Palpitations are one of the most common reasons for referral to cardiologists; most are assessed as being medically benign. Eighty consecutive subjects referred for 24-hour ECG recording completed a questionnaire at the time of assessment and a follow-up self-report questionnaire at 18 months. Many of those with and without abnormal hearts reported distress, concern about their symptoms, and limitation of everyday activities. There were few differences between these groups at assessment or at follow-up. There was little change in mental state or in disability in either group over 18 months. Present symptomatic treatment is largely ineffective and there is a need to evaluate psychological and behavioral interventions.