Monitor 100 hearts over a 24-hour period and 99 of them will have a skipped beat or small rhythmic abnormality. Most people never know and it doesn't matter.

But some cases of heart arrhythmia can be an indication of a structural heart disease. And the result, if untreated, could be death, according to Dr. Jeffrey S. Osborn, a cardiologist specializing in heart arrhythmias. Osborn and Dr. Brian Crandall will be featured on the Deseret News/Intermountain Health Care Hotline today from 10 a.m. to noon.

"If it's structural heart disease, a lot of skipped beats can be a baseline for sudden death," Osborn said. "Those who fall into the high-risk category can fall over dead from arrhythmias. Unfortunately for the small set it strikes, it can be deadly."

Most atrium (upper heart chamber) irregularities are not life-threatening but are more apt to be "a nuisance." Those of the ventricle (lower heart chamber) are much more likely to be serious, Osborn said.

Many people "fall into the realm of careful observation" to determine what's causing the arrhythmia, how serious it is and whether it should be treated with medications or surgery - or even at all.

"To suppress every skipped beat is not the thing to do," Osborn told the Deseret News, adding that medications can be dangerous if not well applied to a condition.

Often, the doctor-patient team has a real choice: surgical intervention with one of the new high-tech devices that are so effective or medication? Thorough study is needed, but sometimes age and other factors dictate what is probably the best treatment option.

"If a patient's younger, I recommend the studies," said Osborn. "In a 16-year-old facing a lifetime of medication, it may be cheaper - and just better - to get it fixed.

"And sometimes people just don't feel good with medications, and that will justify doing a procedure," he said, adding that "medicine is a double-edged sword" because of side effects and noncompliance with taking the medicine as scheduled.

But the role of medications in treating heart arrhythmias shouldn't be underestimated, either, he said. "LDS Hospital has done good studies in cooperation with the U. (University Hospital) showing drugs do have a role. For instance, after a heart attack, people should be treated with beta blockers.

"But in the battle of drugs vs. devices, devices generally won out. It's like having a paramedic in your chest."

Technology is not the only thing that has forced doctors to look at the efficacy of medications - even those that have served patients very well for many, many years.

There are drug interactions that are problematic. And sometimes interactions with nonprescription things, like over-the-counter remedies. There are side effects. And one of the biggest problems is still compliance. With all the good intentions in the world, some people seem to be just incapable of taking their medications in appropriate doses or at the prescribed times.

And devices and their popularity have taken away some of the incentives pharmaceutical companies had to develop newer and better drugs.

"Drug companies are looking to find drugs that have niches," Osborn said.


Additional information

Fielding questions

Dr. Brian Crandall and Dr. Jeffrey Osborn, both cardiologists specializing in heart arrhythmias will be on hand to field telephone questions today from 10 a.m. to noon at the Deseret News/Intermountain Health Care Hotline. The toll-free hotline number, 1-800-925-8177, can be called from anywhere in the Intermountain Region. All calls are confidential.