Normally, the electrical signal in the heart begins in a particular location (the sinoatrial node) and spreads in an ordered way thorugh specialized conducting pathways to activate the whole heart. However, other parts of the heart are also able to start a contraction of the heart, and these are known as ectopics.
They can occur from the top two chambers of the heart (atria) when they are called atrial ectopics or premature atrial contractions (PACs) or from the bottom two chambers when they are call ventricular ectopics of premature ventricular contractions (PVCs).
Ectopic beats are very common, and in many people don’t cause any symptoms. In most cases, even if they cause symptoms, ectopic beats are not an indicatior of any serious cardiac disease, but it is usually necessary to undergo assessment to make sure.
Ectopics are often asymptomatic and patients may have hundreds or even thousands of them every day without noticing. In other cases, patients notice even single ectopic beats. The symptoms are usually of very short-lived palpitations (lasting a second or so). Sometimes the extra beat is felt, whilst sometimes a small pause is felt. They usually happen during anxiety, stress, and when not distracted by other activities (for example when trying to relax or get to sleep). They may be more common when alcohol or caffeine intake is high. If a patient has a number of ectopics one after another they may feel dizzy Again, you might feel dizzy, experience fainting, or become conscious of your heartbeat.
Many cases of ectopics are not harmful as long as you do not have constant symptoms. In some cases, it may indicate a problem with the function of the heart, or problems with the heart muscle, or arteries supplying the heart. Your doctor will ask you about your symptoms, your cardiac history, and whether there is any family history of problems with the heart.
If you have frequent symptoms, an electrocardiogram (ECG) may capture the ectopics and make the diagnosis clear. If your symptoms are less frequent, or your doctor wants to find out how many ectopics you are having, they may suggest a 24-hour ECG which records how many ectopics have occurred throughout the recording period.
Your doctor will also likely suggest an echocardiogram (ultrasound) which will assess the shape, function and valves of the heart. It is likely that this will be normal, but it is important because if your heart function is reduced or there is evidence of areas of the heart that are not working the treatment may be different.
If you are getting frequent ectopics, your doctor may suggest you undergo a treadmill test to see if the ectopics disappear on exercise. Usually ectopic beats that disappear on exercise are less concerning than those which persist or increase on exercise.
Your doctor may also suggest a CT coronary angiogram (CTCA) to look for narrowings in the arteries supplying the heart muscle which can sometimes cause ectopics, particularly if they occur on exercise. If you have frequent ectopy and lots of disease on CT coronary angiography your doctor may discuss an invasive angiogram with you to clarify the situation.
Your doctor may also suggest an MRI scan of the heart to look in detail for problems with the shape of the heart or scarring of the heart muscle that may indicate where the ectopics are coming from.
In most cases, there is no need for treatment. Some patients find that stopping smoking, reducing alcohol, reducing caffeine and strategies to reduce stress are helpful. If the ectopics are causing symptoms, then a medication called a beta-blocker is often highly effective at reducing symptoms. For patients who have ongoing symptoms despite beta-blocker or alternative drugs, an ablation procedure may be offered, but this is rarely required.
In cases in which there is felt to be an underlying cause (coronary artery disease, heart failure) then treatment of this is the most important aspect.
Ectopy is usually a nuisance rather than a life-threatening problem with the heart but requires careful evaluation and work-up by an expert Consultant Cardiologist. Our consultants are available for appointments any day of the week and on weekends as well.
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