Medically reviewed by Dr Nabila Laskar, Consultant Cardiologist (GMC 7040901). An ectopic heartbeat is an extra beat arriving earlier than expected. They are extremely common and, in a structurally normal heart, usually harmless.
An extra beat starting in the upper chambers is a premature atrial contraction (PAC); one starting in the lower chambers is a premature ventricular contraction (PVC). The pause afterwards makes the following beat forceful, which is why ectopics feel like a missed beat followed by a thump. See /conditions/heart-palpitations.
Caffeine, alcohol, nicotine, poor sleep, dehydration, stress, large meals, hormonal changes, low potassium or magnesium, an overactive thyroid, some decongestants and inhalers, and periods of intense training.
Assessment is warranted if ectopics are very frequent, occur in runs, worsen with exercise, or come with chest pain, breathlessness or fainting — and for anyone with known heart disease or a family history of cardiomyopathy or sudden cardiac death.
A 24-hour to 7-day Holter monitor counts every beat and quantifies your ectopic burden as a percentage (see /conditions/holter-monitor), with an echocardiogram to confirm the heart is structurally normal and blood tests for thyroid function and electrolytes.
In a structurally normal heart, occasional ectopics are not dangerous and need no treatment. They matter when very frequent, occurring in runs, worsening with exercise, or alongside known heart disease. A Holter and echocardiogram settle the question.
Most healthy people have some every day, and burdens well under 1% of total beats are generally benign. Cardiologists become more interested as the burden rises into double-digit percentages, particularly for ventricular ectopics.
Stress raises adrenaline, making ectopics both more frequent and far more noticeable, which in turn raises anxiety. Objective reassurance from a Holter recording is usually the most effective way to break that cycle.
Usually not. With a normal echocardiogram and a low Holter burden, the focus is on triggers such as caffeine, alcohol, sleep and stress. Medication or ablation is reserved for a high burden or intrusive symptoms.