Ventricular extrasystoles: when should we worry?
DOI:
https://doi.org/10.14409/sigme.2025.4.e0028Keywords:
Ventricular premature beats, tachycardia-induced cardiomyopathy, catheter ablationAbstract
Ventricular premature beats (VPBs) are a common arrhythmia, traditionally considered benign. However, a high burden of VPBs can lead to VPB-induced cardiomyopathy (VPB-CMP), a reversible depression of left ventricular function. This review analyzes current evidence on the identification, risk stratification, and management of VPBs. We reviewed the literature on VPBs, focusing on their pathophysiology, high-risk electrocardiographic features, and prognostic factors. We also examined diagnostic tools, including cardiac magnetic resonance imaging (CMR), and therapeutic options like pharmacological agents and catheter ablation. A high VPB burden (>10-20% of total beats) and specific morphologies (e.g., epicardial origin with QRS duration >150 ms) are key predictors of VPB-CMP. Treatment involves correcting underlying causes, using drugs like beta-blockers, and, crucially, catheter ablation. Ablation is the first-line therapy for established VPB-CMP, offering high success rates. It is essential to identify and manage high-risk VPBs to prevent long-term cardiovascular complications. Early intervention, particularly with catheter ablation in selected patients, is crucial for improving patient prognosis.
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Copyright (c) 2025 Agustín Vignatti, Mauro García, Agustín Furrer, Emiliano Chaves
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