• Clinical science

Ventricular premature beats

Abstract

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.

Etiology

  • Idiopathic
  • Cardiovascular disease (e.g., CAD, myocarditis)
  • Electrolyte imbalances (e.g., hypokalemia, hypomagnesemia)
  • Side effect of certain drugs (e.g., digoxin, psychiatric medications)
  • Caffeine; , alcohol

References:[1]

Classification

  • 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 cardiac arrhythmias

References:[1]

Clinical features

  • Most patients are asymptomatic.
  • Skipped beat
  • If frequent VPBs, possibly → lightheadedness, dizziness, palpitations, irregular heart beat

References:[1]

Diagnostics

If patient suspected of VPBs → evaluate with ECG → if confirmed, rule out underlying disease (e.g., echocardiography, exercise treadmill stress test) with further procedures

ECG findings

  • Common ECG characteristics
    • QRS duration ≥ 120 ms with a block-like QRS morphology
    • 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
  • 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!

Additional procedures

References:[1]

Treatment

References:[1]

last updated 08/15/2018
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