• Palpitations refer to a sensation of irregular heartbeats. It may be associated with other symptoms such as dizziness, light headedness, shortness of breath or chest pain.
• Irregular heartbeats are very common. Most of the time, they are benign in nature and require no treatment. Occasionally, they might indicate a significant underlying heart problem and may require specific treatment.
• Treatment of palpitations entirely depends on the underlying cause and establishing symptom-rhythm correlation (i.e. correlating the sensation of palpitations with an actual abnormal heartbeat). This is often difficult to establish due to the infrequent nature of palpitations.
• Several tests could be performed to establish symptom-rhythm correlation, including Holter monitor, event monitor and implantable loop recorders.
• Once the cause of palpitations is established; sometimes no treatment is required and if treatment is required it is usually in the form of a medication or an ablation procedure.

• An electrophysiology study (EPS) is a cardiac procedure where a number of catheters are inserted into the heart typically through the femoral vein in the groin.
• This allows the electrophysiologist to examine the electrical system of the heart and establish the presence of any abnormalities.
• If an abnormality is present, an ablation might be required where a special catheter (ablation catheter) cauterizes the abnormal area.
• The procedure is mostly performed as a day procedure but sometime an overnight admission may be required.
• Each abnormal heart rhythm (arrhythmia) has a different ablation procedure. The success rate and potential complication rate varies according to the arrhythmia being treated.

• Syncope is a transient loss of consciousness usually related to insufficient blood flow to the brain.
• There are several causes for syncope which ultimately dictate how it can be treated.
• Syncope could be benign (typically referred to as fainting), in response to painful or obnoxious stimulus such as the sight of blood. This is referred to as vasovagal syncope and its treatment is largely avoiding the triggering stimulus.
• It could also be due to low blood pressure or slow heart rate due to medications or disease in the electrical conduction system of the heart.
• Seizures and epilepsy could also present with syncope and sometime a review by a neurologist may be required
• Treatment of syncope depends on the underlying cause, sometimes no treatment is required and in other times, syncope could be dangerous or life threatening, and urgent treatment is required.

• A pacemaker is a cardiac device connected to the heart with a number of wires (leads). The leads are inserted typically through the axillary or subclavian vein under the collar bone and the pacemaker is placed under the skin in that area.
• Typically, it is inserted to treat slow heart beats due to disease in the electrical conduction system of the heart.
• A defibrillator is a special pacemaker that has a pacemaker function but can also deliver an electric shock to treat dangerous heart rhythms in certain patients.
• Following insertion, the pacemaker is followed up by attending a pacemaker clinic once or twice a year where the electrical parameters of the device are tested. It can also be followed up remotely by a remote monitor.
• Pacemakers are battery powered, the battery lasts several years (7-10 years on average) depending on the number of factors, when the battery is depleted, another procedure is performed to replace it with a new pacemaker.

Atrial fibrillation (AF) is an irregular heart rhythm where the top chamber of the heart (the atrium) beats erratically leading to irregular and often fast heart beats. It is the most common cardiac arrhythmia, and its incidence increases significantly with age.

Common conditions that increase the chances of developing AF include obesity, hypertension, obstructive sleep apnea, and excessive alcohol and energy drinks consumption.

AF commonly presents with palpitations (sensation of irregular heart beats) but can also present with other symptoms such as fatigue and shortness of breath. AF can increase the risk of stroke in some patients and in these patients, anticoagulants (blood thinning medications) are often prescribed.

Treatment of atrial fibrillation often involves multiple modalities such as medications, ablation procedures as well as treatment of the underlying causes and risk factors. Treatment approaches differ significantly according to age, symptoms, duration of AF as well as the underlying co-morbidities.