Ectopic Beats / Extrasystoles

This is a condition that commonly presents with palpitations. These can be troubling for the patient but the condition is almost always benign and would not be classed as an arrythmia.

Whilst our normal electrical impulses are being conducted through the cardiac cells, any one of these cells can activate independently. This classically gives rise to symptoms of “missed” or “skipped” beats, usually at rest. If the extra beat arises in the atria it is called an atrial or supraventricular ectopic (SVE). If it arises from the ventricle, the term is ventricular ectopic (VE).

Lifestyle factors that contribute to an increased frequency and awareness include caffeine, alcohol and stress.

    Investigations

    • An echocardiogram is usually recommended to ensure there is no structural abnormality causing the extra beats
    • Extended ECG monitoring may also be recommended to confirm the diagnosis

    Management

    If the echo is normal, the first line is reassurance & to identify possible precipitants and seeing if these can be modified to reduce symptoms.

    Drug treatments can be offered if there are ongoing symptoms – these are typically:

    • Beta-blockers/ calcium channel blockers or
    • Drugs which stabilise the rhythm of the heart – anti-arrhythmics

    In resistant cases with ongoing profound symptoms despite medical therapy, or if there is a very high burden of ectopic beats, an ablation could be considered.