Ventricular extrasystoles

Ventricular extrasystoles (ventricular premature contractions, VES) arise as a result of the presence of an ectopic focus in the cardiac conduction system distal to the bifurcation of the bundle of His or in the ventricular myocardium. VES can also occur in healthy individuals.

Ventricular extrasystoles:

Clinical symptoms

VES are often asymptomatic. If they manifest clinically, it is mostly palpitations. Accumulation of VES can result in syncope or chest pain.

Diagnostics

Diagnosis is based on EKG. We observe the following changes on the ECG:

• The QRS complex comes prematurely, it is not preceded by a P wave (in the case of retrograde conduction of the impulse AV node the P wave can be located after the QRS complex) ;
• The QRS complex is abnormal (different in shape from the QRS complex originating from the SA node; it is wide - lasts longer than 120 ms);
• The QRS complex is followed by a complete compensatory pause (R-R^VES before VES and R^VES-R after VES is equal to twice R-R interval sinus rhythm);
• The T wave is large, usually discordant to the QRS complex.
• If there is one ectopic focus in the myocardium, the extrasystoles originating from it have the same shape and are referred to as monotopic.
• If there are multiple ectopic foci in the myocardium generating premature excitations, the extrasystoles have a different shape and are called polytopic.

A more frequent occurrence of KES should lead to a more detailed cardiology examination. We are looking for organic heart disease and left ventricular dysfunction (echocardiography, Holter monitoring, stress EKG, electrophysiological examination).

Classification

Bigeminy (ventricular extrasystoles in bigeminal connection)

The "Lown classification" is still used to classify VES today.

	Classification of VES according to Lown
Degree	VES type
0	no VES
1a	isolated, sporadic, monomorphic VES, < 1/min. and < 30/hour
1b	isolated, sporadic, monomorphic VES, > 1/min., but < 30/hr
2	isolated, frequent, monomorphic VES > 30/hr
3a'	isolated, polymorphic VES
3b	bigeminically bound mono- or polymorphic VES
4a	VES in pairs (couplets)
4b	VES in bursts ie 3 or more consecutive VES
5	early VES ("R on T" phenomenon)
VES 3-5 are referred to as "complex forms of VES"

• Couplet (pair) – 2 extrasystoles coming in a row.
• Nonsustained ventricular tachycardia (salvo, triplet) – 3 extrasystoles in a row.
• Bigeminia - each supraventricular contraction is followed by 1 ES.
• Trigeminy - every 2 supraventricular contractions are followed by 1 ES.

Treatment

Treatment for VES includes:

• antiarrhythmics group I–III (β-blockers, sotalol, propafenone; the possible proarrhythmogenic effect of antiarrhythmics must also be kept in mind);
• catheter radiofrequency ablation of ectopic focus;
• VES triggering ventricular tachycardia runs can be treated by implanting a defibrillator.

Links

Related Articles

• Extrasystole
• Flutter halls
• Ventricular fibrillation
• Antiarrhythmics

External links

• Komorová extrasystola (TECHmED)

Used literature

• HAMPTON, John R. EKG briefly, clearly, simply. 6. edition. Grada, 2005. 149 pp. ISBN 80-247-0960-0.

• HAMAN, Petr. Lecture web EKG : Basics EKG [online]. [cit. 2010-12-11]. <http://www.ekg.kvalitne.cz/tvorba.htm#Supraventrikul%C3%A1rn%C3%AD%20extrasystoly>.

• HOLAJ, Robert. Cardiological group. III. internal clinic VFN a 1. LF UK in Prague, 2009.
• VILIKUS, Zdeněk. Interpretation of EKG at rest and during exercise. Institute of Physical Education Medicine 1. LF UK and VFN; 2010.