Feeling your heart skip a beat can be alarming. For some people, it happens only once in a while. For others, the sensation is more frequent, causing them to wonder whether they're experiencing something harmless or a sign of a more serious heart condition.
Heart palpitations are one of the most common reasons patients seek cardiovascular care, but not all irregular heartbeats have the same cause. Two of the most common heart rhythm abnormalities are atrial fibrillation (AFib) and premature ventricular contractions (PVCs). Although both can create unusual sensations in the chest, they affect the heart differently and carry different levels of risk.
Understanding how these conditions differ, what they typically feel like, and when they should be evaluated can help you make informed decisions about your heart health.
An irregular heartbeat, also called an arrhythmia, occurs when the heart beats too quickly, too slowly, or with an abnormal rhythm.
Some arrhythmias are harmless and occur occasionally in otherwise healthy people. Others can increase the risk of complications such as stroke, heart failure, or sudden cardiac events.
Many people first notice an arrhythmia because they experience heart palpitations. These sensations may feel like:
According to the American Heart Association, occasional palpitations are common and often not a cause for concern. However, frequent or persistent irregular heartbeats, especially when accompanied by dizziness, chest pain, shortness of breath, or fainting, should be evaluated by a healthcare provider.
Atrial fibrillation is the most common sustained heart rhythm disorder, affecting millions of adults worldwide.
In a healthy heart, electrical signals travel through the upper chambers, called the atria, in an organized pattern before moving to the lower chambers, or ventricles. This coordinated electrical activity produces a steady, predictable heartbeat.
With AFib, those electrical signals become disorganized. Instead of contracting normally, the atria quiver rapidly, causing the heartbeat to become irregular and often faster than normal.
One of the biggest concerns with AFib is that blood can collect in the atria instead of flowing normally through the heart. This increases the risk of blood clots, which can travel to the brain and cause a stroke. Because of this risk, AFib often requires long-term management rather than simply treating symptoms when they occur.
Every patient experiences AFib differently. Some people notice symptoms immediately, while others have no symptoms at all and discover the condition during a routine physical exam or heart rhythm test.
Common symptoms include:
Many patients describe AFib as feeling like their heart is constantly "out of rhythm." Rather than noticing an occasional skipped beat, the heartbeat often feels continuously irregular for several minutes, several hours, or even longer.
Episodes may occur occasionally or become persistent over time, making evaluation and treatment especially important.
Premature ventricular contractions, commonly called PVCs, are extra heartbeats that begin in the ventricles, the heart's lower pumping chambers. Unlike AFib, PVCs usually occur as isolated beats rather than a continuously abnormal rhythm.
A PVC happens when an electrical signal starts in the ventricles before the heart's normal heartbeat is expected. The heart then briefly resets before returning to its usual rhythm.
Many people experience occasional PVCs without ever realizing it. Others notice them immediately because of the distinct sensation they create. While isolated PVCs are often harmless, frequent PVCs or those occurring alongside other heart conditions may require additional evaluation to determine whether an underlying cardiovascular issue is contributing to the abnormal rhythm.
PVCs often feel very different from AFib. Rather than a continuously irregular rhythm, PVCs usually occur as isolated extra beats that interrupt an otherwise normal heartbeat.
Patients commonly describe them as:
Some people notice only a few PVCs throughout the day, while others experience several over a short period before their heartbeat returns to normal. PVCs are often more noticeable during periods of rest or while lying in bed because there are fewer distractions competing for your attention.
Although both conditions can cause heart palpitations, they differ in several important ways.
| Feature | AFib | PVCs |
| Heart rhythm | Continuously irregular. Although some patients can have paroxysmal AFib which are runs of intermittent atrial fib | Mostly normal with occasional extra beats |
| Heart rate | Often rapid and irregular | Usually normal |
| Duration | Minutes, hours, or persistent | Seconds or isolated episodes |
| Typical sensation | Fluttering, racing, or chaotic heartbeat | Skip, pause, or hard thump |
| Potential health risk | Increased risk of stroke and other complications | Often harmless when occasional |
The biggest difference is how the heartbeat feels over time. AFib usually creates an ongoing sensation that the heart is out of rhythm, while PVCs tend to feel like individual interruptions separated by otherwise normal heartbeats.
Irregular heartbeats do not always happen without a reason. In many cases, certain lifestyle factors or health conditions can make episodes more likely.
Common triggers include:
Not everyone responds to the same triggers, and some people may never identify a specific cause. Keeping track of when symptoms occur, how long they last, and what you were doing beforehand can provide helpful information for your healthcare provider.
Many people experience occasional palpitations that are ultimately harmless.
However, there are situations when an irregular heartbeat should not be ignored.
You should schedule a cardiovascular evaluation if you experience:
According to the Mayo Clinic, some heart rhythm disorders cause few or no symptoms, making proper evaluation important even when episodes seem minor. Identifying conditions such as AFib early can help reduce the risk of future complications, including stroke.
It is especially important to seek emergency medical attention if an irregular heartbeat is accompanied by severe chest pain, fainting, difficulty breathing, or symptoms of a stroke, such as sudden weakness, numbness, or trouble speaking.
Because irregular heartbeats often come and go, diagnosing the cause usually requires more than simply describing your symptoms. Your healthcare provider may recommend one or more tests to capture your heart's rhythm and evaluate how well your heart is functioning.
Common diagnostic tools include:
These tests help determine whether symptoms are caused by AFib, PVCs, another type of arrhythmia, or a non-cardiac condition. They also help identify any underlying structural heart disease that may require treatment.
Although AFib and PVCs can produce similar symptoms, treatment depends on the underlying cause. Patients with AFib often require treatment to control heart rate or heart rhythm, reduce the risk of stroke, and manage contributing conditions such as high blood pressure or sleep apnea. Depending on the individual, treatment may include medications, lifestyle modifications, cardioversion, catheter ablation, or blood-thinning medications.
Treatment for PVCs is often different. Occasional PVCs in people with otherwise healthy hearts may not require treatment at all. Instead, a healthcare provider may recommend reducing caffeine or alcohol intake, improving sleep, managing stress, staying well hydrated, or addressing other lifestyle factors that may contribute to the extra beats.
If PVCs occur frequently, cause significant symptoms, or are associated with underlying heart disease, additional treatment may be recommended.
Feeling your heart skip, flutter, or race can be unsettling, but those sensations do not always mean the same thing.
AFib typically causes a sustained, irregular rhythm and carries a greater risk of serious complications, including stroke. PVCs, on the other hand, are usually isolated extra beats that are often harmless, though they can still be disruptive or indicate an underlying heart condition in some cases.
The only way to know what is causing your symptoms is through a proper cardiovascular evaluation. The American Heart Association states that recognizing and treating abnormal heart rhythms early can help reduce the risk of complications and improve long-term heart health.
At CardioVascular Health Clinic, we evaluate patients experiencing heart palpitations, irregular heartbeats, dizziness, chest discomfort, and other cardiovascular symptoms. Through comprehensive testing and personalized treatment plans, our team works to identify the cause of your symptoms and help you protect your long-term heart health.
If you've noticed your heart racing, fluttering, or skipping beats, don't ignore the signs. Scheduling a cardiovascular evaluation can provide answers, peace of mind, and, if needed, early treatment to keep your heart beating at its best. l evaluation can provide answers and peace of mind. Contact CardioVascular Health Clinic to schedule a consultation.
