Diagnosing Supraventricular Arrhythmias

Cardiac electrophysiologists at NYU Langone’s Heart Rhythm Center are experts in diagnosing and treating people with all types of supraventricular arrhythmias, including atrial fibrillation and atrial flutter.

To diagnose a supraventricular arrhythmia, your heart rhythm specialist performs a physical exam and asks about your medical and family history to determine your risk for arrhythmias. Diagnostic testing including electrocardiogram, surveillance monitoring, electrophysiologic studies, imaging tests, and genetic testing might also be requested.

Electrocardiogram and Stress Test

An electrocardiogram, or EKG, is used to measure electrical currents in the heart. Your electrophysiologist specializes in interpreting this test, as it is the most important tool used to diagnose supraventricular arrhythmia. In an EKG, small, painless electrodes are placed on your chest, wrist, and ankles to transmit information about your heart’s electrical activity to a computer.

An exercise EKG, also known as a stress test, is conducted while you are using a treadmill. This is a natural way to increase your heart rhythm and allows your doctor to look for changes in electrical activity that signal an arrhythmia.

Surveillance Monitoring

Some supraventricular arrhythmias occur intermittently, so your doctor may order tests that record your heart rhythm over a set period of time, from 24 hours to 2 years. Short-term surveillance monitoring devices are wearable and removed only for showering or bathing. The implantable loop recorder is surgically placed under the skin and provides continuous long-term monitoring.

Holter Device

A Holter device measures and records changes in heart rhythm over a 24- or 48-hour period. During the test, the monitor, which is about the size of a smartphone, is worn over your neck or affixed to your belt or pants. Sticky electrodes are attached to your chest. Your doctor reviews the data collected on the device for evidence of an arrhythmia.

Ambulatory Telemetry Device

If your symptoms are infrequent or unpredictable, your doctor may suggest you wear a lightweight, portable ambulatory telemetry device for up to two weeks. This wireless device records your heart rate through electrodes adhered to your chest. The data is automatically and wirelessly reported to your doctor via a secure website. A nurse contacts you if your heart shows any irregular rhythms.

Implantable Cardiac Loop Recorder

Because some arrhythmias occur intermittently, your cardiologist may recommend an implantable cardiac loop recorder to provide continuous monitoring of abnormal rhythm for up to two years. The device, which is the size of a computer flash drive, is placed under the skin in the upper chest.

Data from the device are downloaded nightly and sent to the Heart Rhythm Center. Members of our team review the data and contact you if they notice an irregularity. If you feel an abnormal rhythm, our experts ask you to record the time it happened and contact your care team. They compare your symptoms with the data previously received.

Electrophysiological Study

During an electrophysiology study, your doctor inserts a long, thin catheter into a vein in the groin. The catheter contains thin, flexible, electrically sensitive wires that are used to measure and map the electrical activity of the heart. If problematic signals are discovered, your doctor uses catheter ablation to stop those signals from occurring.

Imaging Tests

Your electrophysiologists may order an echocardiogram, X-ray, MRI, or CT scan to aid in diagnosing a supraventricular arrhythmia.

Echocardiogram

An echocardiogram is an ultrasound test that uses high-frequency sound waves to produce detailed, moving images of the heart’s anatomy, including the valves and its chambers. These images also show the size of the heart and can help your doctor identify poor blood flow and any problems the heart has contracting.

A transthoracic echocardiogram (TTE) is performed externally by moving a probe across the chest. A transesophageal echocardiogram (TEE) uses an ultrasound probe that is inserted into the mouth and guided into the esophagus, where it can provide up-close images of the heart’s atria.

Chest X-rays

In a chest X-ray, electromagnetic radiation is used to create images of the heart. A chest X-ray may reveal problems in the heart, such as a structural issue, that can lead to an arrhythmia.

MRI Scans

An MRI scan is a computerized, three-dimensional picture of the heart that is made using a magnetic field and radio waves. This test helps your doctor assess the heart’s structure and how well it is pumping blood.

CT Scans

A CT scan uses X-rays to create three-dimensional, cross-sectional images of the heart. Your doctor may use a CT scan to create a map of the heart that serves as a guide during catheter ablation, a minimally invasive procedure used to manage arrhythmia.

Genetic Testing

Certain types of supraventricular arrhythmias may be inherited. Your doctor may recommend genetic testing at NYU Langone’s Inherited Arrhythmia Program to determine whether a genetic heart rhythm disorder is the cause of the arrhythmia.