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The phrase “heart skipped a beat” is often used to describe excitement, fear, anxiety or any other strong emotion.

In real life, the heart skipping a beat or two can occur, and it could be a warning that we need to take heed of.


According to Cardiac Vascular Sentral Kuala Lumpur (CVSKL consultant cardiologist Dr Zulkeflee Muhammad, we don’t usually feel our “normal” heartbeat. It is regular, constant and doesn’t intrude into our consciousness.

However, it can change depending on what we are doing.

When we exercise, the heart can go up to 180 beats a minute. When we are resting, it can beat at a leisurely pace of 60-plus a minute, and we are oblivious to it.

Occasionally, we do feel our heartbeat, but not on a regular basis. If we do keep feeling our heart beating, it could be a sign that there’s something wrong.


Electrophysiology is the study of the electrical systems of the heart. So, a consultant electrophysiologist is a cardiologist who specialises in diagnosing and treating issues with the heart’s electrical system.

“Imagine the heart as an engine. It has its own electrical system, mechanical components (heart muscle), plus other components. All have different properties and functions.

“In a nutshell, the heart contracts at the prompting of its electrical system.

“When this electrical system is compromised, problems arise,” explains Dr Zulkeflee.

An electrophysiologist can carry out an electrophysiology (EP) study to diagnose electrical anomalies in the heart.

This study can look at the electrical properties of the heart, stimulate the heart to trigger any abnormal electrical circuit, as well as be treat those with abnormal electrical rhythms.

“The EP study evaluates the electrical condition of the heart, diagnoses the problem, and guides treatment according to the abnormality,” he adds.


Heart rhythm problems are called arrhythmias. We often describe them as palpitations.

It can mean anything from a fast heart rate (tachycardia) to a slow heart rate (bradycardia) and an irregular heartbeat or extra heartbeats.

It can affect all age groups, but some types are more common in the elderly.

Common triggers include viral illnesses, alcohol, medications, illegal drugs, and even exercise.

Some types occur in people with coronary heart disease, and these can lead to sudden death.

Others can accompany illness such as hypertension, thyroid problems, and even after severe Covid-19.

Some people might not feel the abnormal rhythm at all and only find out about it after a stroke due to the abnormality.

Others may not experience symptoms involving abnormal heartbeats.

Some may feel as if there’s something “stuck” in the chest which is relieved by taking a deep sigh.

“This could be a sign of extra heartbeats,” says Dr Zulkeflee.

What does your heart tell you?-dr-zulkeflee
'Imagine the heart as an engine. It has its own electrical system. The heart contracts at the prompting of its electrical system. When its electrical system is compromised, problems arise,' says Dr Zulkeflee.
When to see a doctor

According to him, those who feel palpitations should seek clarification.

“It doesn’t have to be an electrophysiologist. It could be a simple assessment by a cardiologist to differentiate whether it could be life-threatening or a simple extra beat (benign).”

However, the EP study should be carried out urgently if the palpitations are followed by fainting episodes, dizziness, breathlessness or chest pains.

“We need to increase awareness of arrhythmias and electrophysiology, not only amongst the public, but also among doctors,” says Dr Zulkeflee.


But it has to be said that an electrophysiologist will have a wider range of options to investigate and pick up what’s happening.

Advances in technology means that the diagnostic and treatment arsenal available to an electrophysiologist is becoming ever more sophisticated.

“The EP procedure is minimally invasive. We thread a small catheter through the blood vessel in the groin to the heart.

A catheter is placed inside the right ventricle of the heart for an EP study and radiofrequency ablation.

“There’s no pain, though you might feel discomfort as if there’s something moving around in the chest, or you could feel the heart beating faster.

“But there’s sedation to make the whole experience more comfortable for the patient.

“There are risks, but these are minimal, less than undergoing an angiogram. There could be bleeding, infection or perforation,” says Dr Zulkeflee.

In terms of treatment, there’s a wide variety available to the electrophysiologist. Besides medications, treatment includes ablation therapies such as radiofrequency therapy, cryoablation, pulsed-field ablation, and devices such as pacemakers and implantable cardioverter defibrillators.

Dr Zulkeflee has this advice for everyone: “If you have an issue with heart rhythm, best to see an electrophysiologist.

“If you are not able to, please at least see a cardiologist.”

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