Premature beats (extrasystoles) are among the most common heart rhythm irregularities. Although they often cause concern, in most cases they are benign and not dangerous. In this page, I will explain in simple terms what they are, why they occur, how they are diagnosed, and when treatment is needed.

 

What Are Premature Beats (Extrasystoles)?

Extrasystoles are early heartbeats that interrupt the normal rhythm. Patients often describe them as:

• A skipped beat

• A sudden strong thump

• A brief flutter or pause in the chest

These extra beats can originate from:

• The atria (supraventricular extrasystoles) – generally harmless

• The ventricles (ventricular extrasystoles) – may require evaluation depending on frequency and heart condition

 

What Causes Extrasystoles?

Premature beats can appear even in completely healthy hearts. Common triggers include:

✅ Stress and anxiety
✅ Poor sleep or fatigue
✅ Caffeine, energy drinks, alcohol, smoking
✅ Intense physical activity
✅ Gastric reflux or up-and-down diaphragmatic pressure
✅ Thyroid imbalance (mainly hyperthyroidism)
✅ Electrolyte changes (low magnesium or potassium)

Less commonly, they may be associated with underlying heart disease.

 

What Symptoms Do Extrasystoles Cause?

Many people feel nothing at all, while others may notice:

• A sensation of a skipped or strong beat

• Fluttering or irregular rhythm

• Brief pause followed by a stronger beat

• Discomfort in the chest or throat

• Anxiety or awareness of the heartbeat

⚠️ Important: the discomfort caused by extrasystoles is often more “annoying” than dangerous.

 

When Should You Worry? (Red Flags)

Seek a cardiology evaluation if extrasystoles are accompanied by:

🚩 Fainting or frequent dizziness
🚩 Shortness of breath
🚩 Chest pain
🚩 Very high frequency of irregular beats
🚩 Known heart disease (previous heart attack, cardiomyopathy, valvular disease)

 

How Are Extrasystoles Diagnosed?

Cardiac tests may include:

🔹 Electrocardiogram (ECG)
🔹 24/72-hour Holter ECG monitoring (to measure frequency)
🔹 Echocardiogram (to assess heart function)
🔹 Blood tests (electrolytes, thyroid function)

Do Extrasystoles Need Treatment?

In most cases, no medication is necessary.

 

Treatment is recommended when:

• Symptoms significantly affect quality of life

• Extrasystoles are very frequent (>10–15% of daily beats)

• There is underlying heart disease

Possible treatments include:

💊 Beta-blockers or antiarrhythmic medications
⚡ Catheter ablation (in selected cases with frequent ventricular beats)
🧘 Lifestyle modifications (most effective in many patients)

 

How to Reduce or Prevent Extrasystoles

✅ Reduce caffeine and alcohol
✅ Improve sleep and stress management
✅ Stay hydrated
✅ Avoid smoking
✅ Maintain healthy magnesium and potassium levels (through diet or supplements if recommended)
✅ Engage in regular, moderate physical activity

 

Can You Exercise if You Have Extrasystoles?

Yes — in most cases physical activity is safe and beneficial.
Exercise restriction is only necessary in selected patients after cardiology evaluation.