One common complaint I hear from patients in my practice is the sensation that their heart skips a beat, or that every once in a while they experience an unusually strong heartbeat. This can be felt in the chest or even in the neck.
What causes these extra or skipped heartbeats?
The heart’s natural pacemaker, called the sinus node, does an incredible job at keeping the pace of the 100,000 heartbeats we experience every day. By generating electrical impulses, it smoothly adjusts the heart rate up and down, depending on your emotional and physical state. However, every now and then, other parts of the heart muscle send an electrical signal that may preempt the next normal beat, resulting in a premature beat. When these beats come from the upper chamber of the heart, they are known as premature atrial contractions (PACs). When they come from the lower chamber of the heart, they are called premature ventricular contractions (PVCs).
Premature beats may cause the sensation of a skipped or extra heartbeat. These sensations occur because the extra beats “reset” the heart, resulting in a brief pause. This is followed by an unusually strong beat resuming the normal rhythm of the heart. Nearly everyone will have extra beats now and then. Some people have them much more frequently, with extra beats occurring many thousands of times per day.
Are they dangerous?
Thankfully, in most cases, premature beats cause no harm to the heart muscle. When they occur only on rare occasions, usually no treatment is necessary. When premature beats occur frequently, it is worth checking to see if any underlying problems exist with the structure or function of the heart. In rare cases, frequent extra beats can cause a decline in the heart’s pumping function.
How are extra beats treated?
For patients with no underlying abnormality of the structure of the heart, premature beats need no specific treatment even if they occur frequently. However, many people find the symptoms caused by the extra beats to be extremely bothersome. For patients with symptoms, or in whom the premature beats are affecting the function of the heart, effective therapies include:
• Medications: Beta-blockers and other similar medications can sometimes be effective at eliminating or decreasing the frequency of premature beats. These medications are usually well tolerated, but in some people may cause fatigue, low mood or depression, decreased ability to exercise, or sexual side effects.
• Catheter ablation: This is a procedure in which small catheters (thin, flexible tubes) are inserted into the heart through a vein in the leg. These catheters are then used to cauterize tiny areas of the heart in order to eliminate the premature beats. The procedure is safe and effective. You may discuss the risks and benefits of this procedure with your physician.
Whom may I contact for more information?
Our physicians at the Al-Sabah Arrhythmia Institute at Mount Sinai St. Luke’s are available to discuss this topic further with you. For an appointment, please call (212) 523-2400.