---
title: Premature beats (extrasystoles)
description: What ventricular and atrial premature beats are, why the heart seems to skip a beat, how premature beats are detected, when to look for heart disease, which treatment approaches clinical guidelines describe and when urgent help is needed.
type: disease
preset: ventricular-premature-beats
morePresets: [atrial-premature-beats]
aliases:
  - extrasystole
  - premature ventricular contractions
  - PVC
  - ventricular premature beats
  - VPB
  - ventricular ectopic beats
  - premature atrial contractions
  - PAC
  - atrial premature beats
  - APB
  - skipped heartbeat
sources:
  - tier: guideline
    org: minzdrav-rf
    title: Желудочковые нарушения ритма сердца. Внезапная сердечная смерть
    year: 2025
    doi: 10.15829/1560-4071-2025-6670
    url: https://cr.minzdrav.gov.ru/view-cr/569_2
  - tier: guideline
    org: esc
    title: 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death
    year: 2022
    doi: 10.1093/eurheartj/ehac262
    url: https://doi.org/10.1093/eurheartj/ehac262
  - tier: guideline
    org: minzdrav-rf
    title: Наджелудочковые тахикардии
    year: 2025
    doi: 10.15829/1560-4071-2025-6448
    url: https://cr.minzdrav.gov.ru/view-cr/619_3
  - tier: reference
    org: msd-manuals
    title: Ventricular Premature Beats (VPB)
    year: 2024
    url: https://www.msdmanuals.com/professional/cardiovascular-disorders/specific-cardiac-arrhythmias/ventricular-premature-beats-vpb
  - tier: reference
    org: msd-manuals
    title: Ectopic Supraventricular Arrhythmias
    year: 2024
    url: https://www.msdmanuals.com/professional/cardiovascular-disorders/specific-cardiac-arrhythmias/ectopic-supraventricular-arrhythmias
  - tier: reference
    org: msd-manuals
    title: Ventricular Premature Beats (Consumer Version)
    year: 2024
    url: https://www.msdmanuals.com/home/heart-and-blood-vessel-disorders/abnormal-heart-rhythms/ventricular-premature-beats
  - tier: reference
    org: msd-manuals
    title: Atrial Premature Beats (Consumer Version)
    year: 2024
    url: https://www.msdmanuals.com/home/heart-and-blood-vessel-disorders/abnormal-heart-rhythms/atrial-premature-beats
sources_checked: 2026-10-13
review: null
---

A premature beat (extrasystole) is an extra heartbeat: the electrical impulse starts somewhere other than usual and before the next normal heartbeat would occur.<Cite n={[1, 6, 7]} /> If the extra impulse starts in the ventricles, it is called a ventricular premature beat (VPB, also known as a premature ventricular contraction, PVC); if it starts in the atria, it is an atrial premature beat.<Cite n={[6, 7]} /> Premature beats are very common both in healthy people and in people with heart disease, and nearly everyone has an occasional atrial premature beat.<Cite n={[4, 5]} /> How ventricular premature beats feel and what they mean for the outlook depend on their pattern, but even more on the underlying heart disease, if there is one.<Cite n={1} /> How the impulse normally travels through the heart is explained in the article on the [conduction system of the heart](../../anatomy/conduction-system/).

<Diagram name="extrasystole">
  <p slot="normal">
    Normally every heartbeat is started by an impulse from the sinus node in the right atrium.<Cite n={6} /> The impulse activates the atria, which is the P
    wave on the ECG, and then passes on to the ventricles, which is the QRS complex.<Cite n={7} /> So
    on the ECG strip every QRS complex has a P wave before it.
  </p>
  <p slot="disease">
    In a ventricular premature beat an extra impulse starts in a ventricle before the next normal
    heartbeat would occur.<Cite n={6} /> On the ECG it is an early, wide QRS complex without a P wave
    before it, its T wave points the other way, and it is typically followed by a fully compensatory
    pause.<Cite n={[1, 4]} /> People usually do not feel the premature beat itself: what they feel
    is the stronger normal beat that follows the pause.<Cite n={4} />
  </p>
</Diagram>

## Why it happens

<Patient>

Premature beats often occur in people with a healthy heart.<Cite n={[4, 7]} /> They may become more frequent with anxiety and stress, alcohol, caffeine, some medicines that stimulate the heart, a lack of oxygen and abnormal levels of salts (electrolytes) in the blood.<Cite n={4} /> Atrial premature beats may be caused or made worse by coffee, tea or alcohol and by some cold, hay fever and asthma remedies.<Cite n={7} /> Ventricular premature beats are particularly common in older adults, and atrial premature beats are more common in older than in younger people.<Cite n={[6, 7]} />

But premature beats can also be a sign of heart disease.<Cite n={[4, 5]} /> Causes of ventricular premature beats include [coronary heart disease](../coronary-heart-disease/), especially during or shortly after a heart attack, and conditions that enlarge the ventricles, such as [heart failure](../heart-failure/) and heart valve disease.<Cite n={6} /> Atrial premature beats are common in people with lung disease, such as chronic obstructive pulmonary disease (COPD).<Cite n={[5, 7]} />

</Patient>

<Student>

Ventricular premature beats are single ventricular impulses caused by re-entry within the ventricle or by abnormal automaticity of ventricular myocytes or Purkinje cells.<Cite n={4} />

Ventricular arrhythmias without structural heart disease (SHD) or channelopathies are called idiopathic.<Cite n={1} /> The right and left ventricular outflow tracts are a common source of idiopathic PVCs, and in 70 % of these cases it is the right ventricular outflow tract (RVOT).<Cite n={1} />

PVCs may be single or in pairs (couplets).<Cite n={1} /> They may occur erratically or at predictable intervals, for example every second beat (bigeminy) or every third beat (trigeminy).<Cite n={4} />

</Student>

## Symptoms

<Patient>

Rare single ventricular premature beats in a person without heart disease may cause no symptoms at all or only a feeling that the heart is beating irregularly.<Cite n={1} /> Atrial premature beats rarely cause symptoms.<Cite n={7} /> The main sensation is a strong or skipped heartbeat.<Cite n={6} />

Frequent premature beats with periods of bigeminy, especially in people whose heart pumps less strongly, may lower blood pressure and cause weakness, dizziness and shortness of breath.<Cite n={1} /> Very frequent ventricular premature beats can themselves weaken the heart: the ventricles enlarge and contract less well.<Cite n={[1, 4]} /> In many cases this improves partly or fully once the arrhythmia is treated.<Cite n={1} />

A fast heartbeat, feeling faint and fainting are the three most important symptoms that need a visit to a doctor and tests; if such symptoms come on during an episode, call an ambulance now (see below).<Cite n={1} />

</Patient>

<Student>

When PVCs occur at every second beat, the sinus rate is effectively halved, so mild haemodynamic symptoms are possible.<Cite n={4} />

Arrhythmia-induced cardiomyopathy is dilatation of the ventricles and reduced ventricular systolic function that most likely arose or worsened because of a rhythm disorder, such as frequent PVCs.<Cite n={1} /> PVC-induced cardiomyopathy with very frequent PVCs is particularly likely if the patient already has a cardiomyopathy.<Cite n={4} /> Ventricular enlargement is covered in more detail in the article on [dilated cardiomyopathy](../dilated-cardiomyopathy/).

</Student>

## How it is diagnosed

<Patient>

A doctor may notice extra beats when counting the pulse, measuring blood pressure or listening to the heart.<Cite n={1} /> Premature beats are confirmed on an [electrocardiogram](../../diagnostic/ecg/) (ECG).<Cite n={[6, 7]} /> To record infrequent premature beats and match them with symptoms, doctors use [Holter monitoring](../../diagnostic/holter-monitoring/): a portable device records the ECG continuously during everyday life for 18 hours or longer.<Cite n={1} />

When frequent ventricular premature beats are found for the first time, the European guidelines recommend starting with a 12-lead ECG, recording a premature beat on it whenever possible, and an [echocardiogram](../../diagnostic/echocardiography/) (heart ultrasound).<Cite n={2} /> These tests look for heart disease or rule it out.<Cite n={[1, 4]} /> The doctor may also check for causes that can be corrected, such as blood potassium and magnesium levels and an overactive thyroid.<Cite n={1} /> An exercise test is done if the premature beats appear with exertion or if coronary heart disease is suspected.<Cite n={[1, 4]} /> Sometimes a cardiac MRI is needed.<Cite n={[1, 2]} />

</Patient>

<Student>

On the ECG a PVC is a premature QRS complex of 120 ms or more, without a preceding P wave, with a T wave discordant to the main QRS deflection.<Cite n={1} /> A PVC is typically followed by a fully compensatory pause.<Cite n={4} />

An atrial premature beat occurs relatively early in the sinus cycle and may deform the T wave of the preceding beat; the sinus node is reset, and the pause before the next sinus beat is less than fully compensatory.<Cite n={5} /> Atrial premature beats may be conducted normally, aberrantly or not at all; aberrantly conducted ones (usually with right bundle branch block morphology) must be distinguished from premature beats of ventricular origin.<Cite n={5} />

PVC burden is the proportion of ventricular ectopic beats among all heartbeats during Holter monitoring.<Cite n={1} /> The Russian Ministry of Health guideline calls PVCs frequent when they exceed 10 % of beats, which matters for predicting the risk of arrhythmia-induced cardiomyopathy.<Cite n={1} /> According to the ESC, PVC-induced cardiomyopathy should be considered in patients with an unexplained reduced ejection fraction and a PVC burden of at least 10 %, and cardiac MRI should be considered when it is suspected.<Cite n={[1, 2]} /> In patients with a PVC burden above 10 % and normal ventricular function, ventricular function is assessed regularly.<Cite n={[1, 2]} />

There is no precise definition of excessive supraventricular ectopic activity; by expert consensus, a high burden of atrial premature beats is more than 500 in 24 hours on Holter monitoring.<Cite n={3} />

</Student>

## How it is treated

<Patient>

People with ventricular premature beats who have no heart disease and no weakening of the left ventricle have a good outlook for life, whatever the type of premature beats and their number per day.<Cite n={1} /> If there are very many premature beats, the doctor still checks from time to time how well the ventricles are working.<Cite n={[1, 2]} /> Occasional atrial premature beats in healthy people are generally considered harmless.<Cite n={5} /> If the heart is healthy and the premature beats are infrequent and cause no trouble, no medicines are needed; for a healthy person it is usually enough to reduce stress and avoid caffeine, alcohol and cold or hay fever remedies that stimulate the heart.<Cite n={[1, 6]} />

Before any treatment, the doctor looks for and corrects reversible causes: abnormal blood salt levels, ischaemia, lack of oxygen, fever.<Cite n={1} /> Without heart disease, the premature beats themselves need treatment only if they are clearly bothersome<Cite n={4} /> or if very frequent premature beats have started to weaken the heart.<Cite n={[1, 2]} /> The options are then medicines (beta-blockers or calcium channel blockers, less often other antiarrhythmic drugs) or catheter ablation.<Cite n={[2, 4]} /> In ablation a special catheter is passed through the blood vessels into the heart, and energy is applied to an area of heart muscle to stop the arrhythmia.<Cite n={1} /> The choice depends on whether there is heart disease and where the premature beats come from; the doctor and the patient decide together which way to go.<Cite n={[1, 2]} />

Every antiarrhythmic drug carries a considerable risk of side effects, including new rhythm disorders.<Cite n={1} /> That is why medicines are rarely used for ventricular premature beats: the risk of side effects is usually greater than the benefit.<Cite n={6} />

If there is heart disease, the most important condition for success is treating the disease itself.<Cite n={1} /> If frequent premature beats of one shape have weakened the heart, catheter ablation is recommended, and medicines are used if ablation is not possible, too risky or unsuccessful, or if the patient declines it.<Cite n={[1, 2]} />

Frequent atrial premature beats are rarely treated, only when they cause intolerable palpitations.<Cite n={7} /> For a high burden of atrial premature beats, guidelines recommend treating high blood pressure, losing excess weight and finding and treating sleep apnoea to lower the risk of supraventricular tachycardia.<Cite n={3} />

</Patient>

<Student>

ESC: catheter ablation as first-line treatment is recommended for symptomatic idiopathic PVCs and ventricular tachycardia (VT) from the RVOT or the left fascicles (class I); beta-blockers or non-dihydropyridine calcium channel blockers are indicated in symptomatic patients with idiopathic PVCs or VT from other origins (class I).<Cite n={2} /> The Russian Ministry of Health guideline also names catheter ablation as the treatment of choice for PVCs and VT from the RVOT.<Cite n={1} /> Drug treatment of asymptomatic infrequent PVCs is not recommended in patients without SHD or left ventricular (LV) dysfunction, because their risk of sudden cardiac death (SCD) is low.<Cite n={1} />

In patients with SHD or LV dysfunction, ventricular ectopic activity is associated with an increased risk of SCD.<Cite n={1} /> Nevertheless, no studies have shown that pharmacological suppression of PVCs reduces mortality, and after myocardial infarction class I antiarrhythmic drugs increase mortality compared with placebo.<Cite n={4} />

Frequent or grouped supraventricular premature beats may be regarded as an independent predictor of supraventricular tachycardia (SVT) and atrial fibrillation.<Cite n={3} /> Frequent atrial premature beats are also associated with an increased risk of stroke and death, but it is not known whether this is cause and effect or shared risk factors, such as ageing.<Cite n={5} /> It is not known whether treating a high burden of atrial premature beats with antiarrhythmic drugs or catheter ablation lowers the risk of SVT, stroke and death.<Cite n={3} /> An atrial premature beat can trigger an episode of AV nodal re-entrant tachycardia; see the article on [supraventricular tachycardia](../supraventricular-tachycardia/), and [atrial fibrillation](../atrial-fibrillation/) has its own article.<Cite n={3} />

</Student>

## When to call an ambulance

Call your local emergency number (112 in the EU, 911 in the US and Canada, 999 in the UK) if irregular beats or an episode of arrhythmia come with dizziness, weakness, a fast heartbeat, feeling faint or loss of consciousness.<Cite n={1} /> A fast heartbeat, feeling faint and fainting need tests to rule out dangerous ventricular rhythm disorders.<Cite n={1} /> In people with heart disease, frequent ventricular premature beats may be followed by [ventricular tachycardia](../ventricular-tachycardia/) or ventricular fibrillation, which can cause sudden death.<Cite n={6} />

<Quiz />