Dr Sukhjinder Nijjer
Expert in Palpitations & Ectopic Beats
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Ectopic Heart Beats
Do you have palpitations? Have you ever felt like your heart skipped a beat? Have you ever felt an extra thump in the chest followed by a long gap? You may have felt an Ectopic heart beat. Also known as Cardiac ectopy, these are extra electrical signals that come out of the normal sequence of the heart. These beats can be a normal occurrence and may occur at times of stress and anxiety.
However, in some circumstances they can cluster together to form a more serious arrhythmia. A frequent occurrence can reflect an important heart condition. If you have a large number of them in a day – it can cause the heart to weaken. It can be worthwhile getting cardiac investigations to ensure that your heart is in good condition.
What are cardiac ectopic beats?
The heart beats in a particular sequence due to a specific pathway of electrical signals. The upper two chambers of the heart, the atria are controlled by activity from the sino-atrial node. The lower two chambers, the ventricles are controlled by a signal that comes from the atrial. It receives these signals through a set of fibres called the Bundle of His.
Every cell in the heart can generate an electrical signal, and if one can produce enough electrical signal to activate the chamber before the normal pathway, then there can be a premature heart beat. The heart then has to regulate itself and so there is often a compensatory pause that follows the extra beat. The next heart beat, which is normal, can be feel like a very heavy thump.
What types of ectopic beats are there?
Ectopic beats are very common and many people who feel palpitations experience ectopic beats. There are two main types of ectopic beats:
Premature atrial contraction (PAC)s – these come from the two upper chambers of the heart, called the atria. These are generally benign but in some patients, very high levels of these can predict future atrial fibrillation. The atria are smaller chambers and you may not feel all of the ectopic beats. These type of ectopics can cluster together and occur as ‘runs’ which can be felt like a ‘fluttering’ in the chest.
Premature ventricular contraction (PVC)s – these come from the lower chambers, called the ventricles. The ventricles are powerful chambers of the heart with the left ventricle pumping blood to the entire body and the right ventricle pumping blood to the lungs. This means extra ectopic beats from the ventricles may be felt more strongly than those from the atria. The majority of ventricular ectopics are benign but in some people, if they are occurring in long runs, they can reflect coronary artery disease.
- Some patients with very severe coronary artery disease – with heart artery narrowings that are severe enough to reduce the blood supply to the heart muscle, can trigger an excess of ventricular ectopics beats. In some cases, this can progress into episodes of ventricular tachycardia (VT).
- Less commonly, in patients with a very high level of ventricular ectopic beats, the extra beats can lead to a worsening of the underlying heart muscle. This can be detected on heart scans such as echocardiography or cardiac MRI.
- A very careful assessment has to be made using a combination of 12-lead ECG and ambulatory ECG monitoring. Echocardiography will be used to assess the heart function and look for underlying heart conditions. For the vast majority of patients, this will be sufficient to make a diagnosis and treatment can be started. In patients with frequent ventricular ectopics, Dr Nijjer may ask you to undertake an exercise ECG test. If your ventricular ectopics are reduced by increasing exertion, this can be a reassuring sign. However, if the number of ectopic beats increase on exercise, this can reflect a possible problem with your heart arteries.
- In patients where there is concern about coronary artery disease, Dr Nijjer may ask you to have a CTCA or a coronary angiogram. In patients with very high levels of ventricular ectopy, you may need an ablation procedure to help improve your symptoms and the risk of the heart muscle becoming weaker.
What are the symptoms of cardiac ectopic beats?
When you have an ectopic beat, you will feel a jump or flutter within the rhythm of your heart beat. You may feel it as an extra beat. You may feel it as a missed beat. Some people only feel the thump of the compensatory normal heart beat. You may also feel faint or experience dizziness, or become aware of your heartbeat.
In most cases, episodes of cardiac ectopy occur at times times of anxiety, stress or exercise, and can also be triggered by smoking, drinking alcohol, caffeine intake and in some cases eating certain foods. Some people may find spicy foods are a trigger.
What cardiac tests do I need if I have cardiac ectopic beats?
If you are having persistent ectopic beats, it can be worthwhile completing a number of cardiac investigations to ensure there is no underlying heart condition that warrants treatment.
Common cardiac tests are:
Some selected patients may need:
- Exercise Stress Testing: Treadmill stress testing can be useful to assess for suppression of extra ventricular ectopic beats.
- CTCA or invasive coronary angiography: Patients with a low risk of severe coronary disease will be offered CT Coronary Angiography to assess for heart artery narrowing. However, if the risk of important narrowings is high, you may be offered the gold standard investigation of invasive coronary angiography.
- Cardiac MRI: Cardiac MRI is a specialist test in which very detailed scans of the heart muscle are performed. It allows us to assess the heart muscle for any abnormalities that may be causing excessive ventricular ectopics.
What are the treatments for cardiac ectopic beats?
In many people, cardiac ectopic beats do not require a specific medical treatment. For many patients, we may recommend lifestyle modification – specifically reducing caffeine and alcohol. Increased exercise may also suppress extra beats.
Some patients may require medication to control symptoms of extra beats. Dr Nijjer will work with you to identify which medicine works best for you to control your symptoms while minimising side-effects.
In a small number of patients, catheter ablation may be needed to burn away the part of the heart that is causing the extra beats. This is particularly needed when you have a high level of ventricular ectopics which can cause a deterioration of the heart muscle. Dr Nijjer will discuss this in detail with you.
More Information from the British Heart Foundation
More information is available on the British Heart Foundation (BHF) website.
The page on palpitations and cardiac arrhythmia can be found here.
Click here to download a PDF
Help Your Heart
If you have any concerns regarding your heart health, then please seek a referral to Dr Nijjer.
Call the Team: Monika, Amy, Charlotte, Erin or Grace:
0203 9838 001
Dr Nijjer can be seen at :
68 Harley Street, London, W1G 9QP
He also practices at Cromwell Hospital, Wellington Hospital, BUPA Clinics, BMI Syon Clinic as well as Imperial Private Healthcare.