treating problems with the heart’s electrical system.
Because some arrhythmias come and go, diagnosis may require more than one test. Your care team will select tests based on your symptoms, how often they occur and whether the rhythm could affect your health.
Your provider will ask about your symptoms, overall health and family medical history. This information can provide important clues about the type of arrhythmia you may have.
Your provider may ask about:
Understanding patterns in your symptoms helps your care team determine which tests may be most useful.
During the physical exam, your provider may:
A physical exam cannot diagnose most arrhythmias by itself, but it may identify other health concerns that require evaluation.
A cardiac electrophysiologist has advanced training in the electrical system that controls the heartbeat.
You may be referred to an electrophysiologist if:
The electrophysiologist will review your symptoms, test results, heart health and previous treatments before recommending the next step.
Many arrhythmias are intermittent, meaning they come and go. An arrhythmia may not happen during a routine medical appointment, so your care team may use different tests or monitoring periods to capture it.
An electrocardiogram, also called an ECG or EKG, is a noninvasive test that records the heart’s electrical activity at one point in time.
It can help identify rhythm problems such as:
An ECG may be performed while you are resting or during exercise as part of a stress test.
A portable heart monitor records your heart’s electrical activity as you go about your normal activities. The type of monitor recommended may depend on how often your symptoms happen.
A Holter monitor typically records continuously for one or two days. It may be useful when symptoms happen daily or several times a week.
An event or extended rhythm monitor may be worn for several weeks. It may record automatically when an abnormal rhythm begins or allow you to start a recording when you feel symptoms.
Your care team may ask you to track your symptoms, activities and possible triggers while wearing the monitor.
Some patients may need longer-term monitoring when episodes are infrequent or difficult to capture.
An echocardiogram uses sound waves to create images of your heart.
It can show:
An echocardiogram does not directly diagnose every arrhythmia, but it can identify structural heart conditions that may contribute to an abnormal rhythm or affect treatment choices.
An electrophysiology study, also called an EP study or EPS, examines the heart’s electrical activity from inside the heart.
During the procedure, thin, flexible catheters are guided through blood vessels and into the heart. The electrophysiologist uses the catheters to record electrical signals and map the pathways that control the heartbeat.
An EP study may help your specialist:
An EP study may be recommended when symptoms are significant, noninvasive testing has not provided enough information or your care team is planning a treatment such as catheter ablation.
In some cases, catheter ablation may be performed during the same procedure when the abnormal pathway is identified and treatment has been planned.
Not everyone with a heart rhythm disorder needs the same treatment. Some people may need monitoring only. Others may need medication, a procedure or an implanted device.
Your care team will consider:
Treatment may focus on slowing a fast heart rate, maintaining a regular rhythm, preventing dangerous rhythms or lowering the risk of complications.
Your treatment plan may change over time based on your symptoms, monitoring results and response to care.
Treatment may include managing related health conditions, making lifestyle changes, taking medication or having a heart procedure.
Your care team will explain the expected benefits and risks of each option and help you understand why a particular approach is being recommended.
Healthy habits may reduce certain arrhythmia triggers and support your overall heart health. They do not replace medication or another treatment recommended by your care team.
Your provider may recommend:
Ask your care team whether there are specific activities, foods or substances you should avoid based on your type of arrhythmia.
Medication may be used to slow the heart rate, help maintain a regular rhythm, reduce the risk of blood clots or treat another condition contributing to the arrhythmia.
Your care team may prescribe:
Medication may control an arrhythmia without eliminating its underlying cause. You may need follow-up tests to see how well the medicine is working and monitor for side effects.
Do not stop taking or change the dose of a heart medicine without talking with your health care provider.
Cardioversion is used to restore a normal heart rhythm. It may be recommended for certain arrhythmias, including atrial fibrillation and atrial flutter.
During electrical cardioversion, electrodes placed on your chest deliver a carefully controlled electrical shock that resets the heart rhythm. You will receive medication to help you sleep during the procedure.
In some cases, medication may be used instead of an electrical shock to restore the rhythm.
Cardioversion can return the heart to a normal rhythm, but it does not remove the electrical pathway or tissue causing the arrhythmia. The abnormal rhythm may return. Your care team may recommend medication or another treatment to help maintain the rhythm.
Catheter ablation is a minimally invasive procedure used to treat certain abnormal electrical signals in the heart.
During the procedure, an electrophysiologist guides thin catheters through blood vessels and into the heart. Advanced cardiac mapping helps locate the tissue causing or carrying the abnormal signals. Energy is then applied to the targeted area to block the arrhythmia.
Ablation may be considered when:
The techniques used may vary based on the type and location of the arrhythmia.
An arrhythmia can sometimes return after ablation. Additional monitoring, medication or another ablation procedure may then be considered.
Learn more about catheter ablation.
A pacemaker is a small device placed under the skin, usually in the chest. It sends electrical signals to help keep the heart from beating too slowly.
A pacemaker may be recommended for:
Your care team will check the pacemaker regularly and adjust its settings when needed.
An implantable cardioverter-defibrillator, also called an ICD, continuously monitors the heart for certain dangerous rhythms.
If the device detects a dangerous rhythm, it can deliver electrical therapy to restore a safer heartbeat.
An ICD may be recommended for people who:
Some ICDs can also provide pacemaker therapy when the heart beats too slowly.
Arrhythmias may change over time and the first treatment may not fully control your rhythm or symptoms. This does not mean there are no other options.
Your care team may:
The next step will depend on the type and complexity of the arrhythmia, how it affects you and which treatments you have already tried.
Many people with heart rhythm disorders need ongoing follow-up, even when treatment is working well.
Regular appointments allow your care team to:
Contact your care team if your symptoms happen more often, last longer or feel different from your usual episodes.
Call 911 for severe chest pain, severe shortness of breath, fainting or signs of cardiac arrest.
Banner Health cardiologists and cardiac electrophysiologists diagnose and treat common and complex heart rhythm disorders. Find a heart specialist near you.
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