Ectopic activity of the heart – causes

Author Ольга Кияница

2018-07-02

The normal heart works orderly thanks to the direction of the main pacemaker, called the sinus node. If an irregular, ectopic activity arises in the heart, the activity of the organ changes and in some cases is significantly impaired. Then it is extremely important to conduct timely diagnosis and appropriate treatment.

Sinus node - a group of cells located in the right atrium, which first contract and further from them spread electrical impulses to all other parts of the heart. Nevertheless, all cells in the heart have the ability to start their own heartbeats independently of the sinus node. If this occurs, it causes an early (or premature) heartbeat, known as ectopic, also called an additional stroke.

Ectopic" means irrelevance, in this case meaning that the extra rhythm is an extraordinary, unplanned heartbeat.

Usually, after a short pause after the ectopic reaction, there is an additional feeling of "missed" impact. In fact, many people who experience ectopic heart activity perceive only the sense of missed strokes, and not the presence of the ectopic focus itself.

Video: Heart rhythm disturbance

Symptoms

The term "palpitation" is used to describe the feeling of the heart's own beating. Some say it looks like a flutter in the chest, or the feeling that "the heart is pounding." Others describe it as a knock or movement in the left side of the chest, which can also be felt on the neck or in the ears when lying down.

Such a manifestation as a heartbeat is very common, and in most cases completely harmless. Nevertheless, it can be a nuisance, and sometimes a threat to human life.

Palpitations and ectopic strokes usually do not cause concern. Almost every person has at least a few ectopics determined every day, but the vast majority of them are not manifested. Often, their occurrence is considered as a completely normal phenomenon of cardiac activity.

The time of occurrence of ectopic activity affects sensations. Since the ectopic occurs prematurely, this means that the lower chambers of the heart (ventricles) have less time to fill with blood than usual, and therefore the amount of blood ejected during the ectopic rhythm decreases. However, because of the subsequent short pause after ectopic excitation, the ventricles have a longer than usual period of filling with blood, and therefore the subsequent impact is felt as stronger.

Types of ectopic activity

There are two most common types of ectopic rhythm:

  • Atrial ectopy - an early (extra) electrical impulse comes from the atria, which are the upper chambers of the heart.
  • Ventricular ectopy - an early electrical impulse comes from the ventricles, which are defined as the lower chambers of the heart.

Depending on the order of pathological and normal cardiac contractions, there are:

  • Bigeminia - every second contraction of the heart is an extraordinary, that is ectopic
  • Trigeminia - every third contraction of the heart is an extraordinary, that is ectopic.

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It should be noted that many patients with bigemia or trigeminy have no symptoms, and it is not known why some people feel ectopic and others do not, although stress certainly makes them more visible.

Causes

Ectopic activity is often determined even in clinically healthy people, with the chances of its development increasing if a person is often subjected to stress or too much caffeine is consumed. The use of stimulant substances, such as alcohol, smoking or recreational drugs, can also lead to rhythm disturbance.

Ectopic causes of palpitations often occur when a person does not get enough sleep or works physically.

It is important to note that ectopic activity can occur in certain conditions of the heart. Ectopia is most typical for diseases accompanied by weakening of the heart muscle - with cardiomyopathies, in people who have had heart attacks (myocardial infarction). Therefore, if a patient has frequent ectopics, the function of the heart should be evaluated and evaluated.

A chemical imbalance in the blood can also contribute to the development of ectopia. Especially often, this occurs with a low level of potassium in the blood, which can be caused by some rare metabolic conditions or by taking certain medications, such as diuretics.

The development of palpitations or ectopic strokes is often observed during pregnancy or during menopause.

uchashchennoe

It happens that the frequency of occurrence of ectopics is very unstable - in some days or weeks they are very annoying, and in the other period practically are not felt. It may be unclear which triggers occur in these situations. Also, a person can notice an ectopia at rest, and not during wakefulness or physical exertion. The reasons for this are that the heart beats at rest, it is usually much slower, and this leaves more time for the onset of ectopy interrupting the normal heart rhythm.

Diagnostics

If you are concerned about your heartbeat, you should contact your general practitioner or cardiovascular specialist (cardiologist, arrhythmologist). As a rule, they prescribe additional methods of electrocardiography (ECG) and / or 24-hour cardiac monitoring, which allows us to calculate how many ectopics are determined per patient per day.

For comparison, on average, a clinically healthy person is estimated to have about 100,000 heart rate / day, while people suffering from symptoms of ectopic activity tend to experience several hundred to several thousand ectopic a day or 0.5 to 1-5% load.

If ectopic activity is defined as frequent, then echocardiography (ultrasound scanning of the heart) is performed, necessary to evaluate the function of the heart and exclude cardiomyopathy (weakness of the heart muscle). This is especially important if the patient has a hereditary predisposition to a violation of the rhythm of the heart or sudden deaths occurred among close relatives without obvious explanations.

In addition, routine blood tests can be performed to eliminate metabolic problems by the low potassium level. The work of the thyroid gland is also examined with the help of laboratory tests.

Tests for the diagnosis of ectopic activity:

  • Electrocardiography (ECG)
  • Daily heart monitoring (also known as Holter monitoring)
  • Echocardiography (ultrasound of the heart)
  • MRI scan of the heart
  • Blood tests, including thyroid function research

24-hour (or longer) cardiac monitoring allows you to calculate the frequency and other characteristics of ectopic activity.Moreover, this method of research helps to determine whether ectopics occur predominantly in one place of the heart muscle or the impulses come from several foci. For example, it is possible that all ectopics originate from one site in one chamber or they are generated from several sections of the same chamber. Also, extraordinary pulses can come from different chambers and parts of the myocardium.

Conservative treatment

Depending on the main cause of ectopic activity, an appropriate treatment strategy is selected. Additionally, the severity of clinical signs is taken into account.

Avoiding palpitations and ectopic strokes helps to eliminate triggers (risk factors). It is generally recommended to give up alcohol and caffeine. Another important requirement is to completely stop smoking! If the main heart problem is identified, then its treatment improves the patient's condition.

It is useful to know that most people stop noticing or can ignore ectopic rhythms if there is a sufficient positive attitude.Some people perform regular exercises that help reduce the amount of ectopia. This is especially necessary with a sedentary lifestyle or eating certain types of food.

Reducing stress is an actual and important element of therapy, although in practice this is not always easy to achieve.For this reason, drugs such as beta-blockers or calcium channel blockers can be used to prevent ectopy. It is important that the doctor prescribes the medications, especially if there is a concomitant heart disease or ectopia is defined as very frequent or continuous. Sometimes it is advisable to replace drugs that have been prescribed for admission, especially if they cause ectopic activity.

Thus, treatment for ectopic activity includes:

  • Trigger exception:
    • decrease in the amount of alcohol;
    • decrease in caffeine intake;
    • use of decaffeinated coffee;
    • Avoidance of carbonated beverages (especially energy drinks);
    • to give up smoking;
    • exclusion or reduction of the impact of stress
    • sufficient sleep.
  • Use of medicines as prescribed by the doctor:
    • beta-blockers, for example, bisoprolol, propranolol, metoprolol;
    • calcium channel blockers, such as verapamil or diltiazem;
  • Treatment of major diseases that cause ectopy (pathology of the thyroid gland or electrolyte imbalance in the blood).

Alternative treatment

In rare cases, the therapy described above is unsuccessful. This is mainly due to the fact that the patient is determined by extreme ectopic activity, that is, extraordinary strokes are generated continuously, every 2-10 normal contractions.This usually means that the cause of ectopy is not associated with stress or a temporary phenomenon. Most often, it is determined that a cell or a small group of cells in the heart continuously generate impulses by themselves.

Ectopy, associated with a violation of calcium intake in cardiac cells, can be eliminated by calcium channel blockers, which help to suppress unpleasant manifestations.

If medications do not help to eliminate very frequent ectopy, and especially if continuous ectopic strokes (the so-called ventricular tachycardia) are determined, a procedure is performed using ablative catheters.

Catheter ablation

Catheter ablation is a method in which thin wires (catheters) are inserted into the heart through the veins in the upper part of the thigh. With their help, a 3D computer model of the inner part of the camera is created and ectopic foci are determined. Information on electrical signals recorded by the catheter during ectopic strokes helps to determine where they come from. The catheter then advances to this place, and by means of electric power acts on the center of excitement. Under the influence of high temperatures, there is local destruction of the myocardium (a very small area), due to which further ectopy does not develop.

ablyatsiya

  • What are the successes of ablation?

The success of catheter treatment largely depends on how often ectopia occurs during ablation. The more often, the better the chances of success. Ablation can sometimes be performed when very rare ectopic strokes are detected.Usually this means that the effectiveness of the procedure is significantly reduced.

In most cases, the success rate of ablation is about 80% of ongoing treatment. If the ectopy is often present at the beginning of the procedure and disappears during ablation and is not repeated until the very end of the procedure, this usually indicates a good result of the work. As a rule, in such cases, later ectopic activity will not be repeated. But in some cases there are exceptions.

  • Ablation risks

With ectopy, the risk of catheter ablation is usually very low. A common risk is the damage to the blood vessels in the upper part of the thigh, where catheters are inserted. This can lead to bruising or bleeding, much less often - a more serious injury, when the artery adjacent to the vein is damaged. Such complications may require injecting or surgical treatment. The risk of vascular damage is about 1%.

More serious risks are associated with:

  • Perforating the heart wall catheter, and this may mean that the blood will begin to flow into the pericardial bag. Then for treatment, drainage is inserted, inserted under the ribs, or in rare cases - surgical intervention.
  • There is an opportunity to damage the normal conduction system of the heart (especially if the ectopic focus is located near this area). With the development of postoperative conduction disorders, a pacemaker may be required.
  • If the ectopic focus is located on the left side of the heart, there is a rare risk of causing a stroke as a result of affecting the left side of the heart's blood circulation.

Thus, the risks associated with catheter ablation for eliminating the ectopic focus are as follows:

  • Common (1%):
    • damage to the vein (the operation is practically not carried out).
  • Rare (<1%):
    • perforation by a cardiac catheter, and drainage or, in rare cases, surgical intervention may be required;
    • stroke if the ectopic focus is located on the left side of the heart;
    • damage to the conduction system of the heart, which sometimes requires the use of a pacemaker.

Ablation usually takes about 2 hours, after which most patients return home on the same day.

After ablation, some time is spent on recovery, which is almost entirely related to the healing of puncture sites in the upper part of the thigh. This usually requires several days of rest and, as a rule, for a week, the ability to perform moderate physical exertion is renewed.

Forecast

The presence of ectopy is almost always defined as a benign condition that does not affect the duration or quality of life, as well as the development of other diseases. The most important test to confirm this is echocardiography, and sometimes an MRI scan of the heart, which helps to fully appreciate the work of the organ. If the heart function is maintained and normal, the prognosis is determined to be good, and the presence of ectopic activity is just an unpleasant symptom.

If the function of the heart is broken or there is another major organic defect (eg, valve failure or stenosis of the valve), the presence of ectopy is usually a consequence of this defect and requires separate study and treatment.

It is important to note that in people with very frequent ectopic (mainly ventricular, very rarely atrial), the ectopic themselves can lead to the fact that the left ventricle (the main delivery chamber of the heart) expands or increases in size, and this contributes to the violation of cardiac activity.

The risk of expansion of the left ventricle increases in the case when the load on extraordinary reductions is> 10%. A strong effect on the work of the heart has an ectopic load> 25%. If the ectopic rhythms emerge from a single focus, ablation with a catheter is usually performed to completely get rid of the disorder.

Thus, the prognosis for ectopic activity:

  • Almost always great
  • Patients usually begin to develop symptoms with an ectopic load> 0.5-5% / day
  • In rare cases, with very frequent early abbreviations, an increase in the left ventricle and, ultimately, a worsening of heart function may occur.

An unfavorable prognosis is given with an ectopic load> 10-25% / day.

Video: Here's How You Can Get Back to Heart Rhythm in just 1 minute


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