Heart Arrhythmia in Singapore: Types, Symptoms, Diagnosis and Treatment

A heart arrhythmia is any heart rhythm that is abnormal – too fast, too slow or irregular. Arrhythmias range from harmless extra beats that almost everyone experiences to serious rhythm disturbances that need urgent treatment. They are a common reason for cardiology referral in Singapore, often after an episode of palpitations or an abnormal trace at a health screening. This page gives an overview of the main types of arrhythmia, the symptoms they cause, how they are diagnosed and the treatments available. It is general information and not a substitute for advice from your own doctor.

What Is a Heart Arrhythmia?

Every heartbeat is triggered by an electrical impulse that starts in the heart’s natural pacemaker (the sinus node) and spreads through the heart in a set sequence. An arrhythmia happens when these impulses start from the wrong place, travel along an abnormal path, or fire too quickly or too slowly. Some arrhythmias last only seconds; others are permanent. What they share is a disturbance of the heart’s normal, regular rhythm – and the treatment depends entirely on which type is present.

Types of Heart Arrhythmia

Atrial fibrillation (AF). The most common sustained arrhythmia, in which the heart’s upper chambers quiver instead of beating regularly, producing an irregular and often fast pulse. Its main importance is a raised risk of stroke, which is why blood-thinning medication is often needed. Our atrial fibrillation page covers it in detail.

Atrial flutter. A close relative of AF in which the upper chambers beat very fast in a more organised, circular pattern. It causes similar symptoms, carries a similar stroke risk, and is often suitable for catheter ablation.

Supraventricular tachycardia (SVT). Episodes of a suddenly racing but regular heartbeat caused by an extra electrical circuit or pathway. Episodes typically start and stop abruptly, often in younger people with otherwise healthy hearts.

Ectopic beats. Early or extra beats that feel like a skip, thud or flutter. They are extremely common, and in a structurally normal heart occasional ectopics are almost always harmless – although very frequent ones deserve assessment.

Ventricular tachycardia (VT) and ventricular fibrillation (VF). Fast rhythms arising from the lower chambers (the ventricles), usually in people with underlying heart disease. VT can be serious, and VF causes cardiac arrest and is a medical emergency.

Bradycardia and heart block. Bradycardia (a slow heart rate) and heart block (delayed or blocked electrical conduction between the chambers) can cause tiredness, dizziness or blackouts, particularly in older adults, and sometimes need a pacemaker.

Heart Arrhythmia Symptoms

Many arrhythmias first announce themselves as heart palpitations (an awareness of your own heartbeat). Symptoms include:

• A fluttering, racing, pounding or irregular heartbeat
• A sensation of skipped or extra beats
• Dizziness or light-headedness
• Fainting or near-fainting
• Breathlessness or reduced exercise tolerance
• Unexplained tiredness
• Chest discomfort

Some arrhythmias cause no symptoms at all and are found incidentally. In older adults, unexplained falls or fatigue can be the only clue.

When to Seek Emergency Help

Call 995 if palpitations or a racing heartbeat occur together with chest pain, severe breathlessness, fainting or collapse. If someone becomes unresponsive, start CPR and send for an AED (automated external defibrillator) – ventricular fibrillation causes cardiac arrest within seconds. Sudden face drooping, arm weakness or slurred speech may indicate a stroke and also needs a 995 call.

Causes and Risk Factors

• Increasing age
• Existing heart disease: a previous heart attack, heart failure, valve disease or cardiomyopathy (disease of the heart muscle)
• High blood pressure and diabetes, both common in Singapore
• An extra electrical pathway present from birth
• Thyroid disease and electrolyte (blood mineral) imbalances
• Caffeine, alcohol, nicotine and stimulant medications
• Stress, poor sleep and obstructive sleep apnoea
• Fever and acute illness

How Heart Arrhythmias Are Diagnosed

The first step is an electrocardiogram (ECG), a quick recording of the heart’s electrical activity. Because many arrhythmias come and go, further tests are often needed:

• A 24-hour Holter monitor – a small wearable recorder that captures every heartbeat over a day or more, useful when symptoms occur frequently
• An event recorder – worn for longer periods and used when symptoms are infrequent
• An echocardiogram (ultrasound scan of the heart) to check for structural heart disease
• An electrophysiology (EP) study – a specialised catheter test that maps the heart’s electrical system precisely, often performed together with treatment by ablation
• Blood tests for thyroid function and electrolytes

Treatment Options

Treatment depends on the type of arrhythmia, how troublesome it is, and whether it carries risks such as stroke. Many people need only reassurance and trigger management. The main options are:

• Lifestyle measures – moderating caffeine and alcohol, improving sleep, managing stress, and controlling blood pressure, weight and diabetes
• Medication – by drug class, options include beta-blockers, calcium channel blockers and anti-arrhythmic medication to control the rhythm or rate, and anticoagulants to reduce stroke risk in AF and flutter
• Cardioversion – a controlled electrical shock delivered under sedation to restore a normal rhythm
• Catheter ablation – a keyhole procedure that treats the tissue causing the arrhythmia; it is potentially curative for supraventricular tachycardia (SVT) and atrial flutter and can help reduce AF episodes
• Pacemakers and defibrillators – bradycardia and heart block may be treated with pacemakers and implantable devices, while people at risk of dangerous ventricular arrhythmias may be offered an implantable cardioverter-defibrillator (ICD), which corrects them automatically

When to See a Cardiologist

See a cardiologist if you have recurrent palpitations, an irregular pulse, unexplained fainting or near-fainting, or if an abnormal rhythm has been picked up at a screening or on a wearable device. Identifying which arrhythmia is present – and whether it needs treatment at all – usually only takes a few targeted tests.

Frequently Asked Questions

Is a heart arrhythmia dangerous?

It depends on the type. Occasional ectopic beats in a healthy heart are usually harmless, while atrial fibrillation raises stroke risk and ventricular arrhythmias can be life-threatening. This is why new or persistent rhythm symptoms should be assessed rather than assumed to be benign.

What is the most common arrhythmia?

Ectopic (extra) beats are the most common rhythm disturbance overall, and atrial fibrillation is the most common sustained arrhythmia, becoming more frequent with age.

Can stress and anxiety cause arrhythmia?

Stress hormones can trigger palpitations and make some arrhythmias more likely, and anxiety can also make you more aware of normal heartbeats. Tests such as an ECG or Holter monitor can tell the difference.

Can an arrhythmia go away on its own?

Some do – ectopic beats often settle when triggers such as caffeine, alcohol and poor sleep are addressed, and SVT episodes usually stop on their own. Sustained arrhythmias such as AF tend to return and generally need a management plan.

How is an arrhythmia treated?

Treatment ranges from lifestyle changes and medication to cardioversion, catheter ablation and implanted devices such as pacemakers. The right approach depends on the specific arrhythmia and your overall heart health, which is what the diagnostic work-up establishes.