That fluttering, pounding, or skipped-beat sensation in your chest can be alarming. But, it doesn’t always mean something is seriously wrong. Here, Tina Sichrovsky, MD, an electrophysiologist at VMG - Electrophysiology, breaks down the different types of heart arrhythmias, what symptoms actually mean, and when to seek evaluation.
What is an arrhythmia?
“Arrhythmia basically means an abnormal heart rhythm,” Dr. Sichrovsky explains. “It's not a specific diagnosis. Rather, it’s just an umbrella term for all the different rhythm abnormalities.” That includes rhythms that are too fast, too slow, or irregular. Atrial fibrillation, or AFib, is by far the most common.
AFib becomes significantly more common with age. “If you look at patients in their 80s, about 20 percent of people have Afib. So, 1 in 5. That’s how common it is,” states Dr. Sichrovsky. Other arrhythmias, like SVTs (supraventricular tachycardia) and PVCs (premature ventricular contractions), occur far less frequently and are often asymptomatic, meaning many people experience them without ever realizing it.
How to tell if heart palpitations are serious
Not every flutter is cause for concern. “In general, the longer the symptoms last, the more severe the symptoms are,” Dr. Sichrovsky notes. Brief, occasional sensations with no other symptoms are usually benign. But, palpitations accompanied by dizziness or chest pain deserve closer attention.
Interestingly, Dr. Sichrovsky explains that how a person experiences symptoms doesn’t always reflect how serious the underlying condition is. “Some people feel every single heartbeat. A few PVCs a day will make them very uncomfortable.” And yet, others with more serious arrhythmias may have no symptoms at all.
Why early AFib diagnosis matters
Catching and treating AFib early can make a significant difference in outcomes. Left untreated, AFib carries risks of stroke and congestive heart failure. But, there’s another reason timing matters. The heart itself changes the longer it stays in an abnormal rhythm.
“The longer you're in it, the more used to it the heart gets,” Dr. Sichrovsky cautions. This process, called remodeling, can create a snowball effect that makes AFib more likely to recur and harder to treat. “We prefer to see people early, even after one episode, so we can intervene early and the outcome is much better,” she adds.
Today’s treatment options for AFib
Treatment for AFib generally falls into three categories. The first involves lifestyle and risk factor management. For example, addressing triggers like obesity, alcohol use, and sleep apnea – all of which can worsen AFib. The second is medication, either to suppress the arrhythmia directly or simply slow the heart rate.
The third is catheter ablation, a procedure that can potentially cure conditions like AFib, SVT, and PVCs. “That's the only potential cure,” Dr. Sichrovsky notes. “All the other things are just suppressive therapy.”
Monitoring methods for arrhythmia
Many patients now arrive with a diagnosis already flagged by a smartwatch. For others, external monitors worn for about two weeks can capture what is happening. Finally, implantable loop recorders offer the most comprehensive long-term monitoring for less clear-cut cases. This small device is placed under the skin over the heart and continuously records heart rhythm data over an extended period, catching irregular episodes that might otherwise be missed during a short monitoring window.
Clearing up common misconceptions about arrhythmias
One of the biggest misconceptions Dr. Sichrovsky encounters is the belief that no symptoms means no risk. “That, unfortunately, is not always true, especially for atrial fibrillation,” she advises. Patients can be at risk for stroke even without noticeable symptoms.
Another common myth involves ablation success rates, often based on someone else's experience. “You can't really compare one patient to another,” she emphasizes. With proper patient selection and risk factor management, success rates for ablation are typically around 90%.
Dr. Sichrovsky’s clearest piece of advice? Alcohol is a significant trigger for arrhythmias. “Less is better,” she urges. “We recommend no more than three drinks a week. But, if you can stop completely, it's probably the safest.”
To learn more about heart rhythm disorders and the services available at Valley, visit ValleyHealth.com/Heart.
About the Author
Dr. Tina Sichrovsky is an electrophysiologist at Valley Medical Group's electrophysiology practice located at
140 East Ridgewood Avenue in Paramus, NJ.
