An arrhythmia is an irregular heart action that occurs secondary to interruptions in the release of cardiac impulses. Ventricular arrhythmias stem from the ventricles.

There are several different types of ventricular arrhythmias. Arrhythmias occur when the heart rhythm or rate is changed due to abnormal electrical conduction or automaticity. Ventricular arrhythmias can occur with or without heart disease being present. They may occur due to congenital defects, myocardial infarction, hypertrophy of the heart muscle fiber (due to hypertension or valvular heart disease), and deterioration of conductive tissues necessary for normal heart rhythm. In addition, toxic doses of some drugs may also lead to arrhythmias, e.g., cardiac glycosides, which are used to treat some cardiac arrhythmias and congestive heart failure (CHF). Finally, electrolyte abnormalities (e.g., hypokalemia and hypomagnesemia), hyperthyroidism, or obscure (occult) heart diseases may also cause arrhythmia.

The severity of the effects of arrhythmias vary. Signs and symptoms that may occur include, but are not limited to: palpitations, tachycardia, syncope, or presyncope. Severity is generally based on the effects on cardiac output and blood pressure. Effects may be mild, causing no treatment with very limited restriction on activity, to emergencies requiring immediate resuscitation rendering the patient incapacitated. The functional abilities of cardiac patients can be classified in terms of metabolic equivalents (METs). The classification is generally as follows:

• Light to medium housework is 2 to 4 METs

• Heavy housework or yard work is approximately 5 to 6 METs

• Strenuous activity would be 7 to 10 METs, etc.

To determine the limitations on patient's functional abilities, the METs are considered in accordance with what symptoms are exhibited when the activities are carried out. For example, if a patient is performing activity at the 2 to 4 MET level and experiences dyspnea, fatigue, dizziness or fainting, the patient is considered to have low functional abilities, thus making the effects of the arrhythmia significant.

Tests for the condition include: an electrocardiogram (EKG) which reveals a record of the electrical activity of the heart, and the Holter monitor. Laboratory tests to evaluate electrolytes, thyroid function, etc. are used to determine underlying causes. In addition, electrophysiology studies can be done when arrhythmias are infrequent or a serious, sustained arrhythmia is suspected. These studies are considered invasive since the body cavity is entered to introduce programmed stimulation to initiate the arrhythmia.

Treatment depends on the underlying cause and the type of arrhythmia. For example, patients who experience premature ventricular beats (PVCs) and are asymptomatic, require no treatment. However, patients who experience sustained arrhythmia accompanied by symptoms require medications, e.g., beta-blockers, or antiarrythmics. In the case of ventricular tachycardia in unstable patients, cardioversion is indicated. Finally, for patients who do not respond to medication, a cardioverter defibrillator may be implanted in the body to sense the arrhythmia and terminate it with an electrical shock.

Residuals often depend on the presence of underlying heart disease. Patients with underlying disease tend to have higher mortality rates. In addition, patients on specific drugs, e.g., quinidine, lidocaine, etc., are monitored for potential toxicity and potential complications such as the development of additional arrhythmias.

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

• If a Veteran is a former prisoner of war, this disease shall be service connected if manifest to a degree of disability of 10% or more at any time after discharge or release from active military, naval, or air service even though there is no record of such disease during service, provided the rebuttable presumption provisions of 38 CFR 3.307 and/or 38 CFR 3.309 (c) are satisfied [Disease subject to service connection by presumption].

Notes

• When inpatient hospitalization for sustained ventricular arrhythmia or ventricular aneurysmectomy is required, a 100-percent evaluation begins on the date of hospital admission with a mandatory VA examination six months following hospital discharge. Evaluate post-surgical residuals under the General Rating Formula. Apply the provisions of 38 CFR 3.105(e) of this chapter to any change in evaluation based upon that or any subsequent examination.

• The rating criteria for cardiovascular conditions underwent full-scale revision effective on November 14, 2021 and January 12, 1999.  A regulatory change was effective August 13, 1998, updated criteria for cold injury residuals under 38 CFR 4.104, DC 7122.  The changes are not considered liberalizing and should not be used as the basis for reduction unless the disability has actually improved.