Proarrhythmia is an irregular heartbeat caused or worsened by medications, posing a higher risk of heart attack. There are two types, ventricular tachycardia and reduced atrial flutter, with beta-blockers being a common cause. At-risk patients may benefit from a pacemaker or cardiac ablation.
Proarrhythmia is an irregular heartbeat specifically caused or made worse by medications. Often, medications prescribed to treat natural arrhythmia ironically speed up or slow down the rhythm of the heart, triggering proarrhythmia. The condition poses a threat to people who routinely rely on heart medication year after year because it poses a higher risk of a heart attack. Proarrhythmia is most common at the start of drug therapy for heart conditions, but can arise spontaneously after long-term medication use.
There are two main types of proarrhythmia, both of which can cause sudden death. Ventricular tachycardia is a form of proarrhythmia that originates in the ventricles and is characterized by an extremely fast heart rate. Reduced atrial flutter is the second type of proarrhythmia and begins in the right or left atrium; it can last days or weeks.
While atrial flutters can be fast, those associated with medications tend to be extremely slow, under 60 heart beats per minute. The sinus node, located in the right atrium, is responsible for creating the electrical impulses that regulate heart beats. Atrial flutter that begins in that node is formally known as sinus bradycardia, which is not as dangerous or fatal as ventricular abnormalities.
A full heartbeat occurs when currents from the right atrium contract the atria and then, after a short pause to allow blood flow, contract the ventricles flanking the atria. Patients who have structural damage to the atria or ventricles due to heart disease and other medical conditions are more at risk for proarrhythmia. Often, this risk may not show up on routine tests or electrocardiograms. Some doctors may recommend a pacemaker to provide backup heart function in these at-risk patients.
While all heart medications have a propensity to disrupt heart rhythms, beta-blocker medications such as metoprolol and sotalol can cause proarrhythmia in particular, according to medical studies. The irregular heart function caused by these drugs may not be noticed immediately as a heart rhythm problem; instead, the patient may suffer from dizziness or fainting due to too long pauses between heart contractions. Often, combining beta-blockers with a cocktail of other heart rate management drugs triggers proarrhythmia. Therefore, many cardiologists are deciding against combination drug therapy, opting instead to prescribe antiarrhythmic drugs or rate management drugs. Some patients, however, show no improvement with a single style of drug therapy; these people may benefit from cardiac ablation to treat arrhythmia.
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