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Key Features

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  • Atrial premature beats

    • Triggered by an ectopic focus in the atrium

    • One of the most common premature beats occurring in pediatric patients, particularly during the fetal and newborn periods

  • Junctional premature beats: Arise in the atrioventricular node or the bundle of His

  • Ventricular premature beats

    • Sometimes referred to as premature ventricular contractions (PVC) or as ventricular ectopy

    • Relatively common, occurring in 1%–2% of patients with normal hearts

    • Characterized by an early beat with a wide QRS complex, without a preceding P wave, and with a full compensatory pause following this early beat

    • Multifocal ventricular premature beats

      • Always abnormal and may be more dangerous

      • May be associated with drug overdose (tricyclic antidepressants or digoxin toxicity), electrolyte imbalance, myocarditis, or hypoxia

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Clinical Findings

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  • Ventricular premature beats

    • Beats originating from a single ectopic focus all have the same configuration

    • Beats of multifocal origin show varying configurations

    • Usually benign in otherwise healthy patients

    • If exercise results in an increase or coupling of contractions, underlying disease may be present

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Diagnosis

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  • Atrial premature beats

    • May be conducted to the ventricle and therefore followed by a QRS complex

    • May be nonconducted, as the beat has occurred so early that the AV node is still refractory

    • A brief pause usually occurs until the next normal sinus beat occurs

  • Junctional premature beats induce a normal QRS complex with no preceding P wave

  • Ventricular premature beats

    • 24-hour ambulatory ECG

    • Significance of ventricular premature beats can be confirmed by having the patient exercise; as heart rate increases, benign ventricular premature beats usually disappear

    • Echocardiogram may be performed to evaluate ventricular function

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Treatment

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  • Atrial premature beats: Benign and require no treatment when an isolated finding

  • Junctional premature beats: Usually benign and require no specific therapy

  • Ventricular premature beats: Treatment is directed at correcting the underlying disorder

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