PVB (premature ventricular beat); Premature beats; PVC (premature ventricular complex/contraction); Extrasystole; Premature supraventricular contractions; PAC; Premature atrial contraction; Abnormal heartbeat
Ectopic heartbeats are small changes in a heartbeat that is otherwise normal. These changes lead to extra or skipped heartbeats. Often there is not a clear cause for these changes. They are mostly harmless.
The two most common types of ectopic heartbeats are:
- Premature ventricular contractions (PVC)
- Premature atrial contractions (PAC)
Sometimes ectopic heartbeats are seen with:
- Changes in the blood, such as a low potassium level (hypokalemia)
- Decrease in blood supply to the heart
- When the heart is enlarged
Ectopic heartbeats are rare in children without heart disease that was present at birth (congenital). Most extra heartbeats in children are PACs. These are almost always harmless.
In adults, ectopic heartbeats are common. They are most often due to PACs or PVCs. Your health care provider should look into the cause when they are frequent. Most of the time no treatment is needed.
The cardiac conduction system is a group of specialized cardiac muscle cells in the walls of the heart that send signals to the heart muscle causing it to contract. The main components of the cardiac conduction system are the SA node, AV node, bundle of His, bundle branches, and Purkinje fibers. The SA node (anatomical pacemaker) starts the sequence by causing the atrial muscles to contract. From there, the signal travels to the AV node, through the bundle of His, down the bundle branches, and through the Purkinje fibers, causing the ventricles to contract. This signal creates an electrical current that can be seen on a graph called an electrocardiogram (EKG or ECG). Doctors use an EKG to monitor the cardiac conduction system's electrical activity in the heart.
- Feeling your heartbeat (palpitations)
- Feeling like your heart stopped or skipped a beat
- Feeling of occasional, forceful beats
Note: There may be no symptoms.
Exams and Tests
A physical exam may show an occasional uneven pulse. If the ectopic heartbeats DO NOT occur very often, your provider may not find them during a physical exam.
Blood pressure is most often normal.
An ECG will be done. Often, no further testing is needed when your ECG is normal and the symptoms are not severe or worrisome.
If your doctor wants to know more about your heart rhythm, he or she may order:
- A monitor that you wear that records and stores your heart rhythm for 24 to 48 hours (Holter monitor)
- A recording device that you wear, and records your heart rhythm whenever you feel a skipped beat
An echocardiogram may be ordered if your doctor suspects problems with the size or structure of your heart are the cause.
The following may help reduce ectopic heartbeats for some people:
- Limiting caffeine, alcohol, and tobacco
- Regular exercise for people who are inactive
Most ectopic heartbeats DO NOT need to be treated. The condition is only treated if your symptoms are severe or if the extra beats occur very often.
The cause of the heartbeats, if it can be found, may also need to be treated.
In some cases, ectopic heartbeats may mean you are at greater risk for serious abnormal heart rhythms, such as ventricular tachycardia.
When to Contact a Medical Professional
Fang JC, O'Gara PT. History and physical examination: an evidence-based approach. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 10.
Olgin JE. Approach to the patient with suspected arrhythmias. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 62.
Last reviewed on: 5/20/2018
Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.