Ectopic Beats

Ectopic beats are additional beats of the heart, which can cause symptoms ranging from palpitations to fatigue – and sometimes no symptoms at all. Ectopic beats are quite common, and for the vast majority of people they are completely harmless. Since they can sometimes indicate an underlying problem or complication with the heart, however, it’s always a good idea to investigate them properly.

What are ectopic beats?

Ectopic comes from the Greek words ek topos, meaning “out of place”. That’s a good description of the condition: an ectopic beat is an extra, or “premature”, heartbeat, usually occurring slightly before the normal heartbeat. There are two main types of ectopic beats:

Premature atrial contractions (PACs) / Atrial ectopy (AE) – where the additional heartbeat occurs in the top chambers of the heart (the atria)

Premature ventricular contractions (PVCs) / Ventricular ectopy (VE) – where the extra heartbeat happens in the heart’s bottom chambers (the ventricles). (PVCs are generally less common than PACs.)

What causes ectopic beats?

Our heartbeats are controlled by electrical signals from the brain. These signals connect with the heart through a group of cells known as the sinus node – the heart’s natural pacemaker. Sometimes, however, those signals occur outside the sinus node; this can cause the heart’s chambers to contract prematurely in an ectopic beat. It’s not always easy to determine why this happens. In a healthy heart, it’s possible that lifestyle circumstances – such as heightened stress and anxiety, or common stimulants like caffeine and alcohol – are triggering the condition. On the other hand, they could simply be raising awareness of the extra beats. Certain over-the-counter medicines – such as decongestants and flu medicines – can sometimes trigger ectopic beats too.

In some cases, ectopic beats can be associated with an underlying heart issue or abnormality, such as atrial fibrillation or tachycardia cardiomyopathy. A high frequency of extra beats in the bottom chambers can be associated with a risk of longer-term heart dysfunction.

What do ectopic beats feel like?

Ectopic beats don’t always cause symptoms. It’s possible to have the condition without even being aware the extra beats are occurring. When they do cause symptoms, people normally experience them as a palpitation. You might feel a fluttering sensation in your chest, or perhaps even a pounding or thudding feeling, or sometimes just an increased awareness of your heart beating. In certain cases they may cause fatigue or lack of energy, and occasionally even breathlessness. Ectopic beats generally tend to happen when your heartrate is slower – for example in the evenings, or when you’re resting or sleeping.

Who gets ectopic beats?

Anyone can experience ectopic beats. They affect people of all ages, backgrounds and fitness levels.

How are they diagnosed?

It’s usually possible to diagnose ectopic beats from the symptoms you’re experiencing (for symptomless patients, the extra beats are sometimes picked up through other, incidental tests and check-ups). When you come in for an appointment, we will also talk about your medical history, the times when you particularly notice the extra beats, and what you’re doing when they happen. Sometimes we’ll run an electrocardiogram (ECG) to confirm the diagnosis. If the extra beats are difficult to pick up, or fairly infrequent, we may ask you to take a portable heart monitor home to track them over a longer period.

What happens next?

Most ectopic beats are harmless. If you’re generally fit and healthy, with no underlying heart conditions, you may well find they pass away by themselves after a few weeks or months. We might also advise you to make some lifestyle changes, such as reducing your caffeine intake or trying to lower your stress levels with relaxation techniques and exercise. If you’re finding the symptoms particularly uncomfortable, or if they’re quite persistent, we may look to prescribe some medicine – something like a beta blocker, for example, which can help to stop or reduce the frequency of the extra beats. Some patients may also be recommended a procedure to stop or remove the ectopic beats; this is called an ablation procedure.