A noticeable change in heart rhythm, often described as a skipped beat or fluttering, is a common concern for people recovering from viral illnesses, including COVID-19. These sensations are frequently caused by premature ventricular contractions (PVCs). PVCs are a type of irregular heartbeat, or arrhythmia, that originates in the heart’s lower chambers. The relationship between the SARS-CoV-2 virus and the heart’s electrical system is a significant area of study. This article explores the evidence and mechanisms linking PVCs to COVID-19 infection.
What Are Premature Ventricular Contractions?
Premature ventricular contractions are extra heartbeats that occur earlier than the heart’s natural pacemaker expects. These irregular beats start in the ventricles, the heart’s powerful lower pumping chambers. This early electrical signal interrupts the regular rhythm, causing a pause before the next normal beat. The subsequent regular heartbeat often feels stronger than usual because the heart has had more time to fill with blood, leading to the reported “skipped” or “pounding” sensation.
Many people experience PVCs without noticeable symptoms. When symptoms do occur, they are typically felt as a flutter, a flip-flop, or a strong thump in the chest. These extra beats can be triggered by common factors unrelated to infection, such as anxiety, fatigue, high levels of adrenaline from stress or exercise, and the consumption of stimulants like caffeine or alcohol. An imbalance of electrolytes, such as potassium or magnesium, can also make the heart’s electrical cells unstable and prone to triggering PVCs.
Clinical Evidence Linking COVID-19 and PVCs
Clinical data has established a correlation between SARS-CoV-2 infection and the occurrence of ventricular arrhythmias, including PVCs. Studies involving hospitalized patients with acute COVID-19 showed that the prevalence of ventricular arrhythmias ranged from 0.1% to 8% across different patient groups. The incidence of ventricular arrhythmias was notably higher in cases of severe infection, particularly among critically ill patients.
The link persists even after the initial illness resolves, often categorized as post-acute sequelae of COVID-19, or “long COVID.” One study following patients three months after hospitalization found that 18% of monitored patients experienced frequent PVCs, defined as more than 200 per day. These observations suggest that the viral infection can lead to electrical instability in the heart that lingers beyond the acute phase of the disease.
How Viral Infection Affects Heart Rhythm
The SARS-CoV-2 virus affects the heart’s rhythm through several interconnected biological pathways, not solely through direct damage. A primary mechanism is the widespread inflammatory response known as the “cytokine storm,” which is an overreaction of the immune system. Elevated levels of inflammatory molecules can alter the function of ion channels within heart muscle cells, increasing their excitability and making them more likely to fire prematurely. This inflammatory state can also lead to myocarditis, which is inflammation of the heart muscle and a known cause of electrical instability and subsequent arrhythmias like PVCs.
Another significant cause is the disruption of the autonomic nervous system (ANS), often called dysautonomia. The ANS controls involuntary bodily functions, including heart rate and blood pressure, through a balance of sympathetic and parasympathetic signals. COVID-19 can disrupt this balance, leading to inappropriate heart signals that manifest as a racing heart or frequent palpitations. The virus can also cause metabolic disturbances, such as low oxygen levels (hypoxia) or electrolyte imbalances, which trigger PVCs in a stressed heart.
Testing and Treatment for Post-Infection Palpitations
Patients who experience persistent palpitations or skipped beats following a COVID-19 infection should seek evaluation from a healthcare provider. The initial diagnostic step often involves an electrocardiogram (ECG or EKG), which records the heart’s electrical activity at a single moment. Because PVCs can be intermittent, a doctor may recommend an ambulatory heart monitor, such as a Holter or event monitor, worn for several days or weeks to capture the heart rhythm during daily activities.
An echocardiogram, which uses sound waves to create images of the heart, may also be performed to assess the heart’s structure and pumping function and rule out damage like myocarditis.
For many people, isolated PVCs that do not occur frequently are considered benign and do not require specific treatment, often resolving as the body recovers. Management typically begins with lifestyle modifications. These include ensuring adequate hydration, correcting electrolyte deficiencies, and reducing known triggers like caffeine and high stress levels.
In cases where PVCs are frequent, severely symptomatic, or impacting the heart’s function, a heart specialist may prescribe medication like beta-blockers to regulate the rhythm. In rare, severe cases, they may consider a procedure called catheter ablation.