PAC without symptoms need not raise an alarm

Dear Dr. Roach: I am a 72-year-old man in excellent health and physical condition. I ride a bicycle 60 miles a week, and I generally feel good. I have an irregular heartbeat in the form of a premature atrial contraction, which showed up years ago for the first time on a routine EKG. I have had this for many years, and I do not have any effects from it that I am consciously aware of. My family doctor is concerned and wants further tests. A cardiologist told me not to worry about it unless I start to have symptoms like chest pain or dizziness. My question is whether it is OK to just have this sort of irregular heartbeat for many years, or if I should look into it with further testing? — M.M.B.

Answer: Premature beats come in two different types: those that originate in the atria, the smaller upper chambers of the heart (called premature atrial contractions, or PACs); and those from the thicker, larger ventricles (PVCs). Both of these are common, and the vast majority of people with them have no problems. My training and experience correlate to what your cardiologist says. Further, although there are medications and procedures to reduce them, there is no good evidence that the treatment will reduce your risk of a bad event like a heart attack, so treatment would be purely for those few people who are noticeably symptomatic from the premature beats.

The booklet on abnormal heart rhythms explains the more common heart rhythm disturbances in greater detail. Readers can obtain a copy by writing:

Dr. Roach

Book No. 107

628 Virginia Drive

Orlando, FL 32803

Enclose a check or money order (no cash) for $4.75 U.S./$6. Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGood or request an order form of available health newsletters at 628 Virginia Drive, Orlando, FL 32803. Health newsletters may be ordered from