What Is Ventricular Arrhythmia and How Is It Treated?

A healthy heartbeats to a steady rhythm, with the ventricles (the heart’s lower two chambers) and the atria (the heart’s upper two chambers) working harmoniously to keep oxygen-rich blood pumping to all the organs and tissue in the body.

The left ventricle pumps blood through the aorta and out to the rest of the body. The right ventricle pumps blood to the lungs, where the blood exchanges carbon dioxide for oxygen before returning to the heart.

The coordinated contraction and relaxation of the heart’s chambers are controlled by the heart’s electrical system. If there is a disruption or problem with the electrical activity in the lower chambers, the result can be a VA. An arrhythmia can develop anywhere in the heart and cause symptoms that range from mild to life threatening.

The main problem with VA is that the lower chambers aren’t allowed to relax and contract sufficiently or are beating out of sync and cannot fill with enough blood or expel enough blood out to the body.

There are three main types of VA. Each one presents with different symptoms and can lead to unique complications if not properly treated.

• Ventricular tachycardia (VT) is an abnormally fast heart rhythm (more than 100 beats per minute) that starts in the ventricles. Episodes may last a few seconds or several hours. Because the heart is beating so fast, the ventricles don’t have time to fully contract with each heartbeat, so less blood is pumped out to the body.
• Ventricular fibrillation (VFib) describes a condition in which the ventricles quiver, rather than contract and relax in their usual steady, robust pattern. VFib also interferes with the heart’s ability to pump enough blood to meet the body’s demands.
• Torsades de pointes occurs in people with long QT syndrome. The QT interval is the time needed for an electrical signal to activate the ventricles and then recharge. Having long QT syndrome means that the recharging time (which is the vulnerable period) is abnormally long, resulting in rapid, irregular heartbeats. Torsades de pointes (which means “twisting of the points” in French) means the ventricles are beating too fast and are out of sync with the atria. The cells are also out of sync with each other.

The symptoms of VA are similar to those of other types of arrhythmias. In a mild case, you may not be aware of a change in your heart rhythm. But when signs of trouble do develop, they can include:

• racing heart
• fluttering heartbeats
• chest pain
• lightheadedness
• fainting
• sweating
• shortness of breath

Diagnosing VA usually requires an electrocardiogram (ECG) to measure the electrical activity in the heart. But other tests and tools are used to make a final diagnosis. Among them are:

• a review of symptoms, including when they started and how long they last
• a medical history, focusing on factors that may contribute to heart problems
• a physical exam, in which your doctor will listen to your heart, check your pulse, and check for swelling in your lower limbs, which could indicate heart failure or an enlarged heart
• blood tests to check on your levels of electrolytes (potassium, calcium, etc.), which affect heart function
• Holter or event monitors, which are wearable devices that can detect changes in your heart rhythm over a period of days
• echocardiogram, which uses sound waves to create live, moving images of your heart

The best treatment for VA depends on several factors, particularly the type of arrhythmia, as well as your age and overall health. VA may need immediate treatment for acute symptoms, but it may also require long-term care for chronic symptoms.

The three most common types of treatments are:

Antiarrhythmic drugs

Medications that help keep a heart in a normal rhythm are sometimes used alone but may also be prescribed as add-on therapies.

Medications to treat VAs include:

• ranolazine (Ranexa)
• beta-blockers
• amiodarone (Pacerone, Nexterone)
• sotalol (Betapace)
• lidocaine/mexiletine

A study in the Journal of Arrhythmia found that the drug ranolazine can be effective in reducing the number of VA in people with a variety of cardiac conditions, including long QT syndrome.

Research suggests that amiodarone has good effectiveness but is poorly tolerated by many people with VA, while sotalol is generally well tolerated but may have limited effectiveness.

Medications may be used to stop an episode of VA, and medications may also be used as long-term treatments.

Implantable cardioverter defibrillator (ICD)

An implantable cardioverter defibrillator (ICD) is a small device placed in the chest to detect abnormal rhythms and send an electrical shock to the heart to restore a normal rhythm. It is the primary treatment for people with VA and may be used to stop an episode of VA and restore a normal heart rate.

Some people may be concerned that the device may deliver a shock when it’s not needed, however, this is very unlikely and extremely rare. ICDs are very effective and even lifesaving.

Catheter ablation

Using a special catheter threaded through a blood vessel starting in the forearm or upper leg, a doctor can deaden tiny clusters of cells in the heart that are triggering the arrhythmia. The tip of the catheter is fitted with a device that uses radio waves (radiofrequency ablation) or extreme cold (cryoablation) to destroy the troublesome heart tissue.

A 2018 study notes that while catheter ablation is the primary treatment option for VT, the doctor’s experience performing the ablation is an important consideration, as the procedure is not without some risks. The study also notes that antiarrhythmic drugs have limited effectiveness, and people receiving recurrent shocks from their ICDs is an ongoing concern of cardiologists.

Advancing age is one of the main risk factors for VA and most other heart problems. The wear and tear on the heart through the years can cause trouble with the electrical system, valves, and other components of the heart. Some other main risk factors include:

• family history of arrhythmia and other heart disease
• smoking
• misuse of alcohol or drugs
• heart attack and other heart conditions
• heart failure or cardiomyopathy
• electrolyte abnormalities
• respiratory disease
• obesity
• diabetes
• high blood pressure
• thyroid disease
• sleep apnea

Treating VA promptly and thoroughly is critical in avoiding serious, possibly life threatening complications. Without treatment, complications can include:

• lightheadedness
• fainting
• heart failure
• damage to the heart muscle
• kidney problems and other organ trouble
• sudden life threatening cardiac arrest

However, with proper treatment, you can have a normal life expectancy and quality of life. Successful ablation can sometimes eliminate arrhythmias permanently, though the abnormal rhythms can return. At that point, you may need to consider getting an ICD or having a second ablation if your doctor believes that would be effective.

Ventricular arrhythmia is a serious health condition in which abnormal heart rhythms originate in the heart’s lower chambers and affect the way the entire heart functions. The resulting poor blood flow can cause fainting and more severe life threatening complications.

If you notice symptoms, such as a racing or fluttering heart rate or feeling faint, see a doctor for monitoring and diagnosis. If you are concerned about having an ICD, talk with others who have them, perhaps in an in-person or online support group.

VA can be a manageable condition, and given its severity, it’s not one you should ignore.