Palpitations and Heart-Rhythm Assessment in London
Palpitations are common, but the sensation alone does not identify the rhythm. A careful history and the right recording can distinguish benign extra beats from an arrhythmia that needs treatment.
Putting symptoms and rhythm data together.
You may feel racing, pounding, fluttering, missed beats or an irregular pulse. Episodes may occur at rest, during exercise, after alcohol or caffeine, during illness, or without an obvious trigger. Some rhythm problems cause dizziness, breathlessness, chest discomfort or fainting; others are noticed only because a watch has sent an alert.
Dr Bhuva assesses the timing and pattern of symptoms, medical and family history, medication and available ECG information. The purpose is to establish whether an abnormal rhythm is present, what it means for you and whether treatment or monitoring is required.
Possible investigations
- A resting 12-lead ECG
- Ambulatory ECG monitoring matched to how often symptoms occur
- Review of smartwatch or single-lead ECG recordings
- An echocardiogram to assess heart structure and function
- Blood tests or exercise testing where relevant
- Advanced imaging when there is a specific clinical reason
The name of the rhythm matters.
Ectopic beats
Premature beats can feel like a missed beat, thump or brief flutter. Their significance depends on the pattern, symptoms and underlying heart health.
Atrial fibrillation
An irregular rhythm that may require assessment of symptoms, stroke risk, rate or rhythm control and contributing conditions.
Fast rhythms
Supraventricular tachycardia, atrial flutter and other tachycardias may begin and end abruptly. Capturing an ECG during symptoms is especially valuable.
Slow rhythms
A slow pulse may be normal, medication-related or caused by conduction disease. Symptoms and ECG findings guide whether treatment is needed.
Blackouts
Loss of consciousness needs careful assessment because causes range from common faints to potentially important rhythm problems.
Wearable alerts
A watch can provide useful evidence, but its interpretation should take account of trace quality, symptoms and the broader clinical picture.
Palpitation and heart-rhythm questions.
When should palpitations be assessed urgently?
Call 999 if palpitations occur with chest pain, severe breathlessness, fainting or collapse, or if you feel acutely unwell. Brief or intermittent palpitations without emergency features can usually be assessed through a planned appointment.
Which heart monitor is best for intermittent palpitations?
The monitor should match how often symptoms occur. A 24-hour monitor may suit daily symptoms, while longer patch, event or implantable monitoring may be considered for less frequent episodes. Wearable ECGs can add useful information when the trace quality is adequate.
What should I record before the appointment?
Note when episodes happen, how long they last, associated symptoms and possible triggers. Bring any ECG traces or heart-rate graphs from your device.
Does an atrial fibrillation alert prove the diagnosis?
No. It can be an important prompt for clinical review, but the trace and context need assessment and sometimes confirmation with a medical-grade ECG.
Evidence and review.
Urgent symptom advice follows the NHS guidance on heart palpitations. Rhythm monitoring is selected according to symptom frequency and the clinical question.
Written and reviewed by Dr Anish Bhuva, Consultant Cardiologist. Last reviewed 2 September 2026. This page provides general information and does not replace an individual medical assessment.
Arrange a heart-rhythm assessment.
Bring any wearable ECGs, previous monitors and a current medication list.