Missing a beat, not so romantic (arrhythmia)

The proverbial ‘missing/skipping of heart beat’ by sight or fond remembrance of loved one is a romantic thing. However, in context of cardiovascular health, things are not as pleasing. Heart beats in each of us constantly from the time the foetus is ten weeks old in its mother’s womb to the time one takes his last breath. The beauty of this marvel of nature is that it does all its work without making one aware of its presence. In fact in healthy and relaxed state, one should not feel his own heartbeat.

So the notion of missing/skipping of heart beat in itself is abnormal. There are various reasons for the above symptoms. It could be due to a premature extra beat generated from unconventional site either in upper chambers or lower chambers of heart. These extra beats may delay the occurrence of next beat by resetting the natural pacemaker of heart leading to feeling of missing/skipping of a beat. Though it can cause distressing symptoms, the condition itself usually has a benign prognosis. However, if it is frequent or severely distressing, a cardiologist should be immediately consulted. The burden of extra beats can be quantified by 24 hours Holter monitoring test and based on that further management can be decided. Drugs are available for suppressing the extra beats however, are not routinely recommended. On special occasions, an electrophysiological study of the heart is done to map the origin of these extra beats which can be subsequently treated with radio frequency ablation for permanent cure.

Another important cause of missing/skipping of heart beat is related to defects in either impulse formation by the natural pacemaker of the heart or in the conduction of impulse from upper chambers to lower chambers of the heart.

The natural pacemaker of the heart generates beats at a constant rate. It can sometimes be delayed in producing the next beat which is called as the late beat. Late beats are a benign occurrence and do not merit any treatment. However it’s the duration of the pause in the impulse generation that is of importance. Any pause due to missing of heart beat longer than 3 seconds can lead to fainting/syncope and requires implantation of a permanent pace maker device in the heart. Missing beats due to failure in conduction of impulse from upper chambers to lower chambers of heart has equally grave prognosis and requires implantation of a permanent pacemaker device in most cases.

Cardiac Electrophysiologist is a cardiologist that specifically deals with the electrical problems of the heart. There are many diagnostic tests for studying such problems of heart viz. ECG, 24hr Holter test, external and internal loop recorders, and electrophysiological study (which requires admission and is and invasive procedure). General advice is to refrain from tea, coffee and beverages rich in caffeine. Similarly alcohol consumption can also lead to feeling of missing beats. Specific treatment is according to specific cause and is effective.

So next time when your heart skips a beat make sure it’s for a right reason.

Name : Dr. Avinash Verma
Qualification : MBBS, MD, DNB (Cardiology)
Department:  Sr. Consultant Electrophysiologist