In most cases, diagnosing arrhythmias depends upon the use of an electrocardiogram. In some cases, however, the event may be extremely transient, making it difficult to capture on an electrocardiogram. In such an instance, physicians can provide the patient with a 24 hour EKG monitor, Holter monitor, or a similar wearable recording device that will detect any irregularities on demand and transmit them by telephone to the doctor's office, where the findings are converted into an electrocardiogram. Alternately, physicians can use an invasive test called an electrophysiological test, or EP study. For this study, pacemaker wires are inserted intravenously into the heart chambers. These wires can stimulate the heart into an irregular rhythm and record the subsequent findings.

	EKG depicting arrhythmia.

One of the most common forms of arrhythmia, atrial fibrillation, typically runs the atrial chamber at rates of 300 to 400 beats per minute. Fortunately, the AV node does not allow all those beats to reach the ventricles, keeping these chambers at a rate of 100 to 200 beats per minute or slower. Symptoms of atrial fibrillation include a noticeable irregularity in the heartbeat, the detection of an irregular pulse, a sensation of pounding in the chest, and increasing shortness of breath on exertion.

Physicians have typically treated atrial fibrillation by using blood thinners such as aspirin or coumadin/Warfarin to reduce the risk of clotting in the atrium. Normal rhythm can also be restored by an organized electrical shock, usually delivered to the chest wall of the patient, who is under a light anesthetic. However, the medical care that we have used for so long to manage arrhythmia is now moving in the direction of catheter ablation techniques. In this approach, a catheter is introduced into the heart, allowing the physician to directly, but less invasively, destroy any faulty electrical connections. Ablation can possibly eliminate the long-term value of, or necessity for, medication.

Atrial defibrillators, similar to those already in existence to treat ventricular fibrillations, are currently in use on an experimental basis. We hope these devices will enable physicians to treat atrial arrhythmias without reliance on medications. When medications are used, pacemaker implantation is sometimes required to enable full deployment of the medications without concerns for excessive slowing of the pulse. Both pacemakers and defibrillators are now smaller, affordable, technologically more advanced, and more user friendly.

Coronary artery blockages and heart attacks can cause scarring that damages the conductive tissue. In some cases, the electrical connections in the normal tissue may differ enough from those in the scar tissue that electrical short circuits develop. These short circuits can result in symptomatic or even potentially fatal irregularities in ventricular rhythm. Physicians typically treat ventricular fibrillation through the implantation of a defibrillator device, often in conjunction with medical therapies. This device shocks the heart back to a normal rhythm should it suddenly arrest due to a ventricular fibrillation.