[Ventricular extrasystole: prognostic value and therapeutic indication]

Ventricular beats are abnormal rhythms which are frequently detected by modern recording techniques in healthy subjects as well as in patients with heart disease. In the first case, analysis of the literature enables us to exclude any pejorative prognostic implication associated with V.E.B., in the absence of any major risk factor for coronary artery disease. However, when there is an underlying heart disease, a number of subgroups can be distinguished with a high risk of sudden death: coronary insufficiency associated with ischaemic cardiomyopathy, especially in the early post-hospital phase after a myocardial infarction; hypertrophic cardiomyopathy with ventricular tachycardia on the Holter monitor, family history of sudden death, personal past history of syncope; mitral prolapse with clinical symptoms and auscultatory signs; idiopathic long QT syndrome. In contrast, V.E.B.s do not appear to have prognostic significance in idiopathic hypokinetic cardiomyopathies and aortic valvular disease. In general, it is more the clinical setting than the actual morphology which determines the prognostic implications of ventricular extrasystoles. The sub-groups at high risk should be treated with anti-arrhythmics, but the evaluation of the effectiveness of such treatment remains uncertain and the authors believe that the development of studies of ventricular stimulation prior to and during treatment are justified.