Heart rhythm irregularities — commonly marked by sensations of a racing, fluttering, or skipping heartbeat — are a common concern that affect people across age groups, and Mayo Clinic experts have outlined key details on their origins, risk factors, and modern treatment options to help patients navigate these symptoms.
Divya Korpu, a MBBS physician with the Department of Cardiovascular Medicine at Mayo Clinic Health System in Eau Claire, Wisconsin, explains that abnormal heart rhythms, clinically referred to as arrhythmias, are broadly grouped into two classifications: rhythms that beat too quickly, and rhythms that beat too slowly. Most of the noticeable symptoms people report, including racing pulses or skipped beats, fall into the faster arrhythmia category, and these uncomfortable sensations, called palpitations, are often more prominent when a person is resting at night or lying down. In some cases, the unusual rhythm can also trigger an unexpected feeling of panic.
For adults between their 20s and 50s, a common presentation is a sudden jump in heart rate from a normal baseline to 180 to 200 beats per minute. This rapid pulse can lead to lightheadedness, dizziness, heightened anxiety, and even fainting in severe cases.
Fast or irregular beats can originate in either the upper (atrial) or lower (ventricular) chambers of the heart. Beats that start in the top chamber are called premature atrial contractions, or PACs, while those that develop in the bottom chambers are called premature ventricular contractions, or PVCs. While the unusual sensations they cause can feel frightening, Korpu emphasizes that both PACs and PVCs are rarely dangerous or life-threatening, and they do not increase a person’s risk of heart attack, stroke, or death.
Several common triggers and underlying causes are linked to these irregular beats. These include congenital abnormal electrical circuits in the heart, thyroid disorders, hormonal shifts brought on by pregnancy or menopause, and excessive intake of caffeine or alcohol.
Management of these irregularities depends on how frequently symptoms occur and how much they interfere with daily life. If episodes are rare and do not disrupt routine activities, many patients are able to adapt and live with minor discomfort without ongoing intervention. For people who find symptoms bothersome, prescription medication can effectively reduce the frequency of extra heartbeats.
For immediate relief during a sudden episode of racing heart, a vagal maneuver can often interrupt the abnormal rhythm. These simple, at-home techniques include bearing down similarly to when having a bowel movement, blowing into a capped straw, equalizing ear pressure like one does when flying, submerging the face in ice-cold water, or taking a cold shower.
These at-home strategies are only temporary fixes, however. If symptoms persist, clinicians will typically refer patients for further testing and definitive treatment. One common long-term solution is an electrophysiology study followed by catheter ablation. During this procedure, thin catheters are threaded through veins in the groin and guided to the heart, where specialized wires pinpoint the source of the abnormal rhythm. Targeted energy is then delivered through the catheter to disable the problematic electrical circuit.
Catheter ablation for common arrhythmias like PACs and PVCs is usually performed under twilight sedation as an outpatient same-day procedure. After the procedure, patients need a companion to accompany them for 24 hours, must avoid driving for a full day, and should refrain from heavy lifting for one week to allow the groin incisions to heal fully. Once the recovery period ends, most patients can return to all their regular activities.
While PACs and PVCs are the most common fast arrhythmias in younger populations, the most prevalent rapid rhythm condition in older adults is atrial fibrillation, or AFib, or a related condition called atrial flutter. Both conditions become far more common as people age, and they present differently than younger-onset arrhythmias. AFib can cause irregular pulses, palpitations, chest discomfort, lightheadedness, dizziness, fatigue, and occasional fainting. Many patients, however, experience no obvious symptoms, and the condition is only detected during routine medical checkups or testing for other health concerns.
Common triggers for AFib mirror many of those for other arrhythmias, including untreated sleep apnea, excessive caffeine intake, binge or chronic overconsumption of alcohol, thyroid disorders, and hormonal shifts. A small share of patients also report that spicy foods trigger their AFib episodes.
There are multiple evidence-based treatment options available for AFib. These include medications to control elevated heart rate, medications to restore and maintain a normal heart rhythm, and catheter ablation. Unlike ablation for PACs and PVCs, AFib ablation is performed under general anesthesia, and it also is a minimally invasive procedure where clinicians access the heart through the groin to target trigger points on the left side of the heart that sustain the abnormal rhythm. For decades, two primary energy types have been used for the procedure: radiofrequency ablation, which uses heat, and cryoablation, which uses cold to disable problematic tissue.
In recent years, a new nonthermal energy option called pulsed field ablation has been introduced for AFib treatment. This innovative approach selectively targets heart muscle cells, which significantly lowers the risk of serious damage to adjacent tissues and structures, including the esophagus and the phrenic nerve that controls the diaphragm and breathing.
Regardless of the energy type used for AFib ablation, recovery guidelines are similar: patients can expect about one week of restricted activity to heal properly. A key risk associated with AFib is that blood can pool in the heart during irregular beats, forming clots that can travel to the brain and cause a stroke. For this reason, clinicians usually prescribe blood thinners to most patients after an AFib diagnosis, even after they have undergone successful ablation, based on individual stroke risk factors. For patients who cannot tolerate blood thinners, a small permanent device can be implanted in the heart to seal off the left atrial appendage — the structure where 90% of AFib-related clots form — to reduce stroke risk.
Experts stress that anyone experiencing persistent racing heart, skipped beats, or other symptoms of an irregular heart rhythm should schedule an appointment with their primary healthcare provider or a cardiologist to get a proper evaluation and determine if further testing or treatment is needed.
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