Ventricular premature beats (VPBs), also referred to as ventricular premature complexes, premature ventricular beats, premature ventricular complexes, or ventricular extrasystoles, are triggered from the ventricular myocardium in a variety of situations. VPBs are common and occur in a broad spectrum of the population. This includes patients without structural heart disease and those with any form of cardiac disease, independent of severity.
The clinical significance and treatment of VPBs will be reviewed here. Issues related to classification, prevalence, etiology, and evaluation of VPBs are discussed separately. (See "Prevalence and evaluation of ventricular premature beats" and "ECG tutorial: Ventricular arrhythmias", section on 'Premature ventricular contractions'.)
Ventricular premature beats (VPBs) are frequently detected during auscultation or routine electrocardiographic recording. VPBs produce few or no symptoms in the vast majority of patients, and there is no evidence that suppression can extend life expectancy or reduce the risk of an untoward arrhythmic event even in patients with heart disease.
On occasion, patients are incapacitated by palpitations or dizziness related to VPBs. VPBs rarely cause true hemodynamic compromise except in patients with frequent ectopy and severely depressed left ventricular function or when VPBs are concurrent with underlying bradycardia [1,2]. On rare occasions, frequent VPBs can result in left ventricular dysfunction, which improves following suppression of the VPBs or ablation of the VPBs. (See "Tachycardia-mediated cardiomyopathy", section on 'Frequent ventricular ectopy'.)
While VPBs are often thought to be of minimal clinical significance, particularly in patients without a history of cardiac disease, most studies have reported an increased mortality in patients with VPBs. However, prophylactic treatment of asymptomatic VPBs in patients without cardiomyopathy has not been shown to improve mortality. As such, the presence of VPBs should alert the clinician to potential coexistent cardiac disease, which may require additional clinical assessment or therapy. (See "Prevalence and evaluation of ventricular premature beats", section on 'Clinical evaluation'.)