Ectopic Beats

Key Points:
  • Ectopic beats are early beats that are the most common disturbance of heart rhythm.
  • They may be present without any symptoms, or as palpitations described as missed or extra beats, or occasionally cause dizziness.
  • In most cases reassurance is all that is required, as they are usually completely benign, and not a cause of heart disease.
  • Drugs are rarely needed.
  • In patients who have suffered a heart attack previously, the presence of ectopic beats may demand more thorough investigation to assess the future risk of more dangerous heart rhythms.

The term ectopic beats means heart beats 'out of place'. It is applied almost exclusively to early heart beats, and represents the most common disturbance of heart rhythm. An example of ectopic beats is shown in the ECG below. Ectopic beats often occur as single beats, although may occur in pairs or be present every other beat. If three or more occur in a row the term non-sustained ventricular tachycardia is used.

Ectopic Beats

Figure 1

Ectopic beats are often discovered by chance on an ECG or when performing more prolonged monitoring. When ectopic beats do cause symptoms, they are often described as 'dropped beats' or 'extra beats'. Less commonly dizziness is reported.

Most commonly there is no other history of heart disease, and the clinical examination is normal. The ECG (apart from the ectopic beats) is usually normal. In these cases reassurance is all that is required, as the symptoms are completely benign and the outlook for the future is excellent. Sometimes reducing caffeine or alcohol intake may help. In cases where symptoms persist and treatment is required, a small dose of a drug such as a beta-blocker is often effective.

On rare occasions, ectopic beats are seen in patients who have a history of heart disease, such as a previous heart attack. In these cases further assessment may be required, such as an ultrasound scan (echocardiogram). This is because ectopic beats might be a marker of increased risk for dangerous disturbances of heart rhythm. If the tests do identify high risk then other treatments may be considered.


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