Syncope & Arrhythmia Management
Syncope & Arrhythmia Management
Understanding your heart rhythm
Your heart does not just pump, it runs on its own electrical system. Each heartbeat is triggered by a small electrical signal that travels through the heart in a precise pattern. This ensures the heart chambers contract in the right sequence and pump blood efficiently throughout your body. The signal originates at the heart’s natural pacemaker (SA node), spreads through the upper chambers (atria), then travels through a “gateway” called the AV node, which briefly slows the signal to allow proper filling of the heart. It then travels through specialised pathways to the lower chambers (ventricles), causing them to contract simultaneously and pump blood to the lungs and the rest of the body.
When the electrical system is disrupted, it can lead to abnormal heart rhythms (arrhythmias) or even fainting episodes (syncope).
Common Rhythm Conditions We Treat
- Atrial Fibrillation (AF) – irregular and often fast heartbeat
- Atrial Flutter – similar to AF but with a more organised rhythm
- Bradycardia – heart beating too slowly
- PSVT (Paroxysmal Supraventricular Tachycardia) – sudden episodes of rapid heartbeat
- Cardiac Syncope – fainting due to heart rhythm problems
Specialised Diagnostics Services
Heart rhythm problems can come and go, which makes them difficult to detect during a routine clinic visit. That’s why we use a combination of advanced tests to monitor your heart over time and under different conditions so we can accurately identify the cause and tailor the right treatment for you.
1. Tilt Table Test
To investigate unexplained fainting or dizziness. You will lie on a special table that tilts you upright while we continuously monitor your:
- Heart rate
- Blood pressure
- ECG (heart rhythm)
This test helps us understand how your body responds to changes in posture and whether abnormal reflexes or blood pressure changes are causing your symptoms.
2. Holter Monitoring
A portable heart monitor worn during your normal daily activities.
- Records your heart rhythm continuously (usually 24–48 hours)
- Helps detect intermittent symptoms like palpitations, dizziness, or fainting
- Allows us to match your symptoms with any abnormal rhythm
It’s simple, painless, and done while you go about your usual routine.
3. Implantable Loop Recorder (ILR)
For symptoms that happen infrequently but are concerning. This is a small device placed just under the skin of your chest that continuously records your heart rhythm for months and up to 3 years. It is especially useful for:
- Unexplained fainting
- Infrequent palpitations
- Suspected hidden arrhythmias
4. Electrophysiology (EP) Study
A minimally invasive procedure that gives a detailed look at your heart’s electrical system. Thin tubes (catheters) are inserted through a vein (usually from the groin) and guided into the heart. These allow doctors to:
- Map electrical signals in real time
- Identify exactly where an abnormal rhythm starts
- Assess how serious it is
This test not only diagnose the problem but also helps determine if treatments like catheter ablation are needed.
Common Heart Rhythm Conditions
Atrial flutter is a type of abnormal heart rhythm where the upper chambers of the heart (atria) beat very fast. Unlike atrial fibrillation, the rhythm in atrial flutter is usually more regular and organised, but still much faster than normal. This happens when then heart’s electrical signal gets caught in a repetitive loop, most commonly in the right atrium.
As a result:
• The atria beat very fast
• The lower chambers (ventricles) unable to keep up
• The heart pumps less efficiently
Common Symptoms
• Palpitations (fast or fluttering heartbeat)
• Shortness of breath
• Dizziness
• Fainting
• Tiredness
Causes:
Atrial flutter is often linked to:
• Underlying heart disease
• Previous heart procedures
• Structural changes or scarring in the heart
Treatment focuses on:
• Slowing the heart rate
• Restoring a normal rhythm
• Reducing stroke risk
While medications can help control symptoms, they usually do not cure atrial flutter. Procedures such as:
- Electrical cardioversion (resetting the heart rhythm)
- Catheter ablation (targeting the abnormal circuit) are often recommended, with ablation offering a long-term solution for many patients.
Bradycardia means a slower-than-normal heart rate, typically fewer than 50 beats per minute at rest.
A slow heart rate is not always a problem. In fact, it can be normal in:
• Athletes
• Healthy individuals
However, it becomes a concern when the heart is too slow to supply enough blood to the body.
Common Symptoms
• Tiredness
• Dizziness
• Fainting
• Chest discomfort
• Reduced alertness
Causes & Treatment
Bradycardia can be caused by:
• Problems with the heart’s natural pacemaker
• Heart disease
• Certain medications
• Conditions like thyroid disorders or sleep apnoea
Treatment depends on the cause
Doctors may:
• Adjust medications
• Treat underlying medical conditions
If symptoms persist and the heart rate remains too slow, a pacemaker may be recommended to maintain adequate and steady rhythm.
PSVT is a type of sudden, fast heart rhythm that affects the heart’s upper chambers. If often begins and ends abruptly, with heart rates typically between 150-250 beats per minute. Unlike some arrhythmias, PSVT usually causes a regular but very fast heartbeat.
Common Symptoms
• Palpitations
• Chest discomfort
• Shortness of breath
• Dizziness or fainting
• Anxiety
Causes & Treatment
PSVT is usually caused by extra electrical pathways in the heart.
Common triggers include:
• Stress
• Caffeine or alcohol
• Certain medications
• Thyroid or electrolyte imbalance
Treatment options include:
Immediate relief techniques (in some cases):
• Bearing down (Valsalva manoeuvre)
• Cough
• Applying cold stimulus to the face / chew on ice chips
If symptoms continue, medications or electrical cardioversion may be used to restore a normal heart rhythm. For recurrent episodes, catheter ablation is often recommended as a curative treatment.
Cardiac syncope is fainting spells caused by a heart related problem. It can happen when the heart suddenly cannot pump enough blood to the brain, leading to a brief loss of consciousness.
This may be due to:
- Abnormal heart rhythms (too fast or too slow)
- Structural heart disease
- Inherited electrical conditions
Why It Matters
Unlike common fainting, cardiac syncope is usually more serious because it may involve an underlying abnormal heart condition or life-threatening arrhythmia.
Warning Signs
Some people may experience:
- Light-headedness
- Dizziness
But often, it can occur:
- Suddenly, without warning
- During exercise
- While resting or lying down
- Together with palpitations or chest discomfort
Treatment
Treatment focuses on the underlying cause and includes:
- Medications
- Catheter ablation
- Pacemaker
- Implantable cardioverter-defibrillator (ICD)
Cardioneuroablation (CNA)
Cardioneuroablation (CNA) is a minimally invasive procedure use to treat certain conditions where the heart becomes too slow or pauses due to overactive neurological signals. In selected patients, this offers an alternative to a pacemaker by addressing the underlying cause of the problem rather than simply supporting the heart rate.
CNA is most commonly considered for patients with:
- Reflex syncope (fainting due to abnormal reflexes)
- Functional bradycardia (slow heart rate without structural heart disease)
- Certain types of heart block related to excess vagal (nerve) activity
How Does It Work?
During the procedure:
- Thin tubes (catheters) are guided into the heart through a vein
- Doctors identify small clusters of nerves in the upper chambers of the heart, guided by 3D mapping
- These overactive nerve areas are carefully treated (ablated)
By reducing these excessive nerve signals, the heart can maintain a more stable and appropriate heart rate—often without the need for a pacemaker.
Electrophysiology Lab
Our electrophysiology laboratory (EP lab) provides the latest equipment for diagnosing and treating abnormal heart rhythms. The EP lab houses advanced imaging capabilities for complex catheter ablations and the latest intracardiac monitoring and recording equipment.
We are one of the very few EP labs in the region that has such advanced technology, including body surface mapping equipment to precisely identify and map the areas responsible for the arrhythmia. We also have a pacemaker analysing system to efficiently conduct pacemaker tests and follow-up care.
FAQ
An irregular heartbeat, or arrhythmia, happens when the heart’s electrical system does not work properly, causing the heart to beat too fast, too slow, or unevenly.
Yes, some arrhythmias are harmless and cause no symptoms or health risks. However, others may be more serious and require medical treatment.
The duration can vary. Some arrhythmias are brief and resolve on their own, while others can be persistent or long-term.
Exercise is generally beneficial for heart health, but it should be discussed with your doctor — especially if you experience symptoms or have a severe arrhythmia.
Diagnosis may include an ECG, Holter monitoring, echocardiogram, and blood tests to determine possible underlying causes.
Arrhythmia
Common symptoms include palpitations, a fluttering sensation in the chest, dizziness, shortness of breath, and fatigue. Some individuals may also experience chest pain or fainting spells.
Arrhythmia is typically diagnosed through an electrocardiogram (ECG) which records, the heart’s electrical activity. Additional tests may include Holter monitoring, event recorders, or electrophysiological studies to pinpoint the arrhythmia’s source.
Yes, adopting a heart-healthy lifestyle can significantly impact arrhythmia management. This includes regular exercise, a balanced diet rich in fruits and vegetables, avoiding excessive caffeine and alcohol, quitting smoking, and managing stress effectively.
Not all arrhythmias are dangerous. Some are benign and may not require treatment, while others can lead to serious complications like stroke or heart failure. It’s essential to consult a healthcare professional for an accurate diagnosis and appropriate management.
Treatment depends on the type and severity of the arrhythmia. Options may include medications to control heart rate or rhythm, lifestyle modifications, medical procedures like catheter ablation, or the implantation of devices such as pacemakers or defibrillators