Ventricular ectopic beats (VEBs), also called premature ventricular contractions (PVCs) or ventricular extrasystoles, are extra heartbeats that originate in the ventricles rather than in the sinus node (the heart’s normal pacemaker). They are among the most common cardiac arrhythmias and occur in the majority of people at some point, including those with completely healthy hearts.
What causes them
VEBs can be triggered by stimulants such as caffeine, alcohol, and nicotine; by stress and anxiety; by certain medications; by electrolyte imbalances; and by underlying heart disease. In people with a structurally normal heart, VEBs are usually benign. In people with heart disease, particularly those who have had a cardiac arrest, the significance of VEBs depends on their frequency, pattern, and clinical context.
What they feel like
Many people are not aware of VEBs at all. When felt, they are often described as a "missed beat," a "thud" or "flip" in the chest, a "skipped beat," or a sensation of the heart pausing and then beating more strongly. They are frequently more noticeable at rest and may cause anxiety, particularly in cardiac arrest survivors who are hyperaware of their heart.
Are they dangerous?
In the general population without heart disease, VEBs are not dangerous and do not require treatment beyond reassurance. In cardiac arrest survivors, the cardiologist will assess VEBs in the context of the individual’s underlying condition. Very frequent VEBs (more than 10,000 to 15,000 per day) can occasionally cause or worsen ventricular dysfunction over time (VEB-induced cardiomyopathy), and treatment may be considered.
Management
When treatment is needed, options include lifestyle modification (reducing caffeine, managing stress), beta-blockers, other antiarrhythmic drugs, or catheter ablation.
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