Diagnosis and treatment of ventricular extrasystoles

Ventricular extrasystoles (VES) represent in the majority of cases a benign type of arrhythmia, the origins of which are mostly located in the right or left ventricular outflow tract and which are incidentally diagnosed in electrocardiography (ECG). Nevertheless, the patient's history, symptoms and cardiac imaging play a decisive role in the differentiation between a benign vs. a malignant type of VES (i.e. associated with an underlying structural heart disease). The localization of the myocardial origin of ventricular extrasystoles is based on the morphology of the QRS complex in a 12-lead ECG. The treatment of VES primarily depends on the VES burden on ECG Holter monitoring over 24 h, the patient's symptoms and systolic function of the right/left ventricle, on the underlying structural heart disease and the prognostic role of VES in this setting. Pharmacological treatment can be considered but generally catheter ablation is more effective and for the patient with a low risk profile is more comfortable and more efficient.