Premature Atrial Contractions (PACs)

Premature Atrial Contractions (PACs) are amongst the most common forms of arrhythmias.  It is due to the premature discharge of an electrical impulse in the atrium, causing a premature contraction.

Therefore, it is named “premature atrial contraction,” or PAC.  A PAC is premature, because the it occurs earlier than the next regular beat should have occurred.

Symptoms of PACs

Most often, patients with PACs complain of palpitations.  However, rather than reporting a sustained racing heartbeat, they usually describe a “missing” or “skipping” beat.  Some patients even feel that the heart has “stopped” while others describe a sensation of “flip-flop.”  This is due to the fact that the PAC comes too early (prematurely) in the cardiac cycle to have resulted in an effective pulse or heartbeat.  Therefore, no heartbeat is felt until the next regularly-timed heartbeat occurs after a pause (so-called compensatory pause).  Incidentally, the beat after the PAC usually occurs with stronger contraction than usual and can be associated with an urge to cough.  Symptoms of PACs are virtually indistinguishable from those of PVCs as the physiological effects are identical.

Causes of PACs

In the majority of cases, PACs occur in normal healthy individuals without any evidence of heart disease.  Stress or stimulants such as tea, coffee, or alcohol can increase the frequency of PACs.  In the minority of cases, PACs can be a sign of underlying heart condition in the atrium associated with hypertension or valvular condition.

Consequences of PACs

The great majority of PACs are completely benign and require little if any treatment at all.  As mentioned above, in rare cases, PACs may be the only sign of underlying heart conditions and these should be ruled out with appropriate evaluations. However, PACs may change into

  • Atrial Flutter:

Diagnosis

Evaluation is similar as with any patient first seen for palpitations  and arrhythmias and includes blood tests, EKGs, as well as echocardiograms.

Treatment of PACs

As most PACs are benign, treatment is optional and is usually geared toward alleviation of symptoms.  Medications such as beta blockers or calcium blockers are often used but with mixed result.  Most important treatment, after ruling out severe underlying heart conditions, is patient reassurance and teaching of various coping mechanisms.

Comments 18

  1. I have been having PACs for a few months. It feels like my heart is going to come through my chest, a lump in my throat and a deep throb under my diaphragm! ECHO dx PVCs. I’m on a beta blocker, antidepressants, HCTZ. Scheduled for 24H monitor because 30 second EKG didn’t pick them up! Of course not, I get PVCs at bedtime. Are sleeping pills bad to use too? Also I’m worried my symptoms aren’t being taken seriously; cardiologist did not apical pulse for 60 secs, more like 5-7 secs!

  2. Many sites treat PACs as benign, but there are several recently-published (last five years) that show that *frequent* PACs are associated with a higher risk of afib, stroke, and death.

  3. Potassium eliminated my PACs within 18 hours — none for 4 months.
    For 15 years had had increasing PACs. Last one and 1/2 years had increased to average of one PAC every 7-8 seconds on average. Magnesium supplements had no effect. Blood tests average Potassium close to 4.0 Saw 4 cardiologists over 15 years – Ekg documented PACs. Echocardiograms neg times 3. I am a neuroscientist; was studying ion transport in neurons. I read that bllood potassium can be normal but reservoir pool of Potassium in cells can be low. Daily recommended Potassium is 3600 to 4700 mgs a day. My diet, very regular, averaged 1600 meq a day. Walmart- bought Nu-Salt = potassium chloride. Took 1000 mgs three times during day on Thurday – total 3000 mgs. Friday morning checked my wrist pulse and pO2 CPAP monitor and I could not believe it – for 15 years without exception my pulse on the monitor varied from 58-72 every minute. – Friday AM my pulse for 7 1/4 hrs varies from 62-64. Palpated my carotid and felt an entirely regular pulse wave, with a neats of same intensity.
    Imhave continued to take 3000 mgs pot. chloride ‘salt substitute’ for 3 months. Still no PACs.
    My retired life for 8 years has been very low stress. Have not yet had an EKG — but my CPAP pulse monitor is best one used by best sleep study labs.
    There does not seem to he anything I can find in literature to confirm such a finding in my case.
    Perhaps the Two are not causally related……….. ? ?
    I would very much welcome any feedback .. re how naive I am re literature, cardiology, etc.

  4. can PACs and PVCs cause AFIB and heart disese to get worse if not taking Metoprolol that cardiologist prescribed? Have had Ablation and now have pacemaker. Thanks in advance

  5. Cardiologists prescribed pac and ihb with no treatment. Orthopedic doctor prescribed meloxicam or celecoxib for arthtitis and knee pain. Are these meds safe for heart? I need to walk.

  6. Do some Holter tests . See if some strong medication as flecainide might have the effect to reduce them. Compare Holter before and after. You may need a good electrophysiologist for helping you with ablation – one or more.

  7. Thank you all for validating the coughing. Once I start having 15 or so PACS/minute I cannot stop coughing..cannot talk. Very frustrating. I am on Metoprolol ER 2x/day

  8. Was diagnosed with PAT many yrs. ago and treated daily with Propanalol ER 60, which took care of the problem.The last several yrs. I have been periodically bothered with either PVC’s or PAC”s. I see a cardiologist about 2 times a yr. and have an echo usually yearly, have one scheduled for March before I see him. I have been having terrible PAC’c for about a week now, actually went to ER the other night due to anxiety over them. Spent a couple of hrs. on the monitor and sent home with report of PAC’s. I still have them and they are so irritating, hard to sleep and just simply function. I do have some issue with Aortic Valve that he checks with Echo. How can I get them to stop. Help!

  9. My cardiologist just told me I may have PAC. My heart rate went from 125 when it woke me up to 216, called 911, they did an ecg and said it was sinus tacchayardia. My rhythm went down to 120 and stayed there until Sunday when I went to the DR, registered me at 150. Upon sitting it went down to 120, after fluids and beta blockers went to 95. Does this sound like PAC? This happens often.

  10. After my dentist injections stop pain for fix my teeth after 6 months now my neck still strong painful and I feel lost memory even any thing I seen but after one minute will gone ,how I taking care my neck and is that neck problems will effects memories?

  11. How do i know when to go to the hospital or not? I’ve been having bad heart palpitations which sound like PACs and severe cough episodes for three days and it’s keeping me from sleeping. When is it time to be concerned?

    1. Hi Lisa, I have lived with a PAC most of my life. I am not a doctor, but I will describe what I get. I used to feel a flutter in my heart. I would check my pulse and feel my heart stop beating then quickly start again. I would start coughing. The condition would last for a short period, about 5 to 10 minutes. And I would stop coughing. I’m retired now, but when I was working, it would magnify from stress and I would feel a lightheadedness, like passing out. The doctor put me on Beta-blockers to stop the Adrenaline flow. They worked perfectly. It was not a life threatening condition for me. Your case could be something else, so I would go see your doctor immediately. Better to be safe then sorry.

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      Multiple PACs my result in what is called excessive supraventricular ectopic activity (ESVEA), which correlates with an increased risk of atrial fibrillation and stroke.
      Hope this helps,
      Dr T

  12. I am taking 1 pill of digoxin 250 MCG and 1 diltiazem 120 MG a day for my a fibrillation sometimes PAC come out bother me so should I need to take some more diltiazem like 60 MG please help me
    Thank you so much

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