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Ectopic Beats

Ectopic beats are abnormal heartbeats that originate from outside the normal electrical system of the heart. These beats are also known as premature beats because they occur before the next expected regular heartbeat. Ectopic beats can originate from different locations in the heart, such as the atria or ventricles. In most cases, ectopic beats are harmless and do not require treatment. However, in some cases, they can be a sign of an underlying heart condition and may require medical attention. If you are experiencing frequent ectopic beats, it is important to speak with an electrophysiologist to have further assessment and treatment. Clinically, ectopic beats originating from the ventricle, also called premature ventricular contractions (PVCs) are most common and the information below, is mainly related to PVCs
Fig 13 PVC
PVCs are commonly found in healthy individuals and are usually harmless. However, if they occur frequently or in certain patterns, they may be a sign of an underlying heart condition that requires medical attention. PVCs can sometimes be exacerbated by a variety of factors, including stress, caffeine, alcohol, certain medications. PVCs are rarely dangerous in themselves and most of the times they do not cause any symptoms.

However, some people may experience symptoms such as:

heartbeat1

Palpitations or a sensation of skipped beats

chest 1

Fluttering or pounding sensation in the chest

difficulty breathing1

Shortness of
breath

headache1

Dizziness or light-headedness

sick 1

Fatigue or
weakness

heartbeat1

Anxiety or
panic

Occasionally, when PVCs are very frequent (>15-20% of the total heart beats) they may cause loss of synchrony between the right and left ventricles. With time this may lead to the heart muscle becoming weaker and heart failure may develop in some patients (PVC induced cardiomyopathy). If the PVCs are treated and eliminated, the heart failure improves and the heart function recovers back to normal.
Investigations for PVCs include performing a 12 lead ECG which would allow us to know the location of the PVCs, an echocardiogram to check the heart function, a Holter monitor to estimate the percentage of PVCs compared to normal beats (PVC burden)
Fig 12 Bigeminy PVC Converted
Treatment for PVCs depends on the frequency and severity of the symptoms, as well as the underlying cause of the PVCs. Your electrophysiologist would advise you regarding the best treatment for your PVCs. Here are some possible treatments:
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Lifestyle Changes

If the PVCs are infrequent and not causing significant symptoms, the first step may be to make lifestyle changes, such as avoiding caffeine, alcohol, and tobacco, reducing stress, and getting enough sleep.

Fig 15 drugs

Medications

If PVCs are occurring more frequently or causing significant symptoms, medication may be prescribed. Beta blockers, calcium channel blockers, and anti-arrhythmic drugs are commonly used to control PVCs.
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Fig 18 cathlab

Catheter Ablation

In patients not tolerating medications or if medications aren’t effective, catheter ablation is recommended. This is a procedure in which a catheter is inserted through a blood vessel and into the heart to locate and destroy the tissue that is causing the PVCs. The success rate of ablation is high reaching 95% depending on PVC location with only very small risks during ablation.
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