Synopsis
Distinguish common benign ectopy from premature beats that signal structural disease, inherited risk or ectopy-induced cardiomyopathy.
- A premature atrial contraction (PAC) has an early abnormal P wave, usually followed by a narrow QRS unless conducted aberrantly.
- A premature ventricular contraction (PVC) is an early broad QRS without a preceding conducted P wave, usually followed by a full compensatory pause.
- Isolated monomorphic ectopy in an asymptomatic person with a normal heart is commonly benign.
Key red flags
Syncope, exertional symptoms, prior infarction, cardiomyopathy, myocarditis, congenital heart disease or a family history of early sudden death warrants prompt specialist assessment.
Investigation priorities
Confirm premature-beat origin and screen the baseline tracing for ischaemia, pre-excitation, QT abnormality or cardiomyopathy clues.
Management branches
Symptoms correlate with isolated PACs/PVCs and there are no red flags or structural abnormalities.
- Explain the premature beat, pause and post-ectopic thump using the recorded tracing.
- Reduce relevant triggers such as excess caffeine, alcohol, nicotine, stimulants, dehydration and sleep loss.
Key medicines
BisoprololFor troublesome ectopy, an NHS pathway uses 1.25-2.5 mg by mouth once daily initially; titrate cautiously to symptoms and pulse. The product SmPC uses 5 mg daily as a standard cardiovascular starting dose, so low-dose ectopy use is individualised/off-label.