Why In-Office EKG Sometimes Can’t Detect Your Arrhythmia

September 15, 2022

Most cardiac arrhythmias or irregular heartbeats begin as paroxysmal. This means there is no definite pattern in arrhythmia episodes, both in severity and frequency. Paroxysmal arrhythmias, especially atrial fibrillation (Afib), are often very treatable, but they must be diagnosed first.

Often, patients complain to their primary care doctor or cardiologist about chest palpitations – a fast heartbeat, their heart beating “out of their chests,” or fluttering. To diagnose the issue, they are put on an electrocardiogram or EKG. EKG is a handy tool that changed how we monitored the heart when it was first invented. It has saved countless lives over that time. However, it has a significant limitation in that it can only detect an arrhythmia when it occurs. Consider it a snapshot in time. This means that if you have a paroxysmal arrhythmia and you’re not in active Afib, for example, the likelihood is that the arrhythmia will not be detected.

Enter Your Electrophysiologist

The technology we as EPs have at our disposal has improved dramatically over the years, and diagnostics is one area that has seen a great deal of that improvement. For the reasons stated above, electrophysiologists must have several advanced diagnostic tools to detect cardiac arrhythmia. These tools include Holter monitors, which can be likened to a portable EKG, event monitors, and loop recorders, all of which can track heart rhythm over the long term and report back to the electrophysiologist with anomalous data if detected. In most cases, an electrophysiologist is a specialist to offer these diagnostic tools, so if you are suffering from what you believe is an arrhythmia, please speak to your primary care physician about a referral to an electrophysiologist.

Wearable options.

Just a few years ago, there was only one EKG option. Of course, we all know the potential benefit of having that kind of technology on our wrists – being able to monitor your heart rhythm on a semi-consistent basis and understanding if you may have an arrhythmia. However, with that benefit come a few potential drawbacks. These include undue concern and anxiety over false positives, questions about the accuracy of the wearable EKG, and the potential to collect too much data that can overwhelm your medical team. However, with proper training and expectations, a wearable EKG can be helpful to certain patients who have not yet been diagnosed with an arrhythmia. Further, modern technology and newer devices are more accurate than ever before and can at least offer some insight into the workings of your heart.

Ultimately, however, if you believe you are experiencing a problem, you must visit your electrophysiologist to understand why this could be the case.

Most importantly, just because the chest palpitations and fluttering occasionally do not mean they cannot progress. Most arrhythmias begin as paroxysmal or occasional. However, the condition is progressive, and typically patients have stronger and more frequent episodes until they receive treatment. Eventually, these episodes can become persistent and harder to treat. Seeking treatment early and handling the arrhythmia at its first stages often gives you the best choice of treatment options.