Introduction: Ventricular extrasystoles (VES) in childhood occur in both children with congenital heart malformations and those without structural heart pathology. In most cases, no treatment is necessary. In patients with a high frequency of VES and subjective complaints or the presence of an underlying cardiac indication, drug treatment should be initiated.
Aim: The aim of this article is to summarize and evaluate therapeutic approaches in children with VES without underlying structural heart pathology by analyzing the available literature in PubMed, Google Scholar, Cochrane Library, Medscape.
Results: Beta blockers are the first choice for the treatment of VES in children. In case of failure or contraindication to their use calcium antagonists are included. Antiarrhythmic drugs of class I or class III can also be used to treat more complex or resistant VES due to their proarrhythmic potential. If drug therapy fails, ablation of the focus is performed.
Conclusion: Most patients do not require drug treatment. When initiating such treatment, an assessment of the VES, the patient's impact, and possible side effects should be made.
Cohen MI. Frequent premature ventricular beats in healthy children: when to ignore and when to treat? Curr Opin Cardiol. (2019) 34(1):65–72. doi: 10.1097/ HCO.0000000000000581.
Tungar IM, Rama Krishna Reddy MM, Flores SM, Pokhrel P, Ibrahim AD. The Influence of Lifestyle Factors on the Occurrence and Severity of Premature Ventricular Contractions: A Comprehensive Review. Curr Probl Cardiol. 2024 Jan;49(1 Pt B):102072. doi: 10.1016/j.cpcardiol.2023.102072.
Cantillon DJ. Evaluation and management of premature ventricular complexes. Cleve Clin J Med. 2013 Jun;80(6):377-87. doi: 10.3949/ccjm.80a.12168.
Crosson JE, Callans DJ, Bradley DJ, Dubin A, Epstein M, Etheridge S, et al. PACES/HRS expert consensus statement on the evaluation and management of ventricular arrhythmias in the child with a structurally normal heart. Heart Rhythm. 2014 Sep;11(9):e55-78. doi: 10.1016/j.hrthm.2014.05.010.
Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2022 Oct 21;43(40):3997-4126. doi: 10.1093/eurheartj/ehac262.
Uysal F, Turkmen H, Genc A, Bostan OM. Effect of Magnesium on Ventricular Extrasystoles in Children. Clin Pediatr (Phila). 2024;63(10):1436-41. doi:10.1177/00099228231223780.
Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J. 2015 Nov 1;36(41):2793-2867. doi: 10.1093/eurheartj/ehv316.
Dan GA, Martinez-Rubio A, Agewall S, Boriani G, Borggrefe M, Gaita F, et al. Antiarrhythmic drugs-clinical use and clinical decision making: a consensus document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology (ESC) Working Group on Cardiovascular Pharmacology, endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS) and International Society of Cardiovascular Pharmacotherapy (ISCP). Europace. 2018 May 1;20(5):731-732an. doi: 10.1093/europace/eux373.
Bertels RA, Kammeraad JAE, Zeelenberg AM, Filippini LH, Knobbe I, Kuipers IM, et al. The Efficacy of Anti-Arrhythmic Drugs in Children With Idiopathic Frequent Symptomatic or Asymptomatic Premature Ventricular Complexes With or Without Asymptomatic Ventricular Tachycardia: a Retrospective Multi-Center Study. Pediatr Cardiol. 2021 Apr;42(4):883-890. doi: 10.1007/s00246-021-02556-7.
Bertels RA, Kammeraad JAE, van Geloven N, Filippini LH, van der Palen RLF, Tak RO, et al. ECTOPIC trial: The efficacy of flEcainide Compared To metOprolol in reducing Premature ventrIcular Contractions: A randomized open-label crossover study in pediatric patients. Heart Rhythm. 2025 Feb;22(2):536-543. doi: 10.1016/j.hrthm.2024.07.111.
Alekseeva KB, Kruchina TK, Maljarova MS, Novik GA. Efficacy of Propafenone for Treating Idiopathic Premature Ventricular Contractions in Children. Ann Russ Acad Med Sci. 2023;78(5):498-504. doi: 10.15690/vramn13677.
Yamawake N, Nishizaki M, Hayashi T, Niki S, Maeda S, Tanaka Y, et al. Autonomic and pharmacological responses of idiopathic ventricular tachycardia arising from the left ventricular outflow tract. J Cardiovasc Electrophysiol. 2007;18(11):1161–6. doi: 10.1111/j.1540-8167.2007.00929.x.
Adams MJ, Ayers MD, Kean AC. The successful use of verapamil in infants with fascicular ventricular tachycardia. Progr Pediatr Cardiol. 2022;67:101524. doi: 10.1016/j.ppedcard.2022.101524.
Jørgensen AEM, Hermann TS, Christensen HR, Dalhoff KP. Use of Therapeutic Drug Monitoring in Amiodarone Treatment: A Systematic Review of Recent Literature. Ther Drug Monit. 2023 Aug 1;45(4):487-493. doi: 10.1097/FTD.0000000000001079.
Philip Saul J, Kanter RJ; WRITING COMMITTEE; Abrams D, Asirvatham S, et al. PACES/HRS expert consensus statement on the use of catheter ablation in children and patients with congenital heart disease: Developed in partnership with the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American Academy of Pediatrics (AAP), the American Heart Association (AHA), and the Association for European Pediatric and Congenital Cardiology (AEPC). Heart Rhythm. 2016 Jun;13(6):e251-89. doi: 10.1016/j.hrthm.2016.02.009.
