Early studies had been criticised as the presence of heart disease was not investigated with stress testing, echocardiography or invasive tests. VEBs have been described in 1% of clinically normal people as detected by standard ECG and 40–75% of apparently healthy persons as detected by 24–48 hour ambulatory (Holter) ECG recording. This triggered the widely accepted dogma that increasing “severity” of ventricular ectopic activity was directly related to the risk of malignant ventricular arrhythmias and considerable effort had been spent in developing and employing antiarrhythmic drugs to suppress ectopics in the 1960s and '70s. Lown and colleagues 2 proposed a classification and grading of ventricular ectopics based on their frequency and complexity. This was shown to be so in more recent times where patients who have had a myocardial infarct were more prone to sudden death if they had frequent ventricular ectopics. 1 He noted that these irregularities did not interfere with normal lifespan when they were occasional but an ominous prognosis was implied if they were frequent. The first recorded description of intermittent perturbations interrupting the regular pulse, that could be consistent with VEBs, was from the early Chinese physician Pien Ts'Io, around 600 BC, who was the master in pulse palpation and diagnosis. In patients with very high levels of ventricular ectopy, you may need an ablation procedure to help improve your symptoms and the risk of the heart muscle becoming weaker.VENTRICULAR ECTOPIC BEATS: PAST, PREVALENCE AND PROGNOSIS In patients where there is concern about coronary artery disease, Dr Nijjer may ask you to have a CTCA or a coronary angiogram.However, if the number of ectopic beats increase on exercise, this can reflect a possible problem with your heart arteries. If your ventricular ectopics are reduced by increasing exertion, this can be a reassuring sign. In patients with frequent ventricular ectopics, Dr Nijjer may ask you to undertake an exercise ECG test. For the vast majority of patients, this will be sufficient to make a diagnosis and treatment can be started. Echocardiography will be used to assess the heart function and look for underlying heart conditions. A very careful assessment has to be made using a combination of 12-lead ECG and ambulatory ECG monitoring.

This can be detected on heart scans such as echocardiography or cardiac MRI.

Less commonly, in patients with a very high level of ventricular ectopic beats, the extra beats can lead to a worsening of the underlying heart muscle.In some cases, this can progress into episodes of ventricular tachycardia (VT). Some patients with very severe coronary artery disease – with heart artery narrowings that are severe enough to reduce the blood supply to the heart muscle, can trigger an excess of ventricular ectopics beats.The majority of ventricular ectopics are benign but in some people, if they are occurring in long runs, they can reflect coronary artery disease. This means extra ectopic beats from the ventricles may be felt more strongly than those from the atria. The ventricles are powerful chambers of the heart with the left ventricle pumping blood to the entire body and the right ventricle pumping blood to the lungs. Premature ventricular contraction (PVC)s – these come from the lower chambers, called the ventricles. These type of ectopics can cluster together and occur as ‘runs’ which can be felt like a ‘fluttering’ in the chest. The atria are smaller chambers and you may not feel all of the ectopic beats. These are generally benign but in some patients, very high levels of these can predict future atrial fibrillation.

Premature atrial contraction (PAC)s – these come from the two upper chambers of the heart, called the atria. There are two main types of ectopic beats:

Ectopic beats are very common and many people who feel palpitations experience ectopic beats.

Frequent ectopic beats