Premature Atrial and Ventricular Beats

Premature heartbeats are extra heartbeats that begin in the upper chambers of the heart (atria) or the lower chambers (ventricles).

These extra heartbeats disrupt your regular heart rhythm, sometimes causing the sensation of a flip-flop, or skipped beat, in your chest. 

Skipped beats are very common and occur in most people at some point. If you have the occasional skipped beat and are an otherwise healthy person, there's generally no cause for concern.

If you experience a skipped-beat sensation more frequently, you should call your physician for an evaluation.

Symptoms

Premature heartbeats often cause no symptoms. If you feel anything, it may be odd sensations in your chest, such as:

• Flip-flops
• Fluttering
• Pounding or jumping
• Skipped or missed beats
• Increased awareness of your heartbeat

Causes and risk factors

It is not always known what causes the heart to skip beats. Certain changes in the body can lead to the heart's atria or ventricles becoming electrically unstable. Skipped heartbeats can also be associated with:

• Chemical changes or imbalances in the body
• Certain medications, including common asthma medications
• Alcohol or illegal drug use
• Increased adrenaline caused by caffeine, tobacco, exercise or anxiety
• Injury to the heart muscle from coronary artery disease, congenital heart disease, high blood pressure or heart failure

Diagnosis and treatment

To diagnose premature heartbeats, your physician may order some tests.

• Standard electrocardiogram (ECG). During this test, sensors are attached to your chest and limbs to create a graphic record of the electrical signals traveling through your heart. A standard ECG is usually done in a clinic or hospital setting and lasts a few minutes.
• Holter monitor. When you wear this monitor, your heart's activity is recorded for a 24-hour period, which gives your physician an extended look at your heart rhythms.
• Event recorder. An event recorder is carried in your pocket. When you feel symptoms, you push a button and a brief ECG strip recording is made. This enables your physician to see your heart rhythm at the time of your symptoms.
• Exercise stress test. This is a diagnostic test using an ECG to record your heart's electrical activity while you walk on a treadmill or pedal an exercise bike. If exercise leads to extra beats, it can indicate a greater risk of serious heart rhythm problems.

Most people with premature heartbeats won't need medical treatment. In some cases, if you have underlying disease that could result in more serious heart rhythm problems later, your doctor may recommend:

• Lifestyle changes. Tobacco and caffeine are common triggers of premature heartbeats. Eliminating them can decrease the frequency and severity of your symptoms.
• Medications. Beta blockers can suppress extra heartbeats. Your doctor may also recommend anti-arrhythmic drugs or calcium channel blockers.
• Radiofrequency catheter ablation. For premature heartbeats that don't respond to lifestyle changes or medications, radiofrequency catheter ablation may be recommended. This procedure uses radiofrequency energy to destroy the area of heart tissue causing the irregular contractions.