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, it is usually followed by a brief pause. 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, which is generally considered harmless and resolves without medical intervention. If they continue, the cause should be investigated to determine if there is an underlying medical condition such as electrolyte imbalance in the blood, heart injury, or heart disease. Any treatment will be based on the specific diagnosis.
Premature Atrial Contraction
When the early heartbeat originates in the heart’s upper chambers (atria), it is called 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 PVCs rises with age. You are at increased risk of PVC if you have a family history or if you have had a heart attack.
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
- if it happens frequently, you may feel faint or dizzy
Often, the cause of ectopic heartbeat is unknown. But it can be caused or aggravated by:
- some prescription medications
- some illegal drugs (stimulants)
- high levels of adrenaline, usually due to stress
If the condition persists for a long time, it is more likely that there is an underlying condition, such as:
- heart disease
- chemical imbalance
- injury to heart muscle (due to heart disease, infection, or high blood pressure)
Most of the time, the cause of ectopic heartbeat is unknown and requires no treatment. If you feel fine otherwise, you should still advise your doctor during a physical exam so he or she can listen carefully to your heartbeat.
If symptoms occur frequently or become severe, make an appointment with your doctor. He or she will want to conduct a physical exam to see if there are abnormalities of your heart.
If ectopic heartbeat is accompanied by chest pain and pressure, sustained rapid heart rate, or other symptoms, 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 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 a treadmill
- magnetic resonance imaging (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 is not necessary. Most of the time, the symptoms resolve on their own. If your symptoms increase or become very severe, treatment will be based on the underlying reasons for the condition.
If you have had a heart attack or heart failure in the past, your doctor may prescribe beta blockers like acebutolol, atenolol, metoprolol, propranolol, or other medications to help. 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 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, anti-anxiety medication like buspirone or alprazolam may be useful.
Complications are rare, but include ventricular tachycardia (rapid and irregular heartbeat) and other arrhythmias (problems with the 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.