An ectopic rhythm is an irregular heart rhythm due to a premature heartbeat. Ectopic rhythm is also known as premature atrial contraction, premature ventricular contraction, and extrasystole.
When your heart experiences an early beat, a brief pause usually follows. You generally become aware of it on the next beat, which feels much stronger. It can feel like fluttering, or as though your heart skipped a beat.
Most people experience ectopic rhythm on occasion. This is generally harmless and resolves without medical intervention. If ectopic rhythm continues, seek medical treatment. A doctor can investigate the cause to determine if there’s an underlying condition such as electrolyte imbalance in the blood, heart injury, or heart disease. The specific diagnosis will determine your treatment.
Premature atrial contraction
An early heartbeat that originates in the heart’s upper chambers (atria) is a premature atrial contraction (PAC). In healthy children, irregular heartbeats are almost always PACs and are harmless.
Premature ventricular contraction
When the irregularity comes from the lower chambers of the heart (ventricles), it is called a premature ventricular contraction (PVC). The risk of PVC rises with age. You are at increased risk of PVC if you have a family history of PVC or if you have had a heart attack.
Often, the cause of ectopic rhythm is unknown. Some of the factors that can cause or aggravate ectopic rhythm are:
- some prescription medications
- some illegal drugs (stimulants)
- high levels of adrenaline, usually due to stress
If the condition persists for a long time, it’s more likely that there’s an underlying condition, such as:
- heart disease
- chemical imbalance
- injury to the heart muscle due to heart disease, infection, or high blood pressure
Often, you will be unaware that you have ectopic rhythm. It may feel as though:
- your heart is fluttering
- your heart is pounding
- your heart skipped a beat or stopped briefly
- you are hyper aware of your heartbeat
- you feel faint or dizzy
It’s rare, but sometimes a person with ectopic rhythm will develop ventricular tachycardia (rapid and irregular heartbeat) and other arrhythmias (problems with heart rate). People who have had a heart attack or have heart disease or heart abnormalities have a higher risk of complications or sudden cardiac death.
Most of the time, the cause of an ectopic heartbeat is unknown and requires no treatment. If you feel fine otherwise, you should still tell your doctor during a physical exam so they can listen carefully to your heart.
If symptoms occur frequently or become severe, make an appointment with your doctor. They will want to conduct a physical exam to see if there are abnormalities in your heart.
If you experience chest pain and pressure, sustained rapid heart rate, or other symptoms along with ectopic rhythm, seek medical attention immediately.
Diagnostic testing to determine the cause may include:
- echocardiogram: sound waves are used to create a moving picture of the heart
- Holter monitor: a portable device that records your heartbeat for 24 to 48 hours
- coronary angiography: X-rays and contrast dye are used to see how blood flows through your heart
- electrocardiogram (ECG): records electric activity of the heart
- exercise testing: monitoring heart rate during exercise, usually via a treadmill
- MRI: detailed imaging using magnets and radio waves
- heart CT scan: heart scan using X-rays
- coronary angiography: X-rays with contrast dye
In most cases, treatment isn’t necessary. Often the symptoms will resolve on their own. If your symptoms increase, your doctor will base your treatment on the underlying cause.
If you have had a heart attack or heart failure in the past, your doctor may prescribe beta-blockers or other medications. If you have heart disease, your doctor may suggest angioplasty — in which a balloon is used to open a narrowed blood vessel — or bypass surgery.
There are some simple things you can do to reduce the likelihood of premature ventricular contractions (PVCs). Take note of what triggers symptoms, and eliminate them. Common triggers are alcohol, tobacco, and caffeine. Cutting down on or eliminating these substances may help to keep PVCs under control.
If your symptoms are stress related, try self-help techniques like meditation and exercise. If you are experiencing a period of prolonged stress, ask your doctor for information on reducing stress. In severe cases, antianxiety medication may be useful.