What Is Arrhythmia? Types, Causes, Symptoms, and When to See a Cardiologist

Arrhythmia means your heart is beating with an irregular rhythm — too fast, too slow, or in an uncoordinated pattern. As an integrative cardiologist, Dr. Regina Druz, MD, MBA, FACC, FMCP-M evaluates arrhythmia not just by classifying the rhythm disturbance, but by identifying the upstream triggers that standard cardiology workups routinely miss: electrolyte imbalances, thyroid dysfunction, sleep apnea, and autonomic nervous system dysregulation.

What Is Arrhythmia?

An arrhythmia is any abnormality in the electrical system that controls your heartbeat. The heart’s electrical signals normally originate in the sinoatrial (SA) node — the natural pacemaker — and travel through the atria, the AV node, and into the ventricles in a coordinated sequence. When any part of this pathway misfires, generates extra signals, or conducts too slowly or rapidly, an arrhythmia results.

Not all arrhythmias are dangerous. Some — like occasional premature atrial contractions (PACs) or the brief “flip” sensation many people feel — are benign. Others, particularly those involving the ventricles or sustained abnormal rhythms, require prompt evaluation and management.

Types of Arrhythmia

Supraventricular Arrhythmias (Originating Above the Ventricles)

Atrial fibrillation (AFib) is the most common sustained arrhythmia, affecting over 33 million people worldwide. The atria quiver chaotically rather than contracting in a coordinated rhythm, producing an irregular, often rapid heartbeat. The primary dangers are stroke (from clots forming in the fibrillating atria) and heart failure from chronically rapid rates.

Atrial flutter is similar to AFib but with a more organized electrical circuit in the right atrium, producing a rapid but regular atrial rate (typically 300 beats per minute) with a regular or semi-regular ventricular response.

Supraventricular tachycardia (SVT) encompasses several rapid heart rhythms originating above the ventricles. The most common is AVNRT — a reentrant circuit within or near the AV node that causes sudden-onset, regular tachycardia at 150–250 beats per minute.

Premature atrial contractions (PACs) are early beats originating from ectopic sites in the atria. They are extremely common, often felt as “skipped beats,” and are typically benign — though frequent PACs can be a precursor to AFib.

Ventricular Arrhythmias (Originating in the Ventricles)

Premature ventricular contractions (PVCs) are extra beats originating in the ventricles. Occasional PVCs are normal and usually benign. Frequent PVCs (more than 10,000 per day, or more than 20% of total beats) can impair cardiac function and require evaluation.

Ventricular tachycardia (VT) is a rapid, regular ventricular rhythm at 100+ beats per minute. Sustained VT is a medical emergency in most patients, as it can deteriorate into ventricular fibrillation.

Ventricular fibrillation (VF) is chaotic, disorganized electrical activity in the ventricles producing no effective cardiac output. Without immediate defibrillation, it is fatal.

Bradyarrhythmias (Slow Heart Rhythms)

Sinus bradycardia — a resting heart rate below 60 — is normal in athletes and fit individuals. It becomes symptomatic when rates are persistently below 50 and cause fatigue, dizziness, or fainting.

Heart block involves delayed or failed conduction through the AV node. First-degree block is benign. Second-degree Mobitz II and third-degree (complete) heart block can be life-threatening and often require pacemaker implantation.

What Causes Arrhythmia?

Standard cardiology workups evaluate structural heart disease, coronary artery disease, and electrical pathway abnormalities. Integrative cardiology goes further — because the most common triggers in otherwise healthy patients are metabolic and lifestyle factors that a standard EKG and echocardiogram will not capture:

• Electrolyte imbalances — Low intracellular magnesium is the most commonly missed arrhythmia trigger. Magnesium is critical for the electrical stability of cardiac cell membranes. Serum magnesium is a poor surrogate — Dr. Druz uses RBC magnesium or intracellular magnesium testing.
• Thyroid dysfunction — Both hypothyroidism and hyperthyroidism disrupt cardiac electrical conduction. A full thyroid panel (TSH, Free T4, Free T3, reverse T3) is required — TSH alone misses subclinical and functional thyroid abnormalities.
• Sleep apnea — Obstructive sleep apnea is one of the strongest modifiable risk factors for AFib. Nocturnal hypoxia and the resulting surges in sympathetic tone directly trigger atrial arrhythmias. Treating sleep apnea significantly reduces AFib recurrence rates.
• Alcohol — The “holiday heart” phenomenon — AFib triggered by alcohol — is well-documented. Even moderate consumption increases AFib recurrence in diagnosed patients.
• Stimulants — Caffeine in excess, energy drinks, and decongestants (pseudoephedrine) can trigger PVCs, PACs, and SVT in susceptible individuals.
• Structural heart disease — Cardiomyopathy, valvular disease, and prior myocardial infarction create the electrical substrate for reentrant arrhythmias.
• Autonomic imbalance — Excess sympathetic tone (from chronic stress, poor sleep, or deconditioning) lowers the threshold for arrhythmia initiation.

Symptoms of Arrhythmia

Symptoms vary significantly by arrhythmia type and individual sensitivity. Common presentations include palpitations (awareness of the heartbeat, often described as fluttering, pounding, or skipping), rapid heart rate, slow or irregular pulse, dizziness or lightheadedness, near-fainting (presyncope) or fainting (syncope), shortness of breath, chest discomfort, and fatigue disproportionate to activity level. Importantly, some arrhythmias — including AFib — are frequently asymptomatic and discovered incidentally on an EKG.

When to See a Doctor About Arrhythmia

The Integrative Cardiology Approach to Arrhythmia

At Holistic Heart Centers, arrhythmia evaluation includes testing that standard workups omit. Beyond the standard EKG, echocardiogram, and Holter monitor, Dr. Druz evaluates intracellular magnesium and potassium levels, a comprehensive thyroid panel, sleep apnea screening (home sleep testing), inflammatory markers (hsCRP), an autonomic function assessment, and alcohol and stimulant intake history. For patients with AFib, she specifically evaluates sleep apnea treatment status — one of the highest-yield non-pharmacologic interventions available.

Frequently Asked Questions About Arrhythmia

What is the most common type of arrhythmia?

Atrial fibrillation (AFib) is the most common sustained arrhythmia, affecting over 33 million people globally. Premature ventricular contractions (PVCs) and premature atrial contractions (PACs) are the most commonly experienced — felt as “skipped beats” — but are usually benign.

Can arrhythmia be cured?

It depends on the type. SVT and atrial flutter can often be cured with catheter ablation. AFib can be effectively managed and in some patients eliminated with ablation, though recurrence rates vary. Ventricular arrhythmias from specific causes (like electrolyte correction) can resolve completely with treatment of the underlying cause. Arrhythmias from structural heart disease are typically managed rather than cured.

Is arrhythmia dangerous?

The danger depends entirely on the type. Most PACs and PVCs are benign. AFib carries stroke risk and requires anticoagulation assessment. Ventricular tachycardia and fibrillation are life-threatening without treatment. Any new, sustained, or symptomatic arrhythmia warrants medical evaluation.

What triggers arrhythmia?

Common triggers include alcohol, caffeine and energy drinks, sleep deprivation, sleep apnea, electrolyte imbalances (particularly low magnesium and potassium), thyroid dysfunction, physical or emotional stress, and structural heart disease. Identifying and addressing modifiable triggers is a core part of integrative arrhythmia management.

References:

Experiencing palpitations or an irregular heartbeat

The Step 1 Explore visit at Holistic Heart Centers includes a complete arrhythmia workup — standard and integrative — with a personalized management plan.

References

1. Chugh SS, et al. Worldwide Epidemiology of Atrial Fibrillation. Circulation. 2014;129(8):837-847.
2. Linz D, et al. Sleep Apnea and Atrial Fibrillation. J Am Coll Cardiol. 2018;71(19):2123-2135.
3. Csengeri D, et al. Alcohol Consumption, Cardiac Biomarkers, and Risk of Atrial Fibrillation. Eur Heart J. 2021;42(12):1170-1177.
4. Haïssaguerre M, et al. Spontaneous Initiation of Atrial Fibrillation by Ectopic Beats Originating in the Pulmonary Veins. N Engl J Med. 1998;339(10):659-666.