Ventricular premature contractions. Which should be treated?

The treatment of ventricular premature contractions (VPCs) is based on two factors: bothersome symptoms from which the patient desires relief and the association of ectopic ventricular beats with sudden cardiac death. The sudden death risk related to ventricular ectopic beats is real, but appears to be a function of the frequency or pattern in which they occur plus the presence of underlying heart disease. A serious risk exists when frequent, multifocal, successive, or R-on-T-type VPCs occur in a patient monitored late after a fresh myocardial infarction, particularly if left ventricular failure is also present. Current data have been used to formulate levels of risk for sudden cardiac death on the basis of ventricular ectopic beats, which in turn provides a reasonable basis for the treatment of asymptomatic ventricular ectopy.