[Ventricular extrasystole and coronary disease: to treat or not to treat?]
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1Departamento de Medicina, Facultad de Medicina, Universidad de Chile, Hospital del Salvador, Santiago de Chile División Oriente.
Insights
Ventricular premature beats (VPB) require careful assessment, classifying them as benign, hazardous, or malignant. Antiarrhythmic drugs are beneficial for hazardous and malignant VPB when efficacy is confirmed by objective testing, improving long-term survival.
Area of Science:
- Cardiology
- Electrophysiology
Context:
- Controversy surrounds the prognostic significance and management of ventricular premature beats (VPB).
- Recent studies question the efficacy and safety of antiarrhythmic drugs for VPB.
- Accurate VPB assessment is crucial for patient stratification and treatment decisions.
Purpose:
- To outline a comprehensive approach for assessing ventricular premature beats (VPB).
- To classify VPB based on prognostic risk.
- To define indications for antiarrhythmic drug therapy in VPB management.
Summary:
- VPB assessment includes electrocardiographic features, symptoms, underlying heart disease, and ventricular function.
- VPB are categorized as benign, hazardous, or malignant based on these criteria.
- Antiarrhythmic drugs are indicated for hazardous and malignant VPB, with efficacy verified by objective testing.
Impact:
- This classification aids in tailoring treatment strategies for ventricular premature beats (VPB).
- Effective management of hazardous and malignant VPB improves long-term survival, particularly in patients with coronary disease and heart failure.
- Objective testing is essential for confirming antiarrhythmic drug efficacy and guiding therapeutic adjustments.
Abstract:
The prognostic significance of ventricular premature beats (VPB) and their proper management are still a subject of controversy, particularly since during the last few years a number of publications have raised doubts as to the effectiveness and safety of antiarrhythmic drugs. An appropriate assessment of the VPB must consider: 1) electrocardiographic characteristics. 2) Associated symptoms. 3) Presence or absence of underlying disease, and 4) Ventricular function (VF). On this basis VPB may be classified as "Benign" (isolated; asymptomatic; mild or absent cardiopathy, and preserved VF); "Hazardous" (presence of complex VPB; with or without symptoms, and recognized organic heart disease), and "Malignant" (complex VPB and ventricular tachyarrhythmias; symptomatic cardiac disease, and compromised VF). Antiarrhythmic drugs are indicated for "Hazardous" and "Malignant" VPB. However, selection and efficacy must be documented by objective testing (Holter, stress, plasma levels). When utilized in well defined groups of patients, with reduction in the hourly number of VPB (more than 50-70%) and mainly of complex forms, there is clear benefit in terms of long-term survival, including coronary disease and congestive heart failure.