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Tests and diagnosis
By Mayo Clinic staffTo diagnose a heart arrhythmia, your doctor may ask about — or test for — conditions that may trigger your arrhythmia, such as heart disease or a problem with your thyroid gland. Your doctor may also perform heart-monitoring tests specific to arrhythmias. These may include:
- Electrocardiogram (ECG). During an ECG, sensors (electrodes) that can detect the electrical activity of your heart are attached to your chest and sometimes to your limbs. An ECG measures the timing and duration of each electrical phase in your heartbeat.
- Holter monitor. This portable ECG device can be worn for a day or more to record your heart's activity as you go about your routine.
- Event monitor. For sporadic arrhythmias, you keep this portable ECG device at home, attaching it to your body and using it only when you have symptoms of an arrhythmia. This lets your doctor check your heart rhythm at the time of your symptoms.
- Echocardiogram. In this noninvasive test, a hand-held device (transducer) placed on your chest uses sound waves to produce images of your heart's size, structure and motion.
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Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI). Although more commonly used to check for heart failure, these tests can be used to diagnose heart problems that might cause heart arrhythmias. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest.
In a cardiac MRI, you lie on a table inside a long tube-like machine that produces a magnetic field. The magnetic field aligns atomic particles in some of your cells. When radio waves are broadcast toward these aligned particles, they produce signals that vary according to the type of tissue they are. The signals create images of your heart that can help your doctor determine the cause of your heart arrhythmia.
If your doctor doesn't find an arrhythmia during those tests, he or she may try to trigger your arrhythmia with other tests, which may include:
- Stress test. Some arrhythmias are triggered or worsened by exercise. During a stress test, you'll be asked to exercise on a treadmill or stationary bicycle while your heart activity is monitored. If you have difficulty exercising, your doctor may use a drug to stimulate your heart in a way that's similar to exercise.
- Tilt table test. Your doctor may recommend this test if you've had fainting spells. Your heart rate and blood pressure are monitored as you lie flat on a table. The table is then tilted as if you were standing up. Your doctor observes how your heart and the nervous system that controls it respond to the change in angle.
- Electrophysiological testing and mapping. In this test, thin, flexible tubes (catheters) tipped with electrodes are threaded through your blood vessels to a variety of spots within your heart. Once in place, the electrodes can map the spread of electrical impulses through your heart. In addition, your cardiologist can use the electrodes to stimulate your heart to beat at rates that may trigger — or halt — an arrhythmia. This allows your doctor to see the location of the arrhythmia and what may be causing it.
- The heart's electrical system: Working and not. American Heart Association. http://americanheart.org/presenter.jhtml?identifier=34. Accessed Dec. 1, 2010.
- Heart rhythm disorders. Heart Rhythm Society. http://www.hrsonline.org/PatientInfo/HeartRhythmDisorders/index.cfm. Accessed Dec. 1, 2010.
- Long QT syndrome. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/qt/qt_all.html. Accessed Dec. 1, 2010.
- Atrial flutter. Heart Rhythm Society. http://www.hrsonline.org/patientinfo/heartrhythmdisorders/aflutter/. Accessed Dec. 1, 2010.
- Sick sinus syndrome. Heart Rhythm Society. http://www.hrsonline.org/patientinfo/heartrhythmdisorders/sss. Accessed Dec. 1, 2010.
- Mehra R, et al. Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. American Journal of Respiratory and Critical Care Medicine. 2006;173:910.
- Diagnosing arrhythmias. American Heart Association. http://americanheart.org/presenter.jhtml?identifier=3. Accessed Dec. 1, 2010.
- Arrhythmia medications. American Heart Association. http://americanheart.org/presenter.jhtml?identifier=18. Accessed Nov. 30, 2010.
- Ablation. American Heart Association. http://americanheart.org/presenter.jhtml?identifier=6. Accessed Nov. 30, 2010.
- Maze procedure. University of Southern California Keck School of Medicine. http://www.cts.usc.edu/mazeprocedure.html. Accessed Dec. 1, 2010.
- Pacemaker. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/pace/pace_all.html. Accessed Nov. 30, 2010.
- Implantable cardioverter defibrillator. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/icd/icd_all.html. Accessed Dec. 2, 2010.
- Connolly S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. New England Journal of Medicine. 2009;361:1139.
- Wann LS, et al. 2011 ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation (updating the 2006 guideline): A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2010;123:104.
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