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Ventricular extrasystole
Last reviewed: 05.07.2025
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Ventricular extrasystole (VES) - single ventricular impulses that occur due to re-entry involving the ventricles or abnormal automatism of ventricular cells. Ventricular extrasystole is often found in healthy people and in patients with heart disease. Ventricular extrasystoles can be asymptomatic or cause palpitations. The diagnosis is established based on ECG data. Treatment is usually not necessary.
Causes of ventricular extrasystole
Ventricular extrasystoles (VEPs), also called premature ventricular contractions (PVCs), may occur suddenly or at regular intervals (e.g., every third contraction is trigeminal, every second is bigeminal). The frequency of ventricular extrasystoles may increase with stimulation (e.g., anxiety, stress, alcohol, caffeine, sympathomimetic drugs), hypoxia, or electrolyte imbalance.
[ Symptoms of ventricular extrasystole
Patients may characterize ventricular extrasystoles as skipped or "jumping" contractions. It is not the ventricular extrasystole itself that is felt, but the sinus contraction that follows it. If ventricular extrasystoles are very frequent, especially if they occur instead of every second contraction, mild hemodynamic symptoms are possible, since the sinus rhythm is significantly impaired. Existing ejection murmurs may increase, since there is an increase in ventricular filling and the degree of contraction after the compensatory pause.
The diagnosis is established based on ECG data: a wide complex appears without a preceding P wave, usually accompanied by a complete compensatory pause.
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Prognosis and treatment of ventricular extrasystole
Ventricular extrasystoles are not considered significant in patients without heart disease, and there is no need for special treatment, except for pathology that can potentially provoke the occurrence of ventricular extrasystoles. If the patient does not tolerate the symptoms, beta-blockers are prescribed. Other antiarrhythmic drugs that suppress ventricular extrasystoles can lead to more severe arrhythmias.
In patients with structural heart disease (eg, aortic stenosis or post-myocardial infarction), the choice of treatment is controversial, even though frequent ventricular extrasystoles (>10/hour) are associated with increased mortality, because no studies have shown that pharmacological suppression of ventricular extrasystoles reduces mortality. In patients after myocardial infarction, class I antiarrhythmic drugs cause an increase in mortality compared with placebo. This fact probably reflects the side effects of antiarrhythmic drugs. β-Adrenergic blockers are effective in symptomatic heart failure and after myocardial infarction. If the number of ventricular extrasystoles increases with physical exertion in patients with coronary artery disease, percutaneous intra-arterial coronary angioplasty or coronary artery bypass grafting may be necessary.
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