Extrasystoles (ectopic beats)
Extrasystoles are premature heartbeats that occur when an electrical impulse arises earlier than it should. Patients most often describe them as a ‘skipped beat’, a ‘brief thump’, a ‘pause’ or an unpleasant feeling in the chest. Although they can be unsettling, in a large number of cases extrasystoles are harmless and do not indicate serious heart disease.
There are two basic types of extrasystoles – atrial and ventricular. Atrial extrasystoles arise in the atria (the upper chambers of the heart) and are generally harmless. Ventricular extrasystoles arise in the ventricles (the lower chambers) and are also usually benign, but if they are frequent or accompanied by other symptoms, further investigation may be needed.
Extrasystoles can occur in a healthy heart, but also as part of conditions such as high blood pressure, valve disease, thyroid disorders, anaemia or electrolyte imbalances. They can become more pronounced after caffeine, alcohol, nicotine and energy drinks, and during periods of stress, fatigue or lack of sleep. They are also very common in women during the perimenopause and menopause, when hormonal changes and fluctuations in the autonomic nervous system can make the heart more sensitive and trigger premature beats. In some people they occur without a clear cause and do not mean that heart disease is present.
Symptoms depend on how sensitive the individual is. Some people do not feel them at all, while others notice occasional or frequent episodes of skipped beats, especially at rest or before going to sleep. Extrasystoles rarely cause serious symptoms, but they may be accompanied by a feeling of discomfort, brief shortness of breath or anxiety caused by the subjectively unpleasant sensation in the chest.
The diagnosis is usually made with an ECG, but because extrasystoles are often intermittent, a full assessment usually requires 24-hour or extended Holter monitoring. If ventricular extrasystoles are frequent, are accompanied by dizziness, fainting, chest pain or marked shortness of breath, or suddenly get worse, further cardiac investigation is recommended.
Treatment depends on the cause and how severe the symptoms are. For most patients it is enough to avoid known triggers, reduce stress, improve sleep and correct any metabolic or hormonal disorders. If extrasystoles are very frequent or cause marked symptoms, beta blockers may be prescribed or further investigations carried out if needed. In rare cases of extremely frequent ventricular extrasystoles that affect heart function, catheter ablation is also considered.
