A premature atrial contraction is an extra heartbeat that occurs occasionally, often for no known reason, momentarily throwing off the heart’s normal rhythm. This type of extra heartbeat originates in one of the upper chambers of the heart, known as the atria. It’s possible for people who experience premature atrial contractions to feel heart palpitations or other symptoms of the condition, but many people don’t notice anything unusual when they have this extra heartbeat.

Most of the time, sporadic premature atrial contractions are normal and therefore are not a health concern. They are most common among older adults, although they may arise among people of any age, including newborns. Doctors expect that people will have them on occasion without any ill effects.

Premature atrial contractions are more common among people with chronic obstructive pulmonary disorder (COPD), congestive heart failure, diabetes, and high blood pressure. They are also more likely to occur among people who have had heart attacks.

Most people don’t need treatment when they experience premature atrial contractions. However, people with premature atrial contractions may be at increased risk of atrial fibrillation if their premature atrial contractions are not addressed.

When treatment is needed, medication and minimally invasive procedures are used to manage the condition.

Premature atrial contractions are occasional extra heartbeats that disrupt the normal rhythm of the heart. They arise when an unexpected area in the heart fires an electrical impulse that triggers a heartbeat. It may or may not cause noticeable symptoms.

These contractions arise in most people occasionally without a known cause. Premature atrial contractions may occur once or twice per hour in adults over age 50. It’s believed that 99% of adults age 50 and older experience these contractions.

Sporadic premature atrial contractions in healthy people aren’t associated with health problems. However, people who experience 30 or more premature atrial contractions per hour are at increased risk of atrial fibrillation. This is more likely to occur among people born with heart abnormalities or other heart problems.

When a heart beats normally, a group of muscle fibers called the sinoatrial node initiates an electrical impulse. The sinoatrial node is located in the upper right-hand chamber of the heart, known as the right atrium. The electrical impulse causes the two upper chambers of the heart (the atria) to contract or squeeze. After that, the heart’s two lower chambers (the ventricles) contract.

When a person experiences a premature atrial contraction, an electrical signal arises in one of the heart’s upper chambers but not from the sinoatrial node. Often, it arises in an area near the pulmonary veins, where oxygen-rich blood travels from the lungs to the heart. The unexpected signal fires sooner than it should (prematurely), creating an extra, abnormal heartbeat and briefly disrupting the normal heart rhythm.

Doctors don’t always know what causes premature atrial contractions.

They frequently occur in healthy individuals, but may also be caused by health conditions, such as:

• Coronary artery disease
• Heart failure
• Hypertrophic cardiomyopathy, which causes the heart muscle to become thickened
• Left ventricular hypertrophy, when the lower left chamber of the heart is enlarged
• Heart valve disease, including mitral valve disease
• Atrial septal defect, a congenital (or at-birth) condition in which there is a hole between chambers in the heart
• Other heart-related birth defects

Certain lifestyle habits may increase the risk of premature atrial contractions, including:

• Caffeine consumption
• Alcohol consumption
• Experiencing high levels of stress or anxiety
• Smoking
• Illicit drug use

Some medications may cause premature atrial contractions, including:

• Beta-agonists, which treat COPD
• Digoxin, which treats heart failure
• Some chemotherapy drugs
• Sympathomimetics amines, which treat certain heart problems and other conditions
• Tricyclic antidepressants
• Monoamine oxidase inhibitors, which treat depression
• Beta-blockers, which treat high blood pressure
• Certain over-the-counter cold medications
• Certain weight-loss drugs

People who are taller than average may also be at risk of premature atrial contractions. So are those with higher-than-normal levels of B natriuretic peptide, a hormone.

Premature atrial contractions often don’t cause noticeable symptoms. When they do, people may experience:

• Heart palpitations
• Fluttering feelings in the chest or throat
• Feeling that the heart has skipped a beat
• Feeling that the heart has beat an extra time
• A brief moment of dizziness or feeling faint

Because many people don’t experience symptoms of premature atrial contractions, the condition may be diagnosed incidentally. Other people seek a diagnosis because they feel fluttering in the chest.

To diagnose premature atrial contractions, your doctor will review your medical history, perform a physical exam, and order one or more diagnostic tests.

It’s helpful if you describe the heart palpitations or fluttering feelings in the chest that you experience. If you were born with a heart abnormality or have had a heart attack, share that information with the doctor. Also tell the doctor about certain lifestyle habits, such as how much coffee you drink, whether you smoke, and how much alcohol you consume. You should let the doctor know about any medication you take, including antidepressants, medication for weight loss, treatment for COPD, high blood pressure medication, and over-the-counter cold remedies.

When you have a physical exam, the doctor will listen to your heart with a stethoscope, but you probably won’t experience a premature atrial contraction at that moment. The doctor should check your overall health, paying attention to your blood pressure, heart rate, and other details that could provide clues about your heart’s activity.

Doctors usually order certain tests to diagnose premature atrial contractions. You may be offered:

• Blood tests, which may rule out other conditions or show that a patient has high levels of B natriuretic peptide or elevated cholesterol levels, which may suggest premature atrial contractions.
• Electrocardiogram (ECG or EKG), which shows the heart’s electrical activity. A patient lies on their back while electrodes (sensors) connected to an electrocardiogram machine are attached to the chest, arms, and legs. The machine records the electrical activity of the patient’s heart for a few minutes. Any premature atrial contractions that occur during the test will be recorded, but none may happen during that time. An electrocardiogram can rule out other conditions that could also cause heart palpitations or related symptoms.
• Portable monitors, which are electrocardiogram tests that patients wear at home. A Holter monitor is worn for one or two days. An event monitor can be worn for up to 30 days. Electrodes are attached to the patient’s chest, and wires connect the electrodes to the portable monitor. The devices have straps that allow patients to wear them over the shoulder or neck, or around the waist. For the designated period of time, the Holter monitor or event monitor records the electrical activity of the patient’s heart. Any signs of premature atrial contractions or different conditions that cause similar symptoms will be recorded if they occur.
• Echocardiogram, which is an ultrasound test that shows the structure and function of a patient’s heart. Sonographers (who are trained to operate ultrasound machinery) perform this test. A patient lies on their back while the sonographer places an ultrasound wand (transducer) over the chest and abdomen to assess the heart. This exam is used to identify structural heart problems, which may be present in some people with premature atrial contractions.

Most people won’t need treatment for their premature atrial contractions. Occasional contractions that occur for unknown reasons, which are not associated with heart abnormalities or health problems, do not pose a health risk to patients.

Doctors may recommend that patients decrease or eliminate their consumption of caffeine and alcohol, and that they quit smoking.

When premature atrial contractions interfere with a patient’s quality of life, doctors may prescribe:

• Beta-blockers, a type of blood pressure medication. They may help to regulate abnormal heart rhythms in people with premature atrial contractions.
• Calcium channel blockers, another type of blood pressure medication that may be used to help regulate abnormal heart rhythms caused by premature atrial contractions.
• Anti-arrhythmic medication, such as flecainide. This class of medication helps to regulate heart rhythm problems and may be effective for premature atrial contractions.

If patients don’t respond to medication, doctors may recommend procedures, such as:

• Catheter ablation. During catheter ablation, a minimally invasive procedure, doctors make a small incision in a patient’s artery, usually in the groin. They then insert one or more tubes (catheters) into the artery, threading them through various blood vessels until they reach the heart. (Doctors use live X-ray imaging to guide the catheters.) They direct each catheter to a specific place within the heart and then put sensors (electrodes) at each location. The electrodes help them identify the problem. They then send heat (electrical energy) through a catheter to burn the tissue causing the extra heartbeats. Scar tissue forms at the site, preventing premature atrial contractions.
• Pulmonary vein isolation, a type of catheter ablation that is sometimes used as a treatment for atrial fibrillation. An area of the heart muscle near the pulmonary veins, which carry blood from the lungs to the heart, is targeted and burned. Scarring this spot has been shown to stop premature atrial contractions.

If doctors discover a heart disorder or structural heart disease during these procedures, they recommend treatment of that underlying condition to reduce the risk of complications caused by premature atrial contractions.

Premature atrial contractions that occur sporadically, with no known cause, won’t affect the overall health of most people who experience them.

Treatments should help reduce the risk of complications for people at risk of atrial fibrillation, stroke, or death because of frequent premature atrial contractions or underlying heart conditions.

“At Yale, we tailor the treatment of arrhythmias to each patient,” says Joseph Akar, MD, PhD, director of Yale Medicine’s Electrophysiology & Cardiac Arrhythmia Program. “In addition to offering the latest cutting-edge technology, Yale electrophysiology has expertise in treating complex arrhythmias while minimizing—or completely eliminating—patient exposure to ionizing radiation. We train physicians from all over the country and the world in these techniques, and we lead clinical research efforts that allow us to offer state-of-the-art therapy for arrhythmias.”