Ventricular premature contractions (ventricular premature) are very common in clinical practice, and frequent ventricular premature contractions are not uncommon. As the name implies, one of its distinguishing features is its “frequency”, which is mainly characterized by its “high number”: the total number of premature beats in a 24-hour period is in the thousands, or even 10,000-20,000, and individually up to 40,000-60,000. Most of the premature beats in these patients have one thing in common: although there are many of them, the “pattern” is often one or predominantly one, suggesting that the origin of the premature beats is single or predominantly one, i.e. monogenic ventricular premature. From the etiological point of view, most patients with frequent monogenic premature contractions have no clear cause and most of them are presumed to be “post-myocarditis” (which is not always the case), while very few are caused by cardiomyopathies (e.g. arrhythmogenic right ventricular cardiomyopathy) or, rarely, by coronary artery disease. Here, it should be emphasized that, in most cases, the magnitude of the risk of ventricular prematureness should not be determined by the number alone, but rather by the functional status of the heart itself. Thus, in layman’s terms, frequent ventricular prematureities can be simply divided into two categories: one is simple frequent ventricular prematureities that do not combine with organic heart disease and do not cause particularly serious symptoms or consequences (e.g., syncope, blackness in front of the eyes, etc.) – that is, these ventricular prematureities are only “numerous In other words, this kind of ventricular premature, only “a large number”, but most of them have “benign” tendency in nature, and can “live peacefully” with the patient for many years, and in most of the patients with ventricular premature, this is the case, so the treatment and management of this kind of ventricular premature, can adopt a relatively relaxed Therefore, the treatment and management of this kind of ventricular premature can take a relatively lenient treatment strategy, according to the specific condition, moderate treatment can be; another kind is combined with organic heart disease, such as cardiomyopathy, myocardial infarction, acute myocarditis, heart failure, etc., or can cause serious consequences, this situation needs active treatment, should not be taken lightly. Here, I briefly introduce the common clinical manifestations, examination methods and treatment methods (including radiofrequency ablation) of frequent ventricular premature beats. 1. Symptoms and clinical manifestations of frequent premature ventricular contractions (premature ventricular contractions): 1. A series of symptoms caused by frequent premature ventricular contractions: panic, feeling of cardiac arrest, falling sensation, tingling sensation, chest tightness, chest pain and other discomforts, which are more common in patients with frequent premature ventricular contractions. 2, no obvious conscious symptoms, mostly found during routine physical examination to do ECG, or inadvertently pulse measurement found irregularities and then do ECG and confirmed the diagnosis. It is more common. 3.Some symptoms related to anxiety and tension: after patients are informed that they are suffering from ventricular premature, they will inevitably have different degrees of anxiety and tension, plus some patients themselves are prone to anxiety and tension, so they are more likely to have some uncomfortable performance, such as panic, shortness of breath, like big air, chest tightness, insomnia, etc. In many cases, patients cannot even say whether their discomfort is caused by premature beats or is mainly due to anxiety. The above situation is also common. 4. Long-term frequent premature ventricular contractions cause heart enlargement, which in turn leads to some manifestations of cardiac insufficiency, such as shortness of breath and weakness. This condition is rare. 5.In addition to ventricular premature beats, the corresponding manifestations caused by the heart lesion itself, such as cardiac insufficiency. This is rare. 6.Ventricular premature induces severe malignant arrhythmia, leading to transient blackness, syncope, loss of consciousness, and even sudden death. Rare. 7. Family history of severe cardiac disease and sudden death. Rare. Commonly used examination methods and common findings 1. ECG and 24-hour ambulatory ECG: mainly manifested as frequent ventricular premature in large numbers, mostly monogenic, or dominated by a certain form of ventricular premature. Some patients also have paired ventricular premature and short bouts of ventricular tachycardia (ventricular tachycardia). 2. Ultrasound of the heart (cardiac ultrasound): In most cases, the structure and function of the heart are normal or near normal. A small number of patients have enlarged heart, hyposystolic heart function and myocardial dysplasia. Although this is rare, once found, it should be taken seriously. 3.Magnetic resonance imaging (MRI): Some patients can receive MRI examination when they are suspected of having cardiomyopathy and other conditions that require further definitive diagnosis. 4, cardiac enzymes, electrolytes and other indicators of blood sampling and testing: in most cases, they are normal. Third, the treatment and management It should be emphasized that the treatment and management of frequent ventricular premature must be based on the specific condition of the patient and choose the appropriate treatment strategy. Moreover, as the disease develops and changes, the treatment method may have to be adjusted accordingly. 1. Long-term observation and regular follow-up In principle, this should be true for all patients, especially in the first few years when ventricular premature is first detected. (1) For patients whose cardiac ultrasound and magnetic resonance examination results indicate normal heart structure and function, if their symptoms are not serious and they do not need medication or are unwilling to take medication for a long time, and if they are not willing to undergo radiofrequency ablation surgery, they can adopt the approach of “long-term observation and regular follow-up”. The follow-up interval can be once every few months or six months to once a year at first, and the interval can be enlarged appropriately later. Depending on the results of each examination, the next step of treatment can be decided. (2) If the patient’s heart itself has structural or functional abnormalities, or has severe symptoms, then other treatment measures are often required. (2) Drug treatment Mainly some anti-arrhythmic drugs, including Western and Chinese medicines, and for some patients, some additional drugs to improve cardiac function may be applied. In general, there are two shortcomings in drug treatment: first, the treatment effect of frequent ventricular premature is not ideal, some patients even tried many kinds of drugs before they found that none of them can get satisfactory effect, and second, it often needs to be taken for a long time, which is not only inconvenient, but also easy to have some side effects. 3, transcatheter radiofrequency ablation surgery This is a minimally invasive treatment method, simply put, is the use of minimally invasive technology, the special catheter to the patient’s heart, to find the cause of ventricular premature “foci” (origin, often just a few millimeters in size), the release of radiofrequency current, the “foci The “lesion” is eliminated or modified, thus providing a cure for ventricular prematureness or a significant reduction in ventricular prematureness. It should be said that radiofrequency ablation is currently a better means of treating frequent ventricular prematureness. The success rate of it depends on the location of the ventricular premature “lesion” and whether there is a combination of organic heart disease. If the location of the “lesion” is good and there is no organic heart disease, the success rate can reach 90-95%, and the recurrence rate is very low. The success rate is lower and the recurrence rate is higher for those with poorly located lesions or organic heart disease (such as cardiomyopathy), depending on the specific condition. Experienced doctors will make a prediction based on the ventricular premature pattern of the patient’s ECG (general conventional ECG) and ultrasound results before the RF ablation procedure, and fully communicate with the patient about the condition. Generally speaking, radiofrequency ablation is recommended for the following patients: severe symptoms or high psychological stress due to premature beats, poor effect of medication or unwillingness to take medication for a long time; frequent ventricular premature causes restrictions on job recruitment and higher education; the number of ventricular premature is always high (10-20,000 in 24 hours or even more than 20,000/day for a long time); frequent ventricular premature causes heart enlargement and cardiac insufficiency; ventricular premature causes ventricular fibrillation and other malignant Cardiac arrhythmia, etc. 4. Other treatment measures For example, a small number of patients with short-onset ventricular tachycardia or even severe ventricular arrhythmias and organic heart disease may need a special pacemaker (ICD) to prevent sudden death.