Premature Atrial Complexes (PACs) Causes and Treatment

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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, an estimated 50% of all people with or without heart disease have them. While PVCs themselves are usually benign, some research suggests they may be associated with increased cardiovascular risk.

What to Know About Premature Atrial Complexes (PACs)
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.

PAC 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.

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% had at least one PAC in 24 hours of cardiac monitoring.

Experiencing palpitations with PACs is more likely after ingesting alcohol, nicotine, or medications containing stimulants. Many experts associate caffeine with PACs, but studies have yet to confirm this relationship in the general population.

How Significant 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.

Some research links PACs, especially frequent PACs (more than 76 PACs each day) with an increased risk of developing atrial fibrillation, stroke, or heart disease.

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.

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 possible, but this form of treatment is invasive and carries the risk of serious complications. Ablating PACs is usually reserved for those patients in whom the PACs are symptomatic, drug-resistant, very frequent, or triggering more serious arrhythmias, such as atrial fibrillation.

A Word From Verywell

PACs are very common and are almost always benign—so unless there is a good reason to do otherwise, the usual treatment is to leave them alone. If you have PACs that are producing palpitations or are concerned about your heart disease risks, discuss treatment options with your doctor. Remember that all treatments beyond lifestyle changes carry risks.

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