Palpitations are a reason for cardiology referral. These can be due to ectopic heart beats, atrial arrhythmias (abnormal heart rhythm arising from the upper chambers of the heart) or ventricular arrhythmias (abnormal heart rhythm from the lower chambers of the heart). By far, the most common type of palpitation is ectopic heart beats. This condition is usually not sinister, requiring reassurance only.
Atrial fibrillation is also a cause of palpitations and it is the most common heart arrhythmia. It arises due to abnormal uncoordinated fast electrical impulses from the atria (upper chambers of the heart) causing the heart to beat quickly. It can be short-lived and self-terminating known as paroxysmal atrial fibrillation or persistent, lasting for days and weeks often requiring electrical cardioversion or medication to restore regular rhythm. Atrial fibrillation can become permanent. It can cause symptoms of shortness of breath or chest pain due to the fast heart rate it causes. Some patients have no symptoms.
Atrial fibrillation increases the risk of developing blood clots within the left atrium (left upper chamber of the heart) which when dislodged can cause a stroke. About a fifth of strokes is due to atrial fibrillation. Some factors increase the risk of blood clot formation in atrial fibrillation including advancing age and the presence of such medical conditions as heart failure, high blood pressure, diabetes mellitus, previous strokes and vascular disease. Anticoagulant therapy with warfarin or direct oral anticoagulants (DOACs) is necessary for patients with an increased risk of stroke. Treatment of atrial fibrillation also involves the slowing of the heart rate using medication such as beta-blockers, calcium blockers and digoxin and restoring regular rhythm by means of electrical cardioversion or anti-arrhythmic medication in suitable patients. Following successful cardioversion, some patients may be considered for pulmonary vein isolation. These patients are usually symptomatic and continue to have bouts of atrial fibrillation despite receiving anti-arrhythmic medication. This procedure is complex often taking several hours using radiofrequency waves or cryoablation (freezing technique) to create thin lines of scar tissue to stop electrical impulses arising from the pulmonary veins (a known trigger of atrial fibrillation) from entering the heart. Further information can be obtained from dedicated websites like British Heart Foundation website.