Definition

A premature ventricular beat (PVB) is an extra heartbeat caused by abnormal electrical activity. It starts in the ventricles (the lower chambers of the heart) before a normal heartbeat occurs. PVB interferes with the heart’s normal rhythm and causes a pause before the next heartbeat. It may feel like a heartbeat is skipped.

PVBs are common, especially among the elderly. They can occur in people who are healthy, in which case they are harmless. However, when they occur after a heart attack or heart surgery, they can lead to dangerous heart rhythms. In some cases, these rhythms can cause sudden death. You should contact your doctor right away if you suspect you have PVBs after a heart attack or heart surgery.

Causes

The causes of PVBs include:

• Physical or emotional stress
• Physical exercise
• Caffeine, alcohol, tobacco, and other drugs
• Certain medications, especially those that stimulate the heart
• Heart disease:
  • Heart attack
  • Coronary artery disease
  • Disorders that cause the ventricles to get larger, such as heart failure
  • Heart valve disorders
  • Congenital heart disease

Risk Factors

PVB frequency increases with age and are most common in the elderly. PVBs are also more common in men. Other factors that may increase your chance of PVBs include:

• African Americans ethnicity
• Heart disease
• Use of caffeine, alcohol, tobacco, or other drugs

Symptoms

In many cases, there are no symptoms. When symptoms do occur they can include:

• Feeling the heart beating (palpitations)
• Feeling of a skipped or missed heart beat

In people with heart disease, PVBs can cause decreased blood flow from the heart to other parts of the body. This can produce lightheadedness and fainting.

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may be referred to a cardiologist.

Tests may include:

• Blood tests to evaluate any substances that may cause heart rhythm problems.
• Electrocardiogram (EKG) tests the electrical activity of the heart.
• Holter monitor if the heart rhythm disturbance does not show up on an EKG. This type of monitoring is helpful because it measures heart activity over a longer period of time.
• Echocardiogram —Ultrasound of the heart and surrounding structures.

Treatment

In most cases, no treatment is needed. However, it can be helpful to reduce stress and avoid caffeine, alcohol, and tobacco. If a medication you are taking may be causing the PVBs, your doctor may change the medications or adjust the dosage.

You may need to take medication if you have significant symptoms from PVBs, have heart disease, or if the pattern of the PVBs indicates a risk of developing more serious heart rhythm problems. Beta-blockers are generally tried first since they are relatively safe medications. Anti-arrhythmic medications may be used, but they may also increase the chances of developing dangerous heart rhythms. Other medications that may be used include calcium channel blockers. Talk with your doctor about the best treatment for you.

Prevention

To help reduce your chances of PVBs:

• If you smoke, talk to your doctor about how you can successfully quit
• If you consume caffeine and/or alcohol, do so in moderation

Society of Thoracic Surgeons http://www.sts.org/patients

Health Canada http://www.hc-sc.gc.ca

Selzman KA, Gettes LS. Exercise-induced premature ventricular beats: Should we do anything differently? Circulation. 2004;109:2374-2375.

Ventricular premature beats (VPB). The Merck Manual Professional Edition website. Available at:
http://www.merckmanuals.com/professional/cardiovascular_disorders/arrhythmias_and_conduction_disorders/ventricular_premature_beats_vpb.html
Updated September 2013. Accessed December 29, 2014.