Premature atrial extrasystoles

PACs for short.  PAC

So you get extra atrial beats, from somewhere in the atria outside the SA node.  The P waves therefore look odd, esp if they fall on top of a T wave.  They can even be upside down if close to the AV node, the depolarisation is therefore in reverse and the PR interval is abnormally short.  You usually do get a QRS after but sometimes it is blocked completely, and sometimes you get a RBBB pattern (RBBB has a longer refractory period).

You usually get a compensatory pause as the SA node is reset.

So the patient may feel a fast, extra beat, then a skip.

Considered normal!  Can be very frequent eg bigeminy (every other beat is a PAC), and you can get runs (“couplets”).  But if you have an abnormal heart already eg WPW, then it may be a trigger for a re-entrant tachycardia.