Understanding Arrhythmia: Insights on Heart Rhythm Problems

18 January 2022

Article by: Dr How Ann Kee, Consultant Cardiologist and Electrophysiologist
Arrhythmia may feel like heart racing, pounding or fluttering and is often confused with panic attack and anxiety. While this may sound normal, arrhythmia could be a sign of heart problems or can be a red flag to your health.

What is Arrhythmia?

It is a condition with the rate or rhythm of the heartbeat, causing the heart to either beat too rapidly (tachyarrhythmia), too slowly (bradyarrhythmia), or abnormal rhythms such as irregular rhythms or extra heartbeats that arise from abnormal foci.

Dr How Ann Kee
Consultant Cardiologist and Electrophysiologist



  • Fainting, dizziness, loss of consciousness, breathlessness, palpitation, fluttering or skipped beat in the chest, chest discomfort and excessive tiredness.
  • At times, arrhythmia may not cause noticeable symptoms and can only be detected during a routine examination.

Risk Factors

  • Heart attack, blockage of the heart arteries (coronary artery disease), scarring of the heart tissue due to previous heart attack, heart failure, genetic abnormalities in the heart cell proteins (inherited cardiac channelopathies), overactive or underactive thyroid gland and sometimes unknown cause (idiopathic).
  • Certain conditions may increase the risk of developing cardiac arrhythmia such as coronary artery disease, previous heart surgery, heart failure, hypertension, congenital heart disease, diabetes mellitus, medication, substance use, obstructive sleep apnoea, electrolytes imbalance and overconsumption of alcohol or caffeine.
  • Common causes of arrhythmia in children are congenital heart defects, inherited heart problems, structural heart disease and electrical conduction abnormality.


  • Arrhythmia is diagnosed through an electrocardiogram (ECG), Holter monitor or electrophysiology study (EPS).
  • Diagnosis can be difficult if the arrhythmia is paroxysmal, infrequent and asymptomatic.
  • Long-term monitoring using an insertable cardiac monitor (ICM) increases the diagnostic yield.


  • Treatment depends on the type of arrhythmia but are usually treated with catheter ablation or device implantation and medication.
  • The duration of hospitalisation depends on the patient’s condition and complexity of the procedures.


  • If you have a healthy heart, continue living a healthy life – no smoking, maintain a healthy weight, eat a balanced diet, consume caffeine and alcohol in moderation and exercise regularly.
  • If you have existing heart conditions, go for regular check-ups, be compliant to treatment and modify your risk factors.
  • You are also advised to seek immediate medical attention if you have underlying heart disease, family history of heart disorder or if you are pregnant.