The heart is an organ composed of four chambers: two atria and two ventricles, located on the left and right sides.
Each ventricle serves a specific function. The right ventricle contracts and pushes blood into the pulmonary arteries.
The left ventricle contracts and pushes blood into the aorta. The oxygen-rich blood is then delivered to the organs, muscles and tissues in the body.
The atria and ventricles contract in response to an electrical impulse. A resting heart rate for healthy people ranges between 60 and 100 beats per minute.
Extrasystoles refer to premature heart contractions that occur between heartbeats. These extrasystoles can originate in the ventricles, in which case they are called ventricular extrasystoles and are most often harmless.
They can be secondary to various factors, such as age, heart diseases, respiratory issues, stress, alcohol or tobacco consumption, hyperthyroidism, or the side effects of certain medications.
Symptoms
In the majority of cases, premature ventricular contractions are asymptomatic. When felt, they are perceived as a missed or stronger-than-usual heartbeat.
For people who do not have heart disease, these extrasystoles are generally not considered serious. However, when they occur frequently in people with heart disease, a thorough evaluation is required and further tests should be conducted to check for more serious heart rhythm disorders, such as ventricular tachycardia or ventricular fibrillation. These two conditions can lead to sudden cardiac death.
Diagnosis
At the onset of the first symptoms, the patient consults a primary care physician who can make an initial diagnosis upon hearing the extrasystoles during the auscultation. The diagnosis will then be confirmed using various methods. An electrocardiogram is used to confirm the suspected diagnosis and, most importantly, distinguish between ventricular and atrial extrasystoles.
What is an electrocardiogram?
It is a test that records the heart’s electrical activity over a given period of time. It determines the speed at which the heart is beating (heart rate) and whether it is beating normally (heart rhythm). An electrocardiogram is also called an EKG.
If the electrocardiogram does not detect any extrasystoles, the assessment can be completed with a Holter-ECG test (a small device that records the heart’s rhythm for 24-48 hours).
A stress test can also be added, where the patient pedals on a bike while an electrocardiogram is performed and their blood pressure is measured, since some extrasystoles are only felt during exertion.
Echocardiography, using ultrasound, can further refine the diagnosis in certain cases.
Treatment
Not all premature ventricular contractions require treatment. Their frequency and the cause are what determine the need for treatment. Treatment may take various forms. One step is to make lifestyle changes by reducing or stopping alcohol consumption and drug use and trying to reduce stress. Meditation and yoga are helpful tools for this.
Medication is sometimes prescribed, such as beta-blockers or other antiarrhythmic drugs.
In certain cases, an intervention may be necessary, in the form of an ablation procedure. The goal is to target and destroy the tissue in the areas causing the arrhythmia. This can be done using thermal ablation or electroporation, a newer technique.
Premature junctional contractions
In addition to premature ventricular and atrial contractions, premature junctional contractions can also occur. In this case, the arrhythmia originates at the junction between the atria and the ventricles.
Reviewed and approved by Marine Arnaud, MD, Cardiologist at Bordeaux University Hospital (CHU)
