Is your racing heart an arrhythmia? What Mayo Clinic experts say.

Arrhythmia: What a racing or skipping heartbeat really means

Arrhythmia is an abnormal heart rhythm that can make the heart beat too fast, too slowly or irregularly, and recognising the difference between harmless palpitations and a potentially serious rhythm problem is important. A racing, fluttering or skipped heartbeat does not automatically mean that something dangerous is happening, but it can sometimes be a sign of an abnormal electrical rhythm in the heart.

Mayo Clinic cardiovascular medicine specialist Divya Korpu, MBBS, explains that arrhythmias can affect people of different ages and may arise from the upper or lower chambers of the heart. Premature atrial contractions and premature ventricular contractions are common causes of skipped or extra beats and are generally not dangerous in otherwise healthy people.

Older adults are more likely to develop atrial fibrillation or atrial flutter, conditions that require medical assessment because they can increase the risk of blood clots and stroke. Modern treatment ranges from medicines and temporary techniques called vagal manoeuvres to catheter ablation, including newer pulsed field ablation for selected patients.

Key Takeaways

Arrhythmia occurs when the heart’s electrical signals produce an abnormal rhythm.
PACs and PVCs often cause harmless sensations of skipped or extra beats.
Atrial fibrillation becomes more common with age and can increase stroke risk.
Catheter ablation can treat some abnormal electrical circuits in the heart.
Chest pain, shortness of breath or fainting with an abnormal heartbeat requires urgent medical attention.

What is an arrhythmia?

The heart is an electrical organ as well as a muscular pump. Every heartbeat depends on precisely timed electrical signals that tell the heart’s chambers when to contract. In a normal rhythm, the electrical signal begins in a specialised group of cells called the sinus node, travels through the upper chambers, reaches the atrioventricular, or AV, node and then passes into the lower chambers, known as the ventricles. This coordinated electrical activity allows the heart to pump blood efficiently throughout the body.

An arrhythmia occurs when this electrical system does not produce or conduct signals normally. The result can be a heartbeat that is too fast, too slow or irregular. The medical term for a fast heartbeat is tachycardia, while a slow heartbeat is called bradycardia. A normal heart can also speed up during exercise or slow during sleep, so a change in heart rate by itself does not necessarily mean that an arrhythmia is present.

This distinction is important because people frequently use the words “racing heart”, “palpitations” and “arrhythmia” as though they mean the same thing. They do not. Palpitations describe the sensation of being aware of the heartbeat. An arrhythmia describes an abnormal electrical rhythm. A person can experience palpitations without having a dangerous arrhythmia, while another person can have an arrhythmia without feeling anything at all.

Why does the heart suddenly race or skip?

The Mayo Clinic explains that a racing or skipped heartbeat can occur when an abnormal electrical signal interrupts the heart’s normal rhythm. People may experience this as a racing, fluttering or skipping sensation in the chest. Some people also experience anxiety or a sense of panic when the sensation occurs. These symptoms can be particularly noticeable at night or when lying down, when there are fewer distractions and the heartbeat may become more noticeable.

In younger adults, particularly people in their 20s through 50s, the heart can sometimes suddenly accelerate from a normal rate to approximately 180 to 200 beats per minute. Such a rapid rhythm can produce lightheadedness, dizziness, anxiety and, in some cases, fainting. The speed and suddenness of the change can understandably be frightening, but the sensation itself does not tell a person whether the rhythm is harmless or requires treatment.

That is why recurrent or unexplained episodes should be assessed by a healthcare professional rather than diagnosed from symptoms alone. An electrocardiogram, commonly called an ECG or EKG, can provide information about the electrical activity of the heart. Depending on how often symptoms occur, clinicians may also use longer-term heart rhythm monitoring to capture an episode that does not happen during an ordinary office examination.

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PACs and PVCs: The common causes of a skipped beat

Some of the most common causes of the sensation that the heart has skipped a beat are premature atrial contractions, or PACs, and premature ventricular contractions, or PVCs. PACs begin in the upper chambers of the heart, called the atria. PVCs originate in the lower chambers, called the ventricles.

A premature beat occurs earlier than expected. After it happens, the following normal beat can feel stronger, which can create the sensation that the heart paused and then gave a powerful thump. In other words, what feels like a skipped beat can actually be an early beat followed by a brief change in the timing of the next beat.

For many otherwise healthy people, occasional PACs and PVCs are not dangerous. PACs and PVCs are most common in younger people. For older adults, the most common fast rhythm is atrial fibrillation (AFib) or atrial flutter. These are different types of heart rhythms which become increasingly common with age.

These premature beats generally are not life-threatening and do not cause heart attacks or strokes or increase the risk of death. Current guidance similarly describes premature beats as generally not a concern, although frequent premature ventricular beats can sometimes contribute to weakening of the heart muscle, particularly in susceptible people.

Several factors can make premature beats more noticeable or more frequent. The supplied Mayo Clinic identifies an abnormal electrical circuit present from birth, thyroid disorders, hormonal changes associated with pregnancy or menopause, and excessive caffeine or alcohol consumption. Broader Mayo Clinic guidance also identifies stress, nicotine, certain medicines and stimulants as possible contributors to palpitations and premature beats.

When a racing heart becomes more concerning

Not every fast heartbeat is an emergency, but some symptoms make medical evaluation particularly important. Mayo Clinic advises people who feel that their heart is beating too fast, too slowly or skipping beats to arrange a health assessment. A cardiologist may be involved when a heart rhythm disorder is suspected.

The situation becomes more urgent when an abnormal heartbeat is accompanied by chest pain, shortness of breath or fainting. Mayo Clinic identifies these symptoms as reasons to seek emergency medical care. A person who believes they may be experiencing a heart attack should call 911 or the appropriate local emergency number.

Fainting deserves particular attention because it can indicate that the heart is temporarily failing to provide enough blood flow to the brain. Similarly, significant dizziness during a very rapid heartbeat can indicate that the rhythm is affecting the heart’s ability to maintain adequate circulation.

The important principle is that the severity of an arrhythmia cannot reliably be determined by how dramatic the heartbeat feels. Some frightening palpitations are caused by benign premature beats, while some potentially important arrhythmias produce few or no symptoms.

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What causes arrhythmia?

Arrhythmias can have many causes because the heart’s electrical system is influenced by the structure of the heart, other organs, hormones, medications, substances and inherited characteristics.

The Mayo Clinic specifically identifies thyroid disorders, hormonal changes, excessive caffeine and alcohol and abnormal electrical circuits present from birth. Atrial fibrillation, another major form of arrhythmia, can also be associated with untreated sleep apnea, alcohol consumption and other underlying health conditions.

Current Mayo Clinic expands this picture to include coronary artery disease, previous heart attacks, cardiomyopathy, high blood pressure, diabetes, sleep apnea, electrolyte abnormalities, certain medicines, smoking, genetic factors and some forms of drug misuse. Stress and anxiety can also contribute to palpitations and may influence the perception of an abnormal heartbeat.

This is one reason doctors do not treat every arrhythmia in the same way. The electrical rhythm is only part of the medical picture. A clinician also needs to understand the patient’s age, medical history, heart structure, medications, symptoms and potential underlying causes.

Atrial fibrillation becomes more important with age

The Mayo Clinic distinguishes the common premature beats seen in younger people from the fast rhythms that become more common among older adults. Atrial fibrillation, commonly called AFib, and atrial flutter are particularly important because they can have consequences beyond the sensation of an irregular heartbeat.

AFib occurs when the electrical signals in the atria become chaotic. Instead of contracting in a coordinated rhythm, the upper chambers quiver irregularly while electrical signals reach the ventricles in an abnormal pattern. The result is often an irregular and sometimes rapid heartbeat.

Symptoms can include palpitations, chest discomfort, dizziness, lightheadedness, fatigue, weakness, reduced ability to exercise and shortness of breath. Some people have no noticeable symptoms at all, and AFib may be discovered during a routine examination or while undergoing another medical procedure.

AFib matters because blood can pool in parts of the atria when they are not contracting normally. Blood pooling can encourage clot formation. If a clot travels through the bloodstream to the brain, it can block blood flow and cause an ischaemic stroke. Consequently, treatment for AFib is not limited to making the heartbeat feel normal. Preventing blood clots and reducing stroke risk are central parts of management.

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How is arrhythmia treated?

Treatment depends on the type of arrhythmia, its cause, the symptoms it produces and the individual’s risk factors. Some people with occasional PACs or PVCs require no specific treatment beyond monitoring and addressing possible triggers. If premature beats become troublesome, medication may be used to suppress them.

For certain sudden fast rhythms, doctors may recommend a technique known as a vagal manoeuvre. These techniques stimulate the vagus nerve and can sometimes interrupt particular abnormal electrical rhythms. The Mayo Clinic describes several manoeuvres, including bearing down as though having a bowel movement, blowing into a straw with one end closed, clearing the ears as though during an aircraft flight, putting the face into ice-cold water or taking a cold shower.

These techniques are temporary measures and do not eliminate an underlying abnormal electrical circuit. They also are not appropriate for every type of arrhythmia, which is why a person with recurrent episodes should obtain professional medical advice rather than repeatedly attempting to manage unexplained rapid heartbeats independently.

When an abnormal electrical pathway is responsible for repeated episodes, catheter ablation may provide a more definitive treatment. During an electrophysiology study, doctors use specialised catheters to map the heart’s electrical activity and identify the source of the abnormal rhythm. The catheter can then deliver energy to eliminate the tissue responsible for the abnormal electrical circuit.

For certain arrhythmias, this can be performed through blood vessels accessed from the groin. The Mayo Clinic describes ablation for some rapid rhythms as typically being performed with sedation and often as a same-day procedure, although exact treatment, anaesthesia and recovery requirements vary according to the arrhythmia and individual patient.

Catheter ablation and the newer pulsed field approach

Catheter ablation has traditionally relied on thermal energy. Radiofrequency ablation uses heat to destroy targeted tissue, while cryoablation uses extreme cold. These techniques remain important tools in the treatment of abnormal heart rhythms.

A newer approach called pulsed field ablation, or PFA, uses a nonthermal form of energy. Rather than heating or freezing tissue, the technique delivers short bursts of high-energy electrical pulses that affect targeted heart cells. Mayo Clinic describes the technology as irreversible electroporation and reports its use for selected patients with atrial fibrillation.

The significance of PFA is its potential to selectively affect heart muscle while reducing the likelihood of damaging nearby structures. The supplied Mayo Clinic specifically discusses structures such as the oesophagus and the phrenic nerve, which is involved in controlling the diaphragm and breathing.

PFA does not mean that every person with AFib should receive this treatment. Catheter ablation remains an individual clinical decision based on the patient’s rhythm, symptoms, medical history, previous treatment and overall risk profile. Mayo Clinic’s current information describes PFA as an option for selected patients rather than a universal replacement for other treatments.

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Why blood thinners can be important in AFib

One of the most important differences between occasional PACs or PVCs and atrial fibrillation is the potential for blood clot formation.

People with AFib may be prescribed anticoagulant medication, commonly referred to as a blood thinner, depending on their individual risk of stroke. The purpose is not primarily to slow the heartbeat. Instead, anticoagulation reduces the blood’s ability to form harmful clots.

The need for anticoagulation can continue even after catheter ablation because eliminating the abnormal rhythm does not automatically eliminate every underlying risk factor for stroke. The supplied Mayo Clinic explains that people diagnosed with AFib or atrial flutter may continue to receive blood-thinning treatment after ablation depending on their individual circumstances.

For people who cannot tolerate anticoagulant medication, the source also describes another strategy involving a permanent device that seals off the left atrial appendage, the area where many clots associated with AFib develop. This approach is designed to reduce stroke risk in appropriately selected patients.

When should you see a doctor about arrhythmia?

A racing or skipping heartbeat should not automatically be interpreted as a medical emergency, but recurring, unexplained or worsening symptoms deserve professional assessment. The same applies when palpitations occur alongside dizziness, lightheadedness or fainting.

Mayo Clinic recommends medical evaluation for people who experience sensations that their heart is beating too quickly, too slowly or skipping beats. A healthcare professional can determine whether the sensation represents a benign premature beat, another form of arrhythmia or a symptom caused by something outside the heart.

Emergency care is appropriate when an abnormal heartbeat occurs with chest pain, shortness of breath or fainting. These symptoms can indicate a more serious cardiovascular problem and should not be attributed to anxiety or harmless palpitations without medical assessment.

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The bottom line on arrhythmia

Arrhythmia is a broad medical term covering abnormal heart rhythms rather than a single disease. A heartbeat can become too fast, too slow or irregular for many different reasons, and the significance varies substantially from one person to another.

For many younger people, the sensation of a skipped beat is caused by PACs or PVCs, which are generally harmless. For older adults, atrial fibrillation and atrial flutter become increasingly important because they can produce symptoms ranging from palpitations and fatigue to dizziness and fainting, while AFib can also increase the risk of blood clots and stroke.

Modern cardiology offers a growing range of treatments, from medication and rhythm monitoring to catheter ablation and newer nonthermal technologies such as pulsed field ablation. The key is identifying the actual rhythm responsible for the symptoms rather than attempting to diagnose the condition from the sensation alone.

If your heart is racing, fluttering or apparently skipping beats, the appropriate response depends on what is causing the rhythm and what other symptoms are present. As Mayo Clinic advises, people experiencing these symptoms should consult a healthcare professional or cardiologist to determine whether further evaluation or treatment is necessary.