- Clinical science
Ventricular premature beats (VPBs) are extra, abnormal heartbeats caused by ectopic foci within the ventricles. VPBs are very common and most individuals are asymptomatic, but select patients may present with symptoms such as dizziness or palpitations. Typical ECG findings of VPBs include broad QRS complexes, compensatory pauses, and axis deviation, and may be random or have consistent patterns, such as couplets or bigeminy. Most patients do not require treatment. However, any underlying condition, e.g., myocarditis, must be managed appropriately. Patients with frequent VPBs that cause significant symptoms should receive antiarrhythmic drugs or possibly catheter ablation, as they are at risk for sudden cardiac death.
- Monomorphic VPB: Each VPB has the same configuration → identical origin
- Polymorphic VPB: VPBs have different configurations → multiple foci
- See the Lown classification in the overview of
- Most patients are asymptomatic.
- Skipped beat
- If frequent VPBs, possibly → lightheadedness, dizziness, palpitations, irregular heart beat
- Common ECG characteristics
QRS duration ≥ 120 ms with a block-like QRS morphology
- Right ventricular premature beats have a configuration similar to a .
- Left ventricular premature beats have a configuration similar to a .
- VPBs are often followed by a compensatory pause
- Prematurity: the complex may occur earlier than suspected by the prior sinus pattern
- T wave and ST segment changes
- QRS duration ≥ 120 ms with a block-like QRS morphology
- May be random or adhere to a specific pattern, including:
- Single VPBs
- Couplet: two VPBs in a row
- Triplet: three VPBs in a row
Bigeminy: one extrasystole after every single sinus beat
- Premature contractions are mostly of ventricular origin. However, supraventricular premature contractions may also occur (= supraventricular bigeminus)
- Trigeminy: one extrasystole after every two sinus beats
- R-on-T phenomenon
VPBs are a common incidental finding on routine ECGs. The detection of them does not require any further workup in patients who are asymptomatic!
- Only indicated in case of frequent, symptomatic VPBs
- 24-hour Holter monitor
- Exercise stress test
- Most patients do not require any treatment
- Treat any underlying disease (e.g., CAD, myocarditis)
Only treat frequent and significantly symptomatic VPBs
- Antiarrhythmic therapy
- Catheter ablation if antiarrhythmic therapy fails
- Surgical ablation as last resort
- Avoid triggers: e.g., hypokalemia, hypomagnesemia, digoxin