1. What are premature beats? Premature beats, the most common heart rhythm disorder, are also called preterm contractions. The normal heartbeat originates from a tissue called the sinus node in the upper part of the right outer atrium, so the normal heart rhythm is also called sinus rhythm. If, due to inflammation, ischemic necrosis, fibrosis, etc., a lesion is created in any other part of the heart that also emits electrical impulses, causing the heartbeat to occur earlier than the sinus rhythm, this is called premature beats, also called preterm contractions. 2. What are the types of premature beats? There are different ways to classify premature contractions, but the most common one is based on the origin of the contraction, which is most common in atrial and ventricular cases, and also in atrioventricular junctional cases. Of course, atrial and ventricular can be divided into left or right atrial, left or right ventricular origin, or even more detailed, such as left superior pulmonary vein origin atrial premature, right ventricular outflow tract ventricular premature, and so on. There are also categories based on the degree of prematureness or morphology of the premature contractions. The different types mean different health effects, symptoms and treatment strategies and outcomes for the patient. 3. What are the symptoms of premature beats? In most cases, premature contractions are characterized by an intermittent heartbeat or, as some patients describe it, by a “pause”, a feeling of a sudden advance in the heartbeat or a stop. Many patients do not have any obvious symptoms, but are detected during a physical examination or a visit to the doctor for another illness. It is important to point out that many people often go to the doctor because of some unclear symptoms, such as chest tightness, insomnia, etc., and then happen to find premature beats, so the doctors and the patients themselves rashly attribute these symptoms to premature beats. This is definitely wrong. You should have a gynecological or endocrine examination, and there are quite a few patients who actually have mental symptoms such as anxiety disorder. To diagnose the presence and location of premature beats, an ordinary 12-lead ECG is all that is needed. Of course, another or even several 24-hour ambulatory ECGs will help us to understand the number of premature beats and their temporal distribution. However, for the classification and localization of premature beats, it is most important to perform a normal 12-lead ECG, preferably several times, so that each lead can capture premature ventricular contractions, which will help us to accurately determine the type and location of premature beats. In addition, a cardiac ultrasound can be considered to see if there is a clear structural lesion in the heart. In general, premature beats with definite organic heart disease are relatively more clinically necessary to treat, but it also depends on the patient’s specific situation. In a few cases, CT or MRI, or even genetic or immunological tests are needed to help with the diagnosis. 5. What are the risks of premature beats? Most premature beats are not life-threatening, especially atrial premature beats, and there is little need to worry about the risk. However, the presence of premature beats can disrupt the normal sequence of heart contractions and may affect the ejection function of the heart to varying degrees, leading to various discomforts, but mostly not serious. In fact, the vast majority of people seek medical attention mainly out of discomfort or because they are worried about the dangers of premature beats found during a physical examination. Secondly, some patients may have heart enlargement or even cardiac dysfunction due to premature beats. This is usually seen in frequent ventricular premature beats, such as more than 10,000 or even more ventricular premature beats per day for a long period of time, but it is difficult to determine which patient will have an enlarged heart (also called ventricular premature cardiomyopathy), and if you are worried about this, you can have a heart ultrasound every year (every six months in special cases). However, in some patients, premature beats may be caused by cardiomyopathy. Therefore, premature beats and cardiomyopathy are causal factors, and the final decision can only be made after 3-4 months of observation by ultrasound and ECG after ablation or medication to control premature beats. Ventricular fibrillation and even sudden death due to premature ventricular contractions do occur, but they are rare. This is often due to congenital genetic variants (such as Burugada syndrome, long QT syndrome, arrhythmogenic cardiomyopathy, etc.) or electrolyte disorders or certain medications that cause QT prolongation and other electrocardiographic abnormalities, and some ventricular premature events are so early that they appear on the ECG as R on T. There are also ventricular premature events that originate in specific locations, which have a relatively high risk of ventricular fibrillation. Especially in summer, when sweating is high and eating is abnormal, resulting in low blood potassium, the risk of ventricular fibrillation is relatively high and needs to be alerted. However, this type of patient is relatively rare. It is important to find a doctor who specializes in arrhythmias to determine the specific type of condition. 6. What are the causes of premature beats? The most common cause of premature beats is aging. In other words, premature atrial contractions are almost inevitable in the elderly, the older they get, the more frequent they are. Some elderly people in their 70’s or even 80’s are often worried because they find atrial premature beats or a small number of ventricular premature beats, and they seek medical help and take a lot of medication. For the elderly, premature beats, like gray hair, wrinkles or age spots, are a sign of aging of the body’s organs, and most of them are not life-threatening. Unfortunately, the ignorance and lack of respect for science in some patients, together with the limited level of doctors, lead to complications and even death by over-treatment. Another cause of premature beats is myocardial damage due to various causes, including ischemia, infection, inflammation, etc. Under normal circumstances the heart muscle should not issue electrical impulses causing premature beats, once they appear, it means that there is a lesion in one part of the heart muscle, which is like a mole on a smooth skin, or it can be seen as a residual spot of fruits and vegetables after being frosted. Therefore, in addition to natural aging, we should try to have a good diet and regular lifestyle habits to avoid damaging the immune system triggering various inflammatory reactions in the heart leading to premature beats or even cardiomyopathy. Various metabolic diseases such as diabetes, hyperthyroidism, hyperlipidemia, and others such as hypertension, coronary artery disease, myocarditis or cardiomyopathy, are prone to premature beats. Another notable cause is alcoholism. Long-term alcohol consumption can cause a series of damages to the heart, liver and brain, leading to premature beats, tachycardia, atrial fibrillation and other arrhythmias, and even death from heart failure. However, the majority of patients with premature beats (especially ventricular premature beats) are often not found to have a clear cause, and most of them are due to local lesions left over from one or several cases of myocarditis (often behaving like a common cold). 7. How are premature beats treated? As mentioned earlier, most premature beats (especially atrial premature beats) are not dangerous or life-threatening, so they should be evaluated by a specialist after detection, and the few patients who do have life-threatening beats should be treated aggressively, including catheter ablation or even ICD implantation (buried defibrillator). In general, there are several types of patients: atrial or ventricular premature beats can be left untreated or controlled with appropriate medication (in principle, avoid amiodarone because it is not curative and has many side effects) if the number of premature beats is evaluated as benign and is less than 5,000 beats per day. It has many side effects.) If the number of ventricular premature beats is high, exceeding 10,000 per day, catheter ablation may be considered, but it also depends on the patient’s cardiac and overall physical condition and the location of the ventricular premature beats before a decision can be made. In principle, ablation is not considered for atrial premature beats, regardless of the number, because there is no risk, and there are too many sites where atrial premature beats can occur, and most people are often unable to induce premature beats after the operating table, which makes it difficult to ablate thoroughly, and if the effect is pursued, it may be forced to “bombard” the patient, resulting in the patient seemingly feeling good after surgery, which is actually not worth the loss. In contrast, most frequent premature ventricular contractions can be eradicated by ablation. However, it also depends on the location and the level of experience of the surgeon. In fact, even for ventricular premature that causes heart enlargement, heart failure or even ventricular fibrillation, or for a large number of common ventricular premature, ablation should not be overly perfect, because excessive ablation can cause greater long-term damage to the patient’s ventricles. And some ventricular premature may originate in the immediate vicinity of the cardiac conduction system (that is, the system of wires that direct the normal beating of the heart) or near the coronary arteries, and ablation often throws a wrench in the works, which may lead to abandonment of ablation or failure to be complete, but this is also the result of weighing the pros and cons.