[Clinical and prognostic significance of hyperkinetic ventricular arrhythmias]

Ventricular arrhythmias, mainly ventricular premature beats (VPBs) are omnipresent in the general population. They may be detected or induced by means of different techniques such as routine ECG, ambulatory ECG-monitoring, exercise testing and ventricular stimulation during an intracavitary electrophysiologic study. The prevalence and clinical-prognostic significance of VPBs are highly related to the presence and severity of an underlying heart disease. Simple and complex (bigeminal, multiform, repetitive or R on T) VPBs are much more frequent in cardiac patients than in normal subjects. Acute myocardial infarction (AMI), chronic coronary heart disease (CCHD), cardiomyopathies and mitral valve prolapse are the most common clinical conditions in which VPBs occur. In apparently healthy persons, the presence of VPBs does not seem to indicate a greater risk for the future development of cardiac disease. In patients with AMI frequent, and complex VPBs often precede primary ventricular fibrillation and appear to be directly related to the size of the infarct. In the posthospital phase of AMI, as well as in CCHD, the occurrence of high-grade VPBs usually indicates more advanced degrees of both coronary and left ventricular disease as well as the possibility of cardiac and/or sudden death. In cardiomyopathies and mitral valve prolapse the VPBs do not correlate with either clinical, electrocardiographic, echocardiographic or hemodynamic parameters but their complex patterns appear to be a good indicator of patients with high sudden death risk.