Palpitations are a common symptom which may or may not signify an important underlying heart problem. An awareness of a normal heart beat is common and normal. We all experience extra heart beats from time to time and in most cases this is not dangerous, although it may initially be concerning to the patient. Sometimes the heart rhythm can change significantly and this needs careful investigation, for example with an ECG (heart tracing) and 24 hour heart monitor. Occasionally a small device (the implantable loop recorder) is inserted under the skin on the front of the chest to monitor the heart beat continuously for a year or longer. The device can store precise information about the heart rhythm at the time of a patient’s symptoms (e.g. palpitations, blackout) and the information can be downloaded at a later time for analysis.

There are many different types of rhythm change which, depending on the precise rhythm abnormality, can be treated in several different ways, for example with regular medication, a permanent pacemaker, an implantable defibrillator or a sophisticated electrical study (electrophysiological study, EPS) of the heart with a view to stopping the abnormal electrical pathway (radiofrequency ablation).