Inquadramento e stratificazione del rischio nei pazienti con extrasistolia ventricolare

During a cardiological evaluation, premature ventricular contractions (PVCs) may be found, which require careful evaluation using diagnostic methods to discern in which patients there is a high risk of structural heart disease and sudden cardiac death. Epidemiological data show that PVCs occur in about 75% of healthy (or apparently healthy) individuals, without evidence of underlying structural heart disease. PVCs are generally asymptomatic, but can also manifest as palpitations, dyspnea, syncope and fatigue. The first clinical management includes a clinical evaluation, anamnesis and a 12-lead ECG; the latter is fundamental to describe the characteristics of the PVC (morphology, origin, complexity, behavior in relation to physical exercise or meals) that can suggest the benignity or malignancy of the arrhythmia. Echocardiography is important for evaluating left ventricular ejection fraction. Moreover, cardiac magnetic resonance is useful for identifying the presence of myocardial scar indicative of an associated structural heart disease. Therefore, the purpose of this review is to critically analyze the process of evaluating PVCs, which is fundamental for accurate risk stratification and a correct therapeutic approach (pharmacological or ablative).