Ectopic heartbeat is an irregularity of the heart rate and heart rhythm involving extra or skipped heartbeats.

Ectopic heartbeats are small variations in an otherwise normal heartbeat that causes an irregular pulse. They may occur without an obvious cause and are usually harmless.

Sometimes they are associated with chemical (electrolyte) problems in the blood, which need treatment. They can also happen with ischemia caused by a decrease in blood supply to the heart.

Ectopic beats may be caused or made worse by excessive smoking, alcohol consumption, caffeine, certain medications such as stimulants, and some illicit drugs.

Ectopic beats are rare in children who do not have congenital heart disease. Most extra heartbeats in children are premature atrial contractions (PACs), which are almost always benign.

In adults, ectopic beats are common. Their causes should be investigated even if it turns out that no treatment is needed.

Symptoms include:

• Feeling your heart beat (palpitations)
• Feeling like your heart stopped or skipped a beat
• Feeling of occasional, forceful beats

Note: There may be no symptoms.

A physical examination may show an occasional, irregular pulse, but if the ectopic beats do not occur frequently, your doctor may not detect them during a physical exam.

Blood pressure is usually normal.

The following tests may be done:

• Continuous ambulatory cardiac monitoring (Holter monitor or patient-activated recording device)
• Coronary angiography
• ECG
• Echocardiogram

Most ectopic heartbeats do not require treatment. The condition is treated if your symptoms are severe or if they extra beats occur very frequently.

An underlying cause, if discovered, may also require treatment.

Ectopic heartbeats are generally benign, requiring no treatment. Occasionally, they may indicate an increased risk for other cardiac arrhythmias.

• Ventricular tachycardia (occasionally)
• Other arrhythmias (occasionally)

Call your health care provider if you have persistent palpitations, or palpitations with chest pain or other symptoms.

Also call your health care provider if you have this condition and your symptoms worsen or do not improve with treatment.

Limiting caffeine, alcohol, and tobacco may reduce the risk and frequency of ectopic heartbeats in certain people. Exercise often helps those who are inactive.

Olgin JE. Approach to the Patient with Suspected Arrhythmias. In: Goldman L, Ausiello D, eds. Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap. 61.

Toth PP, Shammas NW, Dippel EJ, Foreman B. Cardiac Electrophysiology and Arrhythmias. In: Rakel RE. Textbook of Family Practice. 7th ed. Philadelphia, Pa: WB Saunders; 2007:chap. 39.