From the Guidelines
Ectopy is defined as the abnormal location or displacement of cells, tissues, or organs from their normal anatomical position, commonly describing irregular heartbeats where electrical impulses originate from an abnormal location in the heart. In medical contexts, ectopy most commonly refers to cardiac ectopy, which results in premature contractions. These can occur in the atria (premature atrial contractions or PACs) or ventricles (premature ventricular contractions or PVCs) [ 1 ].
Key Points
- Most isolated ectopic beats are benign and don't require treatment, especially in patients without underlying heart disease [ 1 ].
- However, frequent ectopy may cause symptoms like palpitations, dizziness, or chest discomfort.
- Management depends on symptom severity and underlying conditions, ranging from lifestyle modifications (reducing caffeine, alcohol, and stress) to medications like beta-blockers or calcium channel blockers for symptomatic cases [ 1 ].
- In severe cases with structural heart abnormalities, antiarrhythmic drugs or procedures like catheter ablation might be necessary [ 1 ]. Some key considerations in managing ectopy include:
- The presence of underlying cardiopulmonary disease, drug toxicity, or metabolic derangements [ 1 ].
- The use of beta-blocker therapy to reduce the incidence of arrhythmias during the perioperative period [ 1 ].
- The role of electrophysiologic testing and catheter ablation in select cases [ 1 ].
From the Research
Definition of Ectopy
- Ectopy refers to a condition where there are abnormal heartbeats, also known as arrhythmias, that originate from outside the normal conduction pathway of the heart 2, 3, 4.
- These abnormal heartbeats can arise from the ventricles (ventricular ectopy) or the atria (atrial ectopy) 2, 4.
Types of Ectopy
- Ventricular ectopy: beats arising from within the ventricles, also known as ventricular extrasystoles, premature ventricular contractions or complexes (PVC), and ventricular premature depolarisations (VPD) 2.
- Atrial ectopy: supraventricular beats arising from a focus other than the sinus node, also known as premature atrial complexes (PAC) or atrial premature depolarisations (APD) 4.
Characteristics of Ectopy
- Ventricular ectopy is characterized by a broad (>110 ms), premature, ventricular complex (QRS deflection); no evidence of pure atrioventricular (AV) conduction; a full, more than, or less than compensatory pause; and discordant QRS and T wave axis 2.
- Atrial ectopy is characterized by prematurity and P wave morphology, with associated features of variable atrioventricular (AV) conduction, variable post-ectopic pauses, and variable QRS morphology due to aberrancy 4.
Prevalence and Risk of Ectopy
- Ventricular ectopy is a very common finding on Holter monitoring at all ages, but particularly in the elderly, and is generally infrequent and a benign finding in the otherwise normal heart 2, 3.
- However, in patients with heart disease, ventricular ectopy may be a harbinger to more serious ventricular tachyarrhythmias 2, 3.
- Atrial ectopy is also a common finding on Holter ECG monitoring at all ages, and is generally infrequent and an innocent finding in the otherwise normal heart, but may be a harbinger to more serious atrial tachyarrhythmias in patients with heart disease 4.