What are Abdominal Contractions?

Any contraction or beating of the heart that occurs early and interferes with the normal heart rhythm is called an extrasystole. When the spontaneous contractions originate in the ventricles, the lower chambers of the heart, they are called spontaneous ventricular contractions (SVS).

ACS are one of the most common arrhythmias and occur either in patients with heart disease, such as patients with a history of myocardial infarction, heart failure or any other cardiomyopathy, or in people with a structurally normal heart.

In the second case they are also characterized as idiosyncratic EKS Their frequency is estimated up to 4% in the general population. They may come from either a single focus of the heart or from multiple foci, characterizing the arrhythmia as monofocal or multifocal respectively.

Do they cause symptoms?

EKS manifest with a wide range of symptoms. They can be highly symptomatic causing an indicative “fluttering” feeling, a feeling of an extra strong pulse or a “lump” in the throat, dizziness and rarely shortness of breath but they can be “silent”, asymptomatic, regardless of the number, in which case they may be detected in random medical control.

However, sometimes the absence of symptoms is subjective as “asymptomatic” individuals with a particularly high burden of arrhythmias notice a significant improvement in their physical condition after treatment of the arrhythmia.

What are the main causes?

The most important factors that can cause ACS or increase the burden of an already existing ventricular arrhythmia are any condition that can affect the autonomic nervous system such as anxiety disorders, emotional stress, excessive coffee and alcohol consumption, smoking, electrolyte disturbances, as well as diseases such as myocarditis, cardiomyopathies, arterial hypertension, mitral valve prolapse, anemia and sleep apnea syndrome.

Are they dangerous?

The presence of ACS in patients with structural heart disease is associated with an increased arrhythmic risk, while individuals with ACS and no findings of heart disease generally have a good prognosis.

Therefore, it is particularly important to perform a cardiological examination in every patient with ACS, which can highlight the presence or absence of findings of cardiac disease and contribute to the correct stratification of arrhythmic risk.

The check-up initially includes the taking of family and individual history, the clinical examination of the examinee and then, at the discretion of the cardiologist, the performance of diagnostic tests such as electrocardiogram, echocardiogram, 24-hour Holter rhythm and fatigue test.

In more specific cases, an MRI of the heart and an electrophysiological study are recommended.

In which cases and how are they treated?

Since most ACS are benign, in the absence of structural heart disease, treatment is determined by (1) the presence of symptoms and (2) the total number of ACS per 24 hours. Asymptomatic patients with a low arrhythmic load do not need treatment.

Regular cardiac monitoring and lifestyle changes such as reducing stress, limiting smoking and alcohol and caffeine consumption are recommended. A particularly increased ECS load is considered the presence of >10000 ECS or >10% of the total number of heart contractions per 24 hours.

Clinical studies have documented that ACS load >10% of total systole is a risk factor for heart failure, known as ACS-induced cardiomyopathy, which is usually reversible by eliminating ACS.

Consequently, in symptomatic or patients with frequent ACS that cause a decrease in the systolic function of the heart, their treatment is considered beneficial.

Treatment options are (1) the antiarrhythmic drugsand (2) h invasive treatment with ablation with high frequency current.

Antiarrhythmic drugs affect the electrophysiological properties of the heart and therefore can prevent the occurrence of ACS, but their effectiveness is limited and the therapeutic effect is not permanent.

Newer scientific data document the high success and safety rates of ablation procedures in specific focal ventricular arrhythmias and make invasive treatment the treatment of choice today.

This method is performed in a hospital environment (hemodynamic laboratory) and after local anesthesia in the patient’s lower limb, a peripheral vessel (vein or artery) is painlessly punctured, through which special, thin catheters are pushed into the heart.

The visualization of anatomical structures of the heart in real time using electroanatomical mapping systems and intracardiac ultrasound allow the precise localization of the focus responsible for the presence of ACS. The next step during this procedure is the administration of energy (cautery) with the aim of definitively eliminating the arrhythmia.

In conclusion, apparently idiopathic ECs are common in the general population, usually benign and of low arrhythmic risk. In the majority of cases, monitoring and conservative treatment is recommended. Treating them either with medication or invasively, is considered beneficial in cases of the presence of severe symptoms, complex arrhythmia and a reduction in the systolic function of the heart.