Treating palpitations

Palpitations are a common symptom and are often described as a fluttering, racing or irregular heartbeat. In many cases, they are harmless and triggered by stress, caffeine, alcohol or lack of sleep. However, when palpitations are frequent, persistent or associated with other symptoms, specialist assessment becomes important.

From a cardiology perspective, the key is to distinguish benign rhythm disturbances from clinically significant arrhythmias that may require treatment.

When should palpitations be investigated?

Occasional brief palpitations without other symptoms are usually not concerning. However, medical evaluation is recommended if palpitations are:

frequent or prolonged;
associated with dizziness or fainting;
accompanied by chest pain or breathlessness;
occurring in individuals with known heart disease;
interfering with daily life.

A detailed history is essential. The description of the sensation, duration and triggers provides valuable clues.

Identifying the underlying rhythm problem

Initial investigations typically include an electrocardiogram (ECG). Because palpitations may not occur during the appointment, ambulatory monitoring is often required. This may involve a 24-hour Holter monitor or longer-term wearable monitoring.

Additional tests can include echocardiography to assess heart structure, exercise testing or blood tests to exclude thyroid dysfunction or anaemia.

Common rhythm disturbances identified include:

atrial fibrillation;
supraventricular tachycardia (SVT);
atrial ectopic beats;
ventricular ectopic beats.

Accurate diagnosis determines the appropriate treatment pathway.

When lifestyle changes are not sufficient

Reducing caffeine, managing stress and improving sleep can help in mild cases. However, when palpitations persist or are caused by an underlying arrhythmia, targeted treatment may be required.

Management options depend on the specific diagnosis and may include medication, catheter-based procedures or, in selected cases, device therapy.

Medical treatment

Beta-blockers are often prescribed to slow heart rate and reduce symptom frequency. Other anti-arrhythmic medications may be used depending on the rhythm disorder.

In atrial fibrillation, treatment may also involve anticoagulation to reduce the risk of stroke, alongside rhythm or rate control strategies.

Medication choice is individualised, taking into account age, co-existing conditions and lifestyle.

Catheter ablation

For certain arrhythmias such as SVT or some forms of atrial fibrillation, catheter ablation can offer a definitive solution. This minimally invasive procedure involves passing thin catheters through blood vessels to the heart to identify and treat the abnormal electrical pathway.

In carefully selected patients, ablation can significantly reduce or eliminate symptoms and may avoid long-term medication.

Reassurance and long-term outlook

Not all palpitations indicate serious heart disease. However, when symptoms are persistent or troubling, specialist assessment provides clarity and reassurance.

With accurate diagnosis and personalised treatment, most rhythm disturbances can be effectively controlled, allowing patients to return to normal activity with confidence.

If lifestyle changes haven’t resolved your palpitations, a cardiology consultation ensures that the underlying cause is identified and managed appropriately.