PALPITATIONS - WHAT IS THE MECHANISM, AND WHEN SHOULD WE TREAT THEM

Palpitation is an unpleasant awareness of an abnormal beating of the h eart. This symptom may be brought on by a variety of cardiac disorders , such as cardiomyopathy, valvular heart disease, and coronary artery disease, but the most common cause is primary cardiac arrhythmias. Sev eral noncardiac disorders may also cause palpitations, and in this cas e are an effect of the disease upon cardiac rhythm. Palpitations occur frequently in women at all ages, especially during the luteal phase o f the menstrual cycle, during pregnancy, and during the perimenopausal period. Palpitations occurring at young age and associated with fast heart rate are frequently due to Wolff-Parkinson-White syndrome or oth er forms of re-entrant tachycardia, and may require catheter ablation. A correlation between ovarian hormones and occurrence of paroxysmal s upraventricular tachycardia has recently been reported in female patie nts with normal menstrual cycles; palpitations are frequently reported in cases of mitral valve prolapse, whereas episodes of paroxysmal sup raventricular tachycardia reported during pregnancy may be due to mech anical stimuli or to a suggested arrhythmogenic effect of pregnancy. P alpitations during the perimenopausal period are usually benign and se em to be related to the increased sympathetic activity caused by the m enopause. Although the vast majority of palpitations are benign and ne ed not be treated, an electrophysiological study is indicated for thos e patients who have a documented episode of palpitation associated wit h syncope or with a pulse that is inappropriately rapid during symptom s. The treatment of palpitations due to cardiac arrhythmias is depende nt upon the kind of arrhythmia detected during either invasive or noni nvasive electrophysiological studies.