Skipped heartbeats Premature ventricular contractions (PVCs)

What PVCs are

A premature ventricular contraction is an extra heartbeat that starts in the lower chambers of the heart instead of following the normal electrical pathway.

Because the extra beat arrives early, the heart hasn’t finished filling, so that beat pumps very little blood, which is why you often don’t feel it as a beat at all. What you feel is the pause afterwards, and then the next normal beat, which lands harder because the heart has had extra time to fill.

That’s the sensation people describe as a skip, a thud, a flip, or a jolt. What you’re feeling isn’t a missing beat. It’s an extra one followed by a stronger one.

How common they are

Very. Almost everyone has PVCs. Studies using 24-hour monitors find them in the large majority of healthy adults with no heart disease at all. They become more frequent with age.

Most people never notice them. Some people are simply more aware of what their heart is doing, and that awareness has no bearing on whether the PVCs matter.

If you’ve been feeling these and reading about them at two in the morning, the most likely explanation by a wide margin is that they’re benign. That said, the point of an assessment is to confirm it rather than assume it.

What triggers them

Many people notice them most when lying in bed at night. That isn’t because they’re worse then. It’s because everything else is quiet and you’re paying attention.

When PVCs need a closer look

Most PVCs are harmless. The situations that warrant proper assessment are:

• A high burden

  If PVCs make up a large share of your total heartbeats, generally above about 10 to 15 percent over 24 hours, they can, over time, weaken the heart muscle. This is uncommon, it’s detectable on a monitor, and it’s reversible once treated.

• Existing heart disease

  PVCs carry different significance if you have a previous heart attack, cardiomyopathy, or a weakened heart.

• Fainting or near-fainting

  Associated with the sensations.

• PVCs brought on or worsened by exercise

  Rather than settling with it.

• A family history

  Of sudden cardiac death or inherited heart rhythm conditions.

• Symptoms frequent enough to affect your quality of life

  Regardless of whether they’re dangerous. Being unable to sleep or concentrate because of them is a legitimate reason to seek help.

How they’re assessed

1. 01

   ECG

   Records your heart’s electrical activity and identifies PVCs if they occur during the recording. It also shows where in the ventricle they’re originating, which matters if treatment is considered.

2. 02

   Holter or extended monitoring

   The central test. A monitor worn for 24 to 48 hours, or longer if the sensations are infrequent, counts exactly how many PVCs you have and what percentage of your beats they represent. Holter monitoring is launching soon at this clinic.

   That number is what distinguishes reassurance from further action.

3. 03

   Echocardiogram

   An ultrasound checks that the heart’s structure and pumping function are normal.

   A normal echo alongside a low PVC burden is the combination that allows firm reassurance.

4. 04

   Exercise treadmill test (ETT)

   You walk on a treadmill that gets progressively faster and steeper while your ECG, heart rate, and blood pressure are recorded, including several minutes of monitored recovery afterwards. In PVCs it answers a specific question that a Holter monitor cannot: what your extra beats do when your heart rate rises.

   The box below sets out why that distinction matters.

5. 05

   Blood work

   Thyroid function, electrolytes including potassium and magnesium, and a blood count.

   If you have a smartwatch that records ECG traces, bring them. They aren’t diagnostic on their own but they can be helpful.

What the treadmill test is looking for:

• Usually reassuring

  PVCs become less frequent or disappear as your heart rate climbs, and return only afterwards. This is the common pattern and points toward a benign origin.

• Warrants a closer look

  PVCs appear or become more frequent with exertion, occur in runs, change shape, or cluster in the recovery period, or exercise brings on lightheadedness or chest discomfort.

The test also measures how much exercise you can actually do, and screens for reduced blood flow to the heart muscle, which is occasionally the reason the extra beats are there in the first place. It is particularly worth doing if your symptoms come on during activity, if you exercise seriously, or before considering medication or ablation.

How they’re treated

For most people, the treatment is an explanation. A normal echocardiogram and a low PVC burden mean no treatment is needed. Knowing that reliably is often enough on its own, because a great deal of the distress PVCs cause comes from not knowing what they are.

• Trigger reduction

  Cutting caffeine, alcohol, and nicotine, improving sleep, staying hydrated, and correcting low potassium or magnesium reduces frequency for many people. Worth trying systematically rather than all at once, so you can tell what actually helps.

• Medication

  If symptoms are troublesome, beta blockers or calcium channel blockers can reduce awareness of PVCs and lower their frequency. These are used for symptom relief, not because the PVCs are dangerous.

• Catheter ablation

  For a high PVC burden, particularly where the heart function has been affected, ablation targets the specific spot in the ventricle where the extra beats originate. Success rates are high when the origin is well localized. This is reserved for the minority of cases that warrant it.

What to expect at your appointment

Your first visit is a consultation with a cardiologist, lasting roughly an hour.

Whether the sensations happen at rest or during exertion is particularly useful to know, and is often what decides whether a treadmill test is arranged.

A monitor may be arranged the same day or shortly afterward. A letter goes back to your referring doctor, usually within 1 to 7 days.