Extrasystoles are very common and most often benign when they occur in a healthy heart; they can be serious when combined with heart disease.

Extrasystole is an abnormal heart rhythm (or arrhythmia). During an extrasystole, there is too early a contraction of the heart muscle (myocardium) and this contraction is inserted between normal beats. Normally, the heart contracts after the birth of an electrical stimulation on what is called the sinus node (located on in the right atrium of the heart). The electrical flow propagates to the whole heart, triggering the myocardial contraction, then, this contraction is followed by a pause.

When the electrical impulse originates from a focus other than the sinus node, it is also transmitted to the whole of the heart causing an additional contraction, the extrasystole. We speak of atrial or atrial extrasystole (ESA) when this abnormal focus is located in the atrium, ventricular extrasystole (ESV) when the abnormal focus is located in the ventricle, junctional extrasystole (ESJ) when is located at the junction between atrium and ventricle. The atrial and junctional extrasystoles are grouped together under the name of supra-ventricular extrasystoles, because their appearance and their causes are similar.

Extrasystoles are very common, and all healthy people get a few of them a day. They increase with age. They are also quite common in pregnant women. 

Ventricular extrasystoles (ESV) are more frequent than ESA and commonplace in healthy subjects and all the more so in high-level athletes. Junctional extrasystoles (JES) are rarer.  

Extrasystoles occurring in a healthy heart are favored by stimulants such as alcohol, tobacco, caffeine, drugs (amphetamines, cocaine, etc.), stress, certain drugs such as digitalis or vasoconstrictors in the nasal mucosa. pseudoephedrine base, mainly oral forms yet sold without a prescription. The fine particles of polluted air have also recently been incriminated. VSE is also facilitated by low potassium or magnesium levels and can be found in chronic respiratory illnesses, digestive illnesses such as hiatal hernia or gallstones, hyperthyroidism.

Extrasystoles can occur in a sick heart, and in this case all cardiac pathologies can be concerned, and in particular coronary artery disease (infarct ou angina pectoris), heart valve damage, heart failure, certain congenital heart diseases.  

The elderly, people with cardiac and respiratory pathologies, hyperthyroidism.

Risk factors

• consumption of alcohol, tobacco, drugs, stress.
• the role of caffeine is controversial, but its removal can lead to the disappearance of extrasystoles.
• fine particles in polluted air have also recently been implicated.
• ESVs are also facilitated by a low potassium or magnesium level.
• heart disease.

The extrasystole is sometimes followed by a short break, compensatory rest. The latter results in improved cardiac filling. The following contraction is therefore more efficient, stronger. It is the latter that is felt during palpitations related to extrasystoles and not the extrasystole itself. The symptoms are very variable. Extrasystoles can be experienced as palpitations, feelings of irregular heartbeat, “shock” in the chest, feeling of pausing too long before the next heartbeat. They differ from tachycardias (increased heart rate) which are more painful and cause discomfort.

Very often, extrasystoles are not felt and are discovered during an EKG test done for some other reason. 

It is necessary to consult your doctor when the extrasystoles are felt and numerous, when there are palpitations and a fortiori in the event of chest pain, shortness of breath, or a feeling of discomfort.

Extrasystoles can be heard by the doctor on auscultation.

The electrocardiogram (ECG) is used to make the diagnosis of extrasystole, and it shows whether it is atrial or ventricular extrasystoles, and may show signs suggestive of an underlying cardiac or coronary pathology. But extrasystoles may be absent when the ECG is done. Also is completed by a Holter examination which records with a continuous electrocardiogram, the heartbeat during 24H / 48H. The person wears for 24/48 hours electrodes placed on the chest and connected to a portable recorder. During this time, she should carry out normal activity and note any symptoms she feels. The Holter makes it possible to observe any extrasystoles, their importance, their number, their correlation with the symptoms felt, as well as the presence of attacks of arrhythmias such as tachycardia or fibrillation.

It is necessary to look for events triggering the appearance of extrasystoles.  

The cardiac assessment then includes an echocardiography to estimate the cardiac function and the presence or not of an underlying cardiac pathology. It may be supplemented by other examinations depending on the results. 

They are directly dependent on the variety of extrasystoles and the existence or not of associated heart disease.

Extrasystoles ventricular (ESV) can be serious in themselves if they are numerous, repetitive, that there are several foci of excitation, in particular in cardiac pathologies where they can cause tachycardia or atrial fibrillation with sometimes a risk of sudden death.

Atrial extrasystoles are benign when isolated and occur in a healthy heart. When they are repeated and especially when there is cardiac damage, they can lead to atrial fibrillation (ineffectiveness of the beating of the atria) and impair cardiac function. 

Even in VSEs occurring in a healthy heart, it is necessary to ensure regular monitoring, cardiovascular disease can develop later, especially if there are cardiovascular risk factors, hypertension, diabetes, obesity, cholesterol, sleep apnea. 

Prevention

• Stop smoking,
• Limit the consumption of alcohol and caffeine,
• Learn to manage stress, and failing to be able to remove it entirely.
• Do not use drugs based on pseudoephedrine.
• Walk 30 to 40 minutes at least 3 times a week.  

Treatments

Treatment depends on the severity of symptoms and whether or not there is a heart disease that requires specific treatment.

• When there are no symptoms and the cardiac assessment is normal, we stick to the above recommendations for the prevention of recurrence of extrasystoles.
• When the person is bothered by their extrasystoles, they may be prescribed treatment with beta-blockers which limit heart rhythm disturbances and reduce anxiety, or calcium channel blockers which reduce the rhythm disturbances. Other drugs intended to fight against arrhythmia can be used in case of failure of the latter but their use is limited by their side effects and their contraindications.
• Removal of the cardiac foci responsible for extrasystoles may be considered if symptoms persist despite treatment. The targeted destruction of these foci of irritation by the application of heat (radiofrequency ablation) or cold (cryoablation) is achieved through the introduction of a catheter introduced through the femur and mounted to the heart.
• When there is a risk of tachycardia or ventricular fibrillation in certain heart diseases, placement of an implantable defibrillator may be necessary.

Complementary approaches

•  In case of extrasystoles on a healthy heart, alternative solutions based on plants (valerian, hops, lemon balm, hawthorn, etc.), or homeopathy (Nux vomica, Coffea, Spigelia, Ignata, Digitalis purpurea). Talk to our doctor.
• Honey could have beneficial effects.
• To limit the extrasystoles linked to stress, it is advisable to inhale slowly fully then to block the breathing and start again about ten times.
• “Cardiac coherence” could be beneficial. It is based on the fact that respiratory control influences heart rate. The principle is to practice breathing exercises ideally 3 times a day. During these 3 to 5 minute exercises, it is sufficient to gradually slow down the respiratory rate to 6 breaths per minute. Various smartphone or computer applications offer guides for performing these exercises.