Ventricular Extrasystoles – Causes, Diagnosis And Treatment


Ventricular Extrasystoles

In terms of position in the cardiac cycle, ventricular extrasystoles are  premature ventricular depolarizations, which originates from a source which is located distal to the bifurcation of His fascicle.


Ventricular Extrasystole
Ventricular Extrasystole


The diagnosis of ventricular extrasystoles is based on the symptoms, on the physical examination and on the ECG interpretation.

Symptoms include palpitations, chest discomfort, feeling of heart stopping, followed by a stronger beat, faintness, syncope.

Physical examination may reveal the following: can be collected an early beat, which is followed by a pause (compensatory pause). In case of frequent ventricular extrasystoles, hypotension may occur.

ECG shows the following:

  • Early QRS complex with abnormal configuration and an increased length, which are not preceded by P waves and are followed by ST segment with a T wave which is opposite to the QRS complex. Right ventricular extrasystoles, are generally look like left bundle branch block and left ventricular extrasystoles have the appearance of right bundle branch block.
  • The interval between ventricular extrasystoles and the previous QRS complex is constant (fixed coupling interval).
  • Post ventricular pause is usually fully compensatory, rarely are interpolated ventricular extrasystoles.
Ventricular extrasystole ECG
Ventricular extrasystole ECG

The degree of premature ventricular extrasystoles is variable and can occur at any time in the diastole. Sometimes it is a very short coupling interval which will make that the ventricular extrasystoles to be registered on top of previous T wave, a phenomenon name by the  R / T term. In these circumstances there is  the danger of triggering a ventricular fibrillation.

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Ventricular extrasystoles can be:

  • Unifocal, QRS morphology is identical in all leads;
  • Polifocal, QRS morphology is different in ECG leads, which means that the QRS complexes originate in one or more ectopic outbreaks;
  • Isolated, characterized by the occurrence of a single ventricular extrasystole;
  • Systematized: the appearance of two or more ventricular extrsistoles under the form of bigeminy, trigeminy, etc..

Based on Holter monitoring, Lown proposed the following classification of ventricular extrasystoles:

  1. Class 0: absence  ventricular extrsistoles at least 3 hours;
  2. Class I: premature ventricular extrasistoles, monomorphic and occasional, the occurrence is less than one ventricular extrasistole per minute or less than 30 ventricular extrasystoles per hour.
  3. Class II: frequent monomorphic ventricular extrasystoles, more than one ventricular extrasistole per minute or more than 30 ventricular extrasystoles per hour.
  4. Class IIIa: polymorphic ventricular extrasystoles (multifocal).
  5. Class IIIb:  systematized ventricular extrasystoles (bigeminy, trigeminy).
  6. Class IVa: coupled repetitive ventricular extrasystoles (2 ventricular extrasystoles).
  7. Class IVb: repetitive triplets of ventricular extrasystoles (3 ventricular extrasystoles).
  8. Class V:  R/T phenomena.
Ventricular extrasystole
Ventricular extrasystole


Ventricular extrasystoles that appear on a healthy heart require the removal of trigger factors and in the case of  important symptoms, is recommended the administration of beta blockers and sedatives.

In the case of organic ventricular extrsistoles, the treatment is based on the Lown classification, as follows:

  • Classes I and II benefit from treatment of the disease that lead to the appearance of extrasistoles;
  • Classes III, IV and V: monitoring, determining of pathological substrate, correcting electrolyte and acid-base disorders, myocardial ischemia and other factors incriminated that are causing the ventricular extrasistoles. Administration of beta blockers, amiodarone or lidocaine, all intravenously.







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  1. I’ve had extrasystoles all my life, I recall beeing in 2nd grade elementary and when Soccer game was about to start, the anxiety triggered me the extrasystoles, later I forgot about them for years and then when starting my first job I was under pressure and they returned. At the age 30 I went to see the cardiologist who told me it was a fairly common condition and requested me to stop drinking coffee and chill down about problems, no smoking and a lot of exercise. As I did and extrasystoles almost disappeared.
    Now? I’m 51 yo, I have full control over my emotions and stressfull situations and extrasystoles almost inexistent. In conclusion: Do exersise, not coffe/tea or cigarretes and especially zero stress. Hope this help!

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