Management and prognostic significance of ventricular premature beats
THE CONTEXT
Treatment of ventricular premature beats (VPBs) depends on symptoms and associated heart disease. Suppression with anti-arrhythmic drugs has not been shown to improve prognosis.
Symptoms and investigation
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Treatment may be unnecessary unless symptoms are marked. β-blockers or, in selected situations, catheter ablation can be used for highly symptomatic patients.
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Very frequent VPBs in someone without known heart disease should prompt investigation for structural and ischaemic heart disease.
After myocardial infarction
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VPBs commonly occur during acute myocardial infarction.
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Persistent VPBs exceeding 10 per hour after survival of the acute phase indicate a poorer long-term outcome.
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Anti-arrhythmic drugs do not improve this prognosis and may worsen it. β-blockers are an exception and should be prescribed for other reasons after myocardial infarction.
Associated heart failure
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Heart failure of any cause can be associated with VPBs, which indicate an adverse prognosis.
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Anti-arrhythmic drugs do not improve this prognosis, but effective treatment of heart failure may suppress the ectopic beats.