Ventricular extrasystoles

Contributing factors

Ventricular extrasystoles can occur without any obvious cause, but several factors are known to promote them:

• Lifestyle-related factors:
  • Excessive consumption of stimulants (caffeine, tea, energy drinks);
  • Smoking;
  • Alcohol consumption;
  • Lack of sleep;
  • Stress and anxiety;
  • Intense physical exercise in some individuals.
• Medications:
  • Certain nasal decongestants;
  • Antihistamines;
  • Certain psychotropic drugs;
  • Sympathomimetic drugs.
• Physiological factors:
  • Hormonal variations (pregnancy, menstrual cycle);
  • Dehydration;
  • Electrolyte imbalances (particularly low potassium or magnesium levels).

Associated heart conditions

In some cases, ventricular extrasystoles may be related to an underlying heart condition:

• Coronary artery disease (blockage of the heart’s arteries);
• After-effects of myocardial infarction (heart attack);
• Cardiomyopathies (diseases of the heart muscle);
• Myocarditis (inflammation of the heart muscle);
• Valvular heart diseases;
• Mitral valve prolapse.

It is important to note that even in the absence of heart disease, very frequent ventricular extrasystoles can, in rare cases, lead to reduced heart function if they represent a significant burden (generally more than 10,000 per 24 hours).

The manifestations of ventricular extrasystoles vary greatly from one person to another:

• Absence of symptoms: many people with ventricular extrasystoles experience no symptoms at all;
• Cardiac sensations:
  • Sensation of a “skipped” or “missed” beat;
  • Feeling of a “thump in the chest”;
  • Palpitations (awareness of heartbeat);
  • Feeling of irregular heartbeats;
  • Sensation of “fluttering” in the chest.
• Associated symptoms:
  • Mild occasional shortness of breath;
  • Feeling of anxiety;
  • Transient chest discomfort.

The discomfort experienced is highly subjective and is not necessarily correlated with the frequency of extrasystoles. Some people may be greatly bothered by a few occasional extrasystoles, while others may feel nothing despite frequent occurrences.

It is important to note that these sensations are generally brief and not dangerous. However, they can cause significant anxiety in some patients, which may paradoxically increase their frequency, creating a vicious cycle.

Main diagnostic methods

The diagnosis of ventricular extrasystoles is primarily based on recording the heart’s electrical activity:

• Electrocardiogram (ECG): a basic test that can identify ventricular extrasystoles if they occur during the 10 seconds of recording. However, since extrasystoles are often intermittent, a normal ECG does not rule out their presence;
• Holter ECG: continuous recording of cardiac activity over 24 to 48 hours, allowing quantification of the number of ventricular extrasystoles, their distribution throughout the day, and identification of possible triggering factors;
• Event recorder: a device worn for a longer period (up to several weeks) than the Holter, allowing the patient to record symptomatic episodes on demand.

These tests not only confirm the presence of ventricular extrasystoles but also assess their frequency, morphology (appearance on ECG), and behavior (isolated, in pairs, or in runs).

Basic diagnostic tests can be performed in all Rythmopôle Paris centers, notably at Cardiopôle Yvart (Paris 15th) and Centre Damrémont (Paris 18th).

Additional assessment

When ventricular extrasystoles are identified, a more comprehensive cardiological evaluation may be necessary to look for any underlying heart disease and to assess their impact:

• Echocardiography: evaluates the structure and function of the heart and detects any abnormalities;
• Exercise stress test: observes the behavior of extrasystoles during exercise (their disappearance during exertion is generally a reassuring sign);
• Cardiac MRI: in certain cases, to detect subtle structural abnormalities or areas of myocardial fibrosis;
• Blood tests: to detect electrolyte imbalances or other abnormalities.

These additional tests are available at Institut Mutualiste Montsouris (Paris 14th) and at Cardiopôle Yvart (Paris 15th).

The assessment of risk related to ventricular extrasystoles takes several factors into account:

• • Condition of the heart: the presence of underlying structural heart disease is the most important prognostic factor;

• Arrhythmic burden: the number of extrasystoles over 24 hours (high burden if > 10,000/24h or > 10–15% of all beats);
• Extrasystole morphology: certain morphologies (multifocal, polymorphic) may have different prognostic implications;
• Complexity: isolated extrasystoles, in pairs (couplets), or in runs;
• Left ventricular function: impaired heart function associated with frequent extrasystoles may indicate arrhythmia-induced cardiomyopathy.

This personalized risk assessment, carried out by the rhythmologists at Rythmopôle Paris, helps guide management and determine whether treatment is necessary.

Situations not requiring treatment

In most cases, ventricular extrasystoles do not require specific treatment, particularly when:

• Extrasystoles are infrequent and occur in a healthy heart;
• Extrasystoles are asymptomatic or only mildly symptomatic;
• Extrasystoles disappear during exercise.

In these situations, simple reassurance and regular cardiology follow-up may be sufficient.

Lifestyle and dietary measures

Lifestyle changes can help reduce the frequency of ventricular extrasystoles:

• Reduce or eliminate caffeine, alcohol, and tobacco;
• Manage stress (relaxation techniques, meditation, regular physical activity);
• Improve sleep quality;
• Maintain good hydration;
• Correct any electrolyte imbalances.

Medication

When ventricular extrasystoles are very symptomatic or very frequent, drug treatment may be considered:

• Beta-blockers: first-line treatment, they reduce the influence of the sympathetic nervous system on the heart;
• Calcium channel blockers (verapamil, diltiazem): may be effective in certain cases;
• Antiarrhythmics (flecainide, propafenone): reserved for more severe cases due to potential side effects.

These treatments aim to reduce the frequency of extrasystoles and improve symptoms, but they generally do not eliminate them completely.

Radiofrequency ablation

In carefully selected cases, catheter ablation may be proposed:

• Highly symptomatic extrasystoles resistant to drug treatment;
• Very frequent extrasystoles (> 10,000/24h) with risk of arrhythmia-induced cardiomyopathy;
• Extrasystoles associated with impaired heart function.

This procedure involves precisely locating the origin of the extrasystoles in the heart using an electroanatomical mapping system, then eliminating it by applying radiofrequency energy. It is performed under local anesthesia, lasts about 90 minutes, and is most often done on an outpatient basis.

Ventricular extrasystole ablation can be performed at Institut Mutualiste Montsouris by the rhythmologists of Rythmopôle Paris. The success rates of this procedure range from 70 to 90% depending on the location of the extrasystoles, and it often allows discontinuation of antiarrhythmic drugs.

Recommended medical follow-up

Follow-up for patients with ventricular extrasystoles depends on their frequency, characteristics, and any associated heart disease:

• Annual follow-up for infrequent benign extrasystoles;
• More frequent follow-up (every 3 to 6 months) for frequent extrasystoles or in case of associated heart disease;
• Regular echocardiographic monitoring for very frequent extrasystoles to assess ventricular function.

This personalized follow-up is provided in the various Rythmopôle Paris centers.

Physical activity

Engaging in regular physical activity is generally beneficial, even in the presence of ventricular extrasystoles:

• Moderate exercise can improve vagal tone and reduce stress, both of which help decrease extrasystoles;
• The disappearance of extrasystoles during exercise is a reassuring sign;
• In the case of underlying heart disease, sports recommendations will be adapted to the condition.

Managing anxiety

Ventricular extrasystoles can cause significant anxiety, which in turn can increase their frequency. Here are some tips for managing this anxiety:

• Understand that extrasystoles are generally benign and very common in the population;
• Practice relaxation techniques (deep breathing, meditation, yoga);
• Avoid constantly monitoring your pulse or symptoms;
• Seek medical advice if concerned, to obtain reassurance.

Rythmopôle Paris offers comprehensive expertise in the management of ventricular extrasystoles:

• A team of rhythmologists specialized in the diagnosis and treatment of heart rhythm disorders;
• Comprehensive technical facilities for performing all necessary tests for an accurate diagnosis (ECG, Holter ECG, echocardiography, exercise stress test);
• Expertise in radiofrequency ablation of ventricular extrasystoles at Institut Mutualiste Montsouris;
• A personalized approach that takes into account each patient’s symptoms, preferences, and risk profile;
• Tailored follow-up provided in several centers across the Île-de-France region, ensuring easy access to care.