Spontaneous ventricular contractions (SVS) are early electrical impulses that originate in the ventricles (heart chambers at the bottom of the heart that are responsible for pumping blood).

EKS interfere with the normal rhythm of the heart, disrupting the orderly regularity of its beats. They may occur as single contractions or follow a pattern of twins (each normal heart contraction is followed by an abnormal one) or triad (every two normal heart contractions are followed by an abnormal one). In addition, it is possible for two or more EKS to appear in a row.

The incidence of ACS in patients without known heart disease is estimated at 1-4%. Under normal conditions, a small number of EKGs in daily heart rate recordings (Holter) is expected, but in general recording more than 200 EKGs in 24 hours is considered pathological and needs further investigation.

The majority of patients with EKS are asymptomatic. Symptomatic patients often report palpitations, dizziness, easy fatigue, and more rarely shortness of breath.

The appearance of EKS can be attributed to either cardiac or extracardiac causes. Common extracardiac causes are smoking, alcohol consumption, drug use, but also extracardiac diseases such as lung diseases, sleep apnea syndrome and thyroid diseases. A multitude of cardiovascular diseases can trigger ACS, including arterial hypertension, ischemic cardiomyopathy, myocarditis, heart failure, and various types of cardiomyopathy. However, in a large percentage, EKS appear in patients without any obvious cause, so they are called idiopathic.

Diagnostic testing plays a key role in risk stratification and patient treatment. The initial check-up in each patient includes the basic ECG which can reveal underlying disease and gives information for locating the ectopic center as well as the 24-hour Holter for the quantification of the arrhythmia. In addition, ultrasound control plays a major role in highlighting structural damage. Fatigue electrocardiographic testing gives important information, as elimination of fatigue spikes is usually a good prognostic sign. In patients suspected of having structural heart disease, it is recommended to perform cardiac magnetic resonance imaging, which can reveal areas of cardiac fibrosis. Finally, in possible underlying heart disease, electrophysiological monitoring may contribute to risk stratification.

In general, patients with spontaneous ventricular contractions without underlying cardiac disease have a good prognosis, and the decision for treatment is determined by the presence and intensity of associated symptoms.

Special mention should be made for the cases of patients with a particularly high ECS burden (> 10,000 or >10% of all heart beats in a 24-hour Holter). In this category of patients there is a risk that the multitude of ecstasies will reduce the systolic force of the heart and that cardiomyopathy induced by EKS will occur. In patients with concomitant presence of an abnormal cardiac substrate, specialized management is required to assess the potential for life-threatening cardiac arrhythmias.

The therapeutic approach of patients must be individualized. In symptomatic patients, it is recommended to start medication in order to control the symptoms. Common choices are β-blockers and calcium channel blockers (verapamil, diltiazem) due to their high safety profile, but also antiarrhythmic drugs (flecainide – propafenone) in the absence of structural heart disease.

The invasive treatment with ablation, i.e. the invasive cauterization of the ectopic center ensures high efficiency with safety, very often leading to the cure of the problem. The examination is performed with local anesthesia by advancing catheters through the femoral vessels and aims to locate the responsible center using three-dimensional mapping systems and then to ablate it with a special catheter. In cases of patients who show severe symptoms or cardiomyopathy induced by the high ECS load, the immediate treatment of the arrhythmia with the ablation method is preferred.