What is a cardiac arrhythmia?

  The rhythm of the heart is controlled by impulses issued from the sinus node and is called “sinus rhythm”, and all normal human hearts should be in sinus rhythm. An irregular heartbeat, one that is too fast or too slow, or one in which the electrical impulses that cause the ventricles to contract do not travel down the normal pathway described above is called an arrhythmia. Almost everyone experiences minor, episodic arrhythmias, which are often harmless and do not require treatment, but in the case of recurrent or severe arrhythmias, they require targeted treatment under medical supervision.  Arrhythmias are classified according to their location as ventricular arrhythmias and supraventricular arrhythmias. Ventricular arrhythmias originate in the ventricles, while supraventricular arrhythmias originate above the ventricles, usually in the atria. Arrhythmias can be divided into slow and fast arrhythmias according to the frequency of the heartbeat (the frequency at which electrical impulses are delivered) at the time of the attack. All arrhythmias that can be treated by radiofrequency ablation and surgery are considered tachyarrhythmias.  A tachyarrhythmia is a condition in which the heart beats at a rate (the frequency at which electrical impulses are delivered) greater than 100 beats per minute. In normal people, the heart often beats at a rate greater than 100 beats per minute during exercise, stress or excitement. In the current popular view, the basic mechanisms of tachyarrhythmia include trigger and fold mechanisms. The trigger mechanism refers to a part of the heart where the myocardium “misbehaves” and no longer follows the unified command from the “command”, but delivers electrical impulses continuously or intermittently on its own. Because the “unruly” myocardium delivers electrical impulses earlier and more frequently, it dominates the heartbeat and causes arrhythmias. The foldback mechanism refers to the presence of two separate conduction pathways in a part of the heart that are connected at the beginning and end for a variety of possible reasons, forming a “loop” (foldback loop). The electrical impulses can “loop” around this loop, and each loop produces a heartbeat; since the time required to “loop” is very short, the heartbeat will be very fast. The phenomenon of “circling” is somewhat similar to that between 2 mountains (A and B), where a sound (electrical impulse) is transmitted from A to B to produce an echo, which in turn reaches A and forms a new sound to B, and so on and so forth.  Tachyarrhythmias include premature beats, tachycardia, flutter and fibrillation, corresponding to the site where they occur: atrial premature beats (atrial premature), atrial tachycardia (atrial tachycardia), atrial flutter (atrial flutter), atrial fibrillation (atrial fibrillation), paroxysmal supraventricular tachycardia (supraventricular tachycardia), ventricular premature beats (ventricular premature), ventricular flutter (ventricular flutter), ventricular fibrillation (ventricular fibrillation). Of these, ventricular flutter and ventricular fibrillation are the most serious and fatal arrhythmias, and patients often die quickly if not resuscitated in time. Some ventricular tachycardias may deteriorate into ventricular flutter or ventricular fibrillation and are therefore a potentially fatal arrhythmia. Premature beats are the most common clinical arrhythmia, but most of them do not have serious clinical consequences or even require treatment. Due to the increasing incidence of cardiovascular diseases such as hypertension, coronary artery disease, and heart failure, as well as the development of treatments for these diseases and the corresponding increase in life expectancy, the incidence of atrial fibrillation, one of the complications of these cardiovascular diseases, has also increased and has become an “epidemic” in the field of cardiac arrhythmias. Atrial fibrillation can have serious consequences in terms of disability and death, and the treatment of atrial fibrillation is receiving increasing attention.  The presence or absence of clinical symptoms of arrhythmias and the presentation of clinical symptoms are influenced by many factors, including the underlying health of the heart, the type and severity of the arrhythmia, the frequency, timing and duration of the arrhythmia, and the sensitivity of the patient. Some arrhythmias may not produce any symptoms, and accordingly, the presence of common symptoms of arrhythmias such as spontaneous palpitations does not necessarily imply the presence of an arrhythmia. It is important to emphasize that the presence or absence of symptoms does not necessarily correlate with the severity of the arrhythmia, and treatment of arrhythmias should not be neglected because of the absence or mildness of symptoms. A large proportion of tachyarrhythmias and bradyarrhythmias overlap and cannot be distinguished from each other. Common arrhythmia symptoms include weakness, shortness of breath, panic, profuse sweating, dark confusion, and fainting. Severe arrhythmias such as ventricular flutter and ventricular fibrillation can manifest as sudden death, and some arrhythmias may have their complications as their first clinical manifestation, such as atrial fibrillation, which may manifest as symptoms of stroke (coma, hemiparesis, etc.) when detected.