Treating patients with ventricular ectopic beats

Ventricular ectopic beats (VEBs) are commonly seen in daily clinical practice. They are largely asymptomatic but can cause upsetting symptoms in some patients. In normal hearts, their occurrence is usually associated with no clinical significance. However, there are occasions where the presence of VEBs signifies a susceptibility towards more sinister arrhythmias, especially when heart disease is present. In some patients, VEBs are triggered by the same mechanism that gives rise to ventricular tachycardia which can be cured with catheter ablation. In addition, there are recent reports on the use of catheter ablation in cases where focal ventricular ectopics are found to trigger ventricular fibrillation. Appropriate clinical evaluation and investigations are important in assessing patients with VEBs so that effective treatment can be targeted when necessary. This article discusses the current knowledge and practice in this commonly encountered clinical cardiological problem. The first recorded description of intermittent perturbations interrupting the regular pulse, that could be consistent with VEBs, was from the early Chinese physician Pien Ts’Io, around 600 BC, who was the master in pulse palpation and diagnosis.1 He noted that these irregularities did not interfere with normal lifespan when they were occasional but an ominous prognosis was implied if they were frequent. This was shown to be so in more recent times where patients who have had a myocardial infarct were more prone to sudden death if they had frequent ventricular ectopics. Lown and colleagues2 proposed a classification and grading of ventricular ectopics based on their frequency and complexity. This triggered the widely accepted dogma that increasing “severity” of ventricular ectopic activity was directly related to the risk of malignant ventricular arrhythmias and considerable effort had been spent in developing and employing antiarrhythmic drugs to suppress ectopics in the 1960s and ’70s. This was set to change. VEBs …