Heart Health Heart Disease Palpitations & Arrhythmias Print Premature Atrial Complexes (PACs) Causes and Treatment By Richard N. Fogoros, MD facebook linkedin Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology. He is Verywell's Senior Medical Advisor. Learn about our editorial process Richard N. Fogoros, MD Medically reviewed by Medically reviewed by Jeffrey S. Lander, MD on April 05, 2020 twitter linkedin Jeffrey S. Lander, MD, is a board-certified cardiologist and the incoming President and Governor of the American College of Cardiology, New Jersey chapter. Learn about our Medical Review Board Jeffrey S. Lander, MD on April 05, 2020 Arrhythmia Overview Symptoms Causes Diagnosis Treatment In This Article Table of Contents Expand Normal Heart Rhythm Causes How Important Are PACs? Symptoms Treatment View All Premature atrial complexes, or PACs, are “extra” heartbeats that arise within the atria of the heart. PACs are the most common variety of cardiac arrhythmia. In fact, PACs are so common that most people will have them occasionally. Verywell / Cindy Chung The Normal Heart Rhythm The normal heart rhythm is controlled by a tiny structure called the sinus node, which is located near the top of the heart's right atrium. The sinus node generates the electrical signal that initiates the heartbeat and controls the heart rate. Typically, the sinus node "discharges" these electrical impulses between 50 and 90 times per minute at rest. When a person's heart rhythm is being controlled by the sinus node in this normal fashion, doctors often call it "normal sinus rhythm." Causes PACs are early (that is, premature) electrical impulses that are generated within the cardiac atria, but not from the sinus node. PACs momentarily interrupt the normal sinus rhythm by inserting an "extra" heartbeat. Because a PAC can “reset” the sinus node, there is usually a short pause before the next normal heartbeat occurs. So PACs are often perceived as a “skip” in the heartbeat. If you have been told you have PACs, you can rest assured that you are in the majority. Almost everyone has them. In one study of over 1700 healthy adults, 99 percent had at least one PAC in 24 hours of cardiac monitoring. How Important Are PACs? PACs generally have very little medical significance, and are viewed (appropriately) by most doctors as a variation of "normal." However, in recent years, doctors have learned that PACs may be important in people who have episodes of atrial fibrillation. In some people with atrial fibrillation, PACs are thought to trigger episodes of this arrhythmia. For this reason, some of the ablation procedures that are used to treat atrial fibrillation are aimed at eliminating PACs. However, it remains true that in the vast majority of people who have them, PACs have no known medical significance and pose no known risk. Symptoms Fortunately, in the large majority of people, PACs do not cause any symptoms at all. Still, some people will experience palpitations, in which case they usually describe a "skipping" sensation, or an unusually strong heartbeat. Experiencing palpitations with PACs is more likely after ingesting alcohol, tobacco, caffeine, or medications containing stimulants. Treatment Unless a person's PACs are thought to be triggering episodes of atrial fibrillation, it is almost never "necessary" to treat them. However, occasionally a person will experience intolerable palpitations from their PACs, and treatment will become desirable. The best way to treat PACs is to avoid the substances (alcohol, caffeine, tobacco, etc.) that seem to make symptoms worse. Rarely, the PACs are so disruptive to a person's life that it may be worth trying to suppress them with medication or other interventions. Beta blockers may help reduce symptoms of PACs in some people and are generally recommended as the first step when treatment is deemed necessary. Antiarrhythmic drugs may be effective in reducing PACs, but these drugs are often quite toxic and are not recommended for PACs unless they are causing extremely severe and intolerable symptoms. Ablating the areas of the atria that are producing PACs is now feasible, but this form of treatment is invasive and carries the risk of serious complications. Ablating PACs is virtually always reserved for those patients in whom the PACs are triggering more serious arrhythmias, such as atrial fibrillation. A Word From Verywell PACs are very common and are almost always completely benign—so unless there is a very good reason to do otherwise, by far the wisest treatment is to leave them alone. If you have PACs that are producing palpitations, have a long talk with your doctor before you agree to any treatment more aggressive than lifestyle changes. Was this page helpful? Thanks for your feedback! Did you know the most common forms of heart disease are largely preventable? Our guide will show you what puts you at risk, and how to take control of your heart health. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Conen D, Adam M, Roche F, et al. Premature Atrial Contractions in the General Population: Frequency and Risk Factors. Circulation 2012; 126:2302. Brooks AG, Rangnekar G, Ganesan AN, et al. Characteristics of Ectopic Triggers Associated with Paroxysmal and Persistent Atrial Fibrillation: Evidence for a Changing Role. Heart Rhythm 2012; 9:1367. Chong BH, Pong V, Lam KF, et al. Frequent Premature Atrial Complexes Predict New Occurrence of Atrial Fibrillation and Adverse Cardiovascular Events. Europace 2012; 14:942.