Definition
A premature atrial contraction (PAC) occurs when an extra heart beat originates at the top of the heart (atrium). These extra signals usually, but not always, make their way down to the bottom of the heart. This can often cause someone to feel an extra or a “skipped” beat, though many of these beats are asymptomatic. Nearly everyone experiences a few PACs every day, but frequent PACs have been linked to conditions such as atrial fibrillation.
ECG feature
The PACs are typically identified by a “p-wave” that is observed before the next normal heart beat is expected. The premature p-wave can look normal, but is usually shaped a bit differently. Most of these beats are followed by a normal looking QRS complex, although PACs that are very early may not be able to send a signal to the bottom of the heart. Frequent PACs can be difficult to distinguish from sinus arrhythmia [link to sinus arrhythmia], which is more commonly found in young healthy people. A 12-lead electrocardiogram could further help distinguish between these two.
Cause
A few PACs per day are completely normal. However, frequent PACs can be caused by stretching and scarring of the top chambers (atria) which lead to electrical disturbances. Factors that can contribute to frequent PACs include high blood pressure, diabetes, obesity and several underlying conditions such as heart failure and thyroid disease.
Next step
Those showing signs of two or more PACs during a 30 second period may have frequent PACs and should see their health care provider as soon as possible for a more accurate measurement of daily PAC counts and medical consultation.