Ectopic Heart Beats/Benign Palpitations
What are Ectopic Heart Beats?
Palpitations are effectively a description of an abnormal awareness of your own heartbeat. Very commonly this can be as a result of ‘ectopic’ heart beats.
An ectopic heart beat is an irregular heart rhythm caused by a premature heartbeat, Patients describe several typical symptoms that are caused by ectopics including ‘fluttering in the chest’ ‘thumps’ or ‘missed beats’. Often palpitations caused by ectopics result in a short pauses in the heart rhythm immediately afterwards. This can lead to a sensation of a pause or a feeling of a missed heartbeat.
Where do the ectopic beats come from?
The heart has intrinsic electrical activity and as such the cells of the heart which are distant from the heart’s natural pacemaker cells can discharge small electrical signals which cause it to beat out of sync.
These typically come from either the lower chamber of the heart-the ventricles (PVCs-premature ventricular contractions) or the upper chambers of the heart-atria(PACs- premature atrial contractions).
The ectopics typically give brief symptoms and are generally benign. They do not signify that there is any serious underlying heart rhythm abnormality.
Ectopic Heart Beats FAQ's
Most people get some ectopic beats throughout the day however the number and frequency of ectopics can be increased by stress, alcohol, excessive caffeine, tiredness and stimulants such as cocaine, amphetamines and cannabis. Some women also describe increasing ectopic beats that occur at certain points in their menstrual cycle i.e. they are linked to hormonal changes.
Many people who get ectopic beats (which can be seen on ambulatory heart monitoring) are not aware of having them.
Medical conditions such as coronary artery disease, cardiomyopathy, hypertension and heart valve disease can also trigger ectopic beats.
A 12 lead ECG is a good place to start, this test can be obtained from your GP and will identify if there is any obvious problem on the resting baseline ECG itself. If the symptoms are infrequent then an ambulatory heart monitor (a heart recording system) can be used. This is three electrode stickers that are attached to the surface of your chest wall and attached to an electronic recording system similar in size to a mobile phone. It is performed as an outpatient and you are free to walk around as normal when it is attached.
This allows the heart rhythm to be recorded continuously for several days if required. During the recording period you can make diary entries or activate the device so that the physiologist who analyses the recording can look at specific times when you had symptoms and print of the heart rhythm traces at that time for analysis. Ambulatory recorders are typically performed for 24-72hrs but can be used for longer periods if the symptoms are less frequent.
Some ‘apps’ are now available for mobile devices which allow the user to record their heartbeat as well but often rely on someone capable of interpreting the traces that are recorded.
Some patients may also need an echocardiogram -an ‘echo’ is an ultrasound scan of the heart and is a painless way of visualising the heart structure and function.
Occasionally blood testing may be required if your doctor thinks that there may be an underlying medical condition responsible.
Generally reassurance and avoidance of triggers such as alcohol, caffeine and extreme stress can be enough however if symptoms persist drugs such as beta blockers can be an effective way of suppressing the ectopics. Very occasionally frequent ventricular ectopics arising from one spot in the ventricle can require an ablation procedure- this will be discussed with your doctor at the time of assessment and would be carried out by an electrophysiologist.
Catheter ablation is a procedure done under local anaesthetic with mild sedation and normally takes between 60 and 90 minutes to perform. Three tubes are introduced from the right groin up into the heart. We use a complex mapping system called CARTO to allow us to localise the area the ectopics are coming from and ablate it. In around 80% of cases we can abolish the source of the ventricular ectopics.
Example of ambulatory heart recording of patient with symptomatic PVCs (premature ventricular Contractions) also known as ‘ventricular ectopics’
Example of an ambulatory heart recording system used to record a patient’s heart rhythm being investigated for palpitations