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London Heart

Ventricular ectopics

What are Ventricular ectopics?

Almost all of us will experience ventricular ectopic beats (also known as premature ventricular contractions or PVCs) at some point in our lives. As the name implies these are extra beats of the heart which originate in the bottom chambers of the heart (the ventricles). A normal heart beat originates from the top of the heart (the atria).  Ventricular ectopic beats occur prematurely and cause the heart to beat in a different way for that beat.

Are they dangerous?

If, like most people, you have a structurally normal heart, ventricular ectopics are almost always benign and don’t require any treatment, unless they are causing symptoms. If you are in the much smaller group of people who have evidence of structural heart disease, ventricular ectopics can be a marker of increased risk. This means that experiencing ventricular ectopics makes you more likely to develop other heart rhythm problems. For this reason, if you experience ventricular ectopics, it is important to rule out underlying structural heart disease. To do so, book an appointment to see a heart specialist.

What symptoms may I experience?

Many patients have no symptoms. Others may experience a sensation of fluttering or butterflies in the chest. Some people experience a sensation of their heart stopping or skipping a beat, which can understandably be worrying. This sensation occurs because after an ectopic beat, the heartbeat cycle resets. This is preceded by a short pause which may feel as if your heart momentarily stops. Other common symptoms are a sensation of dizziness, a ‘thump’ in the chest or shortness of breath.  Symptoms are often experienced at night or when resting. The reason for this is that your heart rate is lower at rest and when you are sleeping allowing the ectopic beats more time to occur.

Many patients will experience symptoms sporadically or with no particular trigger. Sometimes patients will experience symptoms intermittently, with weeks or months between episodes.

If you experience any of these symptoms, it is a good idea to arrange a heart screening to check your heart health.

What are the common causes for ectopic beats?

Caffeine in coffee and energy drinks, alcohol and tiredness or disturbed sleep are by far the most common triggers. Indeed some patients will notice an immediate improvement in their symptoms once these are eliminated. Hormonal changes such as those seen in pregnancy or during the menopause may also cause ventricular ectopics. Occasionally viral infections of the lining of the heart ( myocarditis) may cause ectopics.

Will I need further investigations?

If you experience symptoms of ventricular ectopics, you should book an appointment to see a cardiologist. Your cardiologist will take a detailed history and examination. It is important to establish if there is a potential underlying cause, lifestyle factors or a family history of heart disease. Investigations are performed to rule out an underlying cause and to gather more information. You will be given a number of cardiac tests to help reach a diagnosis. 

These may include an electrocardiogram (ECG) which provides a general overview of the heart.  If ectopics are frequent an echocardiogram (heart ultrasound) or Cardiac MRI scan may be performed to confirm that your heart has a normal structure and function and to rule out heart muscle disease (cardiomyopathy). Blood tests are performed to look for other potential causes such as abnormal electrolyte levels (eg sodium and potassium) and thyroid function.

Your specialist may also perform a continuous ECG monitor to establish the ‘ectopic burden’ This is a measure of the percentage of ectopic beats when compared to all your heart beats.  There is emerging evidence that a high ectopic burden (10-30%) may potentially affect the way that your heart beats over time if left untreated. The ECG monitor also helps determine if the ectopic beats are originating from one site or from multiple sites which helps guide treatment.

To organise these cardiac tests, contact us today.

Will I need treatment and what treatments are available?

If tests show that you have a structurally normal heart, you are unlikely to need treatment. Reassurance and understanding that the condition is likely to be benign is all that is required.

Simple lifestyle measures such as reducing caffeine and alcohol intake, smoking cessation, improved sleeping habits and stress reduction will be sufficient to considerably improve or eliminate symptoms.

Medications may also be used to suppress the ectopics and improve symptoms.  If the ectopic beats are originating from one site, then a treatment called catheter ablation may be used. This procedure involves passing fine wires into the heart from the top of the leg in a minimally invasive/non-surgical procedure,  A ‘virtual’ 3D geometry of your heart is created using a computer mapping system. Using electrical signals from within your heart, the exact site of origin of the ectopic beats is located and high frequency energy is delivered at this site to eliminate the abnormal beats. The procedure is minimally invasive and does not involve surgery. Most patients are discharged home on the same day.

Catheter ablation  is very safe and  carries a very high success rate in appropriate patients of over 85%. The risks from the procedure are small and are in the region of 1-2%. These risks include vascular complications (bleeding from the leg) and less frequently bleeding around the heart.  Bleeding around the heart is usually treated very effectively with a small drain inserted from the front of the chest, without requiring an operation. Very occasionally emergency surgery or a permanent pacemaker is required as a result of treatment.

Watch our video FAQs to learn more about catheter ablation.

Summary

  • Ventricular ectopics are very common and most often benign
  • Cardiac investigations are performed to rule out underlying causes, such as heart muscle disease and establish the ectopic burden
  • Lifestyle measures are often sufficient to improve symptoms
  • Medications and catheter ablation are safe and effective. They can be used successfully if there is a high frequency of ectopics or if symptoms persist despite simple measures

If you have any symptoms of ventricular ectopics, book an appointment today.