If during these investigations the heart rate is found to be too slow or the chambers are contracting out of sync to each other and affecting the function of the heart then an operation to fit a pacing box and leads can be performed. Pacing leads are fitted to the surface of either or both the ventricle and the atrium and these are then attached to a box ,which is placed under the skin in either the abdomen or on the chest. The box then generates electrical signals initiating contraction at a programmed rate. Once you have a pacemaker fitted you will also need to be followed up in a pacing clinic, which monitors the battery life of the pacing box and the integrity of the pacing leads.
The electrical system can also malfunction resulting in the heart beating too quickly, which again can lead to problems with heart function or an inability for the heart to pump out enough blood to meet the demands of the body resulting in collapse. These fast rhythms are often collectively referred to as supraventricular tachycardias with rates over 200 beets per minute. These can present with palpitations (an awareness of your heart beating very fast) or with breathlessness, chest pain, tiredness or collapse.
The arrhythmia may be detected on the ECG in outpatients but more often a history of symptoms will prompt the need for longer term monitoring in the form of a Holter monitor, which can continually record your heart rate and rhythm for up to a week. If your symptoms are occurring less frequently you can be fitted with an event / loop recorder. If you have symptoms you press the button and the loop is stored from a few seconds before you pressed the button for a programmed amount of time. This type of monitor can be worn for up to 30 days. If symptoms are less frequent but still problematic the option of having a Reveal device fitted may be discussed. This is a more invasive option as it is inserted just under the skin over the heart and it can remain in place for up to three years.
If a fast rhythm is detected during your follow up the first line of treatment is with medication. If medication does not control the arrhythmia or it is poorly tolerated then the option of an electrophysiological study and ablation may be discussed. This is a catheter procedure used to “map” the electrical activity of the heart and to find a focus that is responsible for the fast heart rate. If a focus is found it may then be possible to ablate (burn or freeze) the area responsible for generating the fast rhythm.