Extrasystoles
Disease Description
Extrasystoles are premature, out-of-sequence contractions of the heart chambers that originate from an ectopic focus under the influence of an abnormal electrical impulse. Depending on the site of origin, extrasystoles are classified as atrial or ventricular.
Causes of the Disease
Extrasystoles may be caused by coronary artery disease, prior myocardial infarction, hormonal and electrolyte imbalances, myocarditis, heart valve disease, alcohol consumption, use of psychoactive substances, and chronic stress.
Symptoms
Typical symptoms reported by patients with extrasystoles include strong or sudden heartbeats, sensations of “skipped” or “paused” beats, a feeling of the heart “flipping” or “stopping” in the chest.
In some cases, extrasystoles are asymptomatic and are detected incidentally during routine examinations based on ECG findings or 24-hour (Holter) ECG monitoring.
Diagnosis
The diagnosis is usually established using a standard ECG or 24-hour ECG monitoring. In many cases, ECG analysis allows precise localization of the ectopic focus responsible for extrasystoles, making it possible to plan interventional treatment in advance if such treatment is indicated.
Treatment
The choice of treatment strategy is based on the clinical presentation, instrumental examination data, and current clinical guidelines. In most cases, treatment of extrasystoles begins with antiarrhythmic drug therapy.
Treatment effectiveness is monitored using repeat 24-hour ECG recordings.
If medication therapy is ineffective, causes significant side effects, or is unsuitable for long-term use (for example, when planning pregnancy), radiofrequency catheter ablation (RFA) may be performed. This procedure eliminates the pathological focus using targeted radiofrequency energy delivered via a catheter.
In many cases, RFA allows permanent elimination of the arrhythmia without the need for long-term medication.
Treatment Prognosis
Extrasystoles can significantly reduce patients’ quality of life and may trigger more serious and persistent cardiac rhythm disorders. Atrial extrasystoles can initiate atrial fibrillation, while ventricular extrasystoles may provoke sustained ventricular tachycardia — a potentially life-threatening condition.
Ventricular extrasystoles require thorough evaluation, including echocardiography, exercise testing, cardiac MRI, or coronary angiography, to rule out structural heart disease.