The word ‘Palpitations’ means different things to different people! It can simply be an awareness of the heart occasionally skipping a beat, which is usually in fact an extra beat called an ‘ectopic beat’! The extra beat isn’t felt because it comes quickly after the previous normal beat, and so the patient may be aware of the gap between normal beats- this can be felt as a ‘lurching’ sensation, much like going over a humpback bridge! The next ‘normal’ beat often then comes with a bit of a thump which the patient may be aware of. To some people, palpitations means an awareness of the heart racing quickly for anything between a few seconds up to several hours. This is called a ‘tachycardia’. This usually needs investigating which may be as simple as wearing a heart rhythm recorder for 24 hours (‘Holter monitor’) whilst the patient gets on with their daily activities. Other tests may be needed. Many types of palpitations either don’t need any treatment or can be controlled with tablets. Some types can be cured by a special operation called an ‘ablation’. In a small number of patients, tachycardias can be dangerous and these patients may be recommended to have a special type of pacemaker called an Implantable Defibrillator (also referred to as an ‘ICD’).