Premature ventricular contractions (ventricular premature) are the most common clinical arrhythmia, occurring in a wide range of populations, with considerable variation in clinical symptoms and varying clinical prognosis of patients. The correct clinical management depends on the risk assessment of ventricular prematureness. I. Ventricular premature without organic heart disease: Generally, the prognosis is good, if there are no obvious symptoms during the attack, it can be left untreated; those who have symptoms can be given psychological guidance to eliminate the triggers (tension, caffeine, etc.), and if necessary, β-blockers or non-dihydropyridine calcium antagonists to relieve symptoms, and other types of anti-arrhythmic drugs are not recommended; research has found that the Chinese medicine ginseng and pine heart capsule has certain efficacy and safety for this kind of ventricular premature. For frequent ventricular premature with obvious symptoms, especially those originating from the outflow tract, catheter ablation can be considered when drug therapy is ineffective, with a higher success rate. Recently, some foreign studies have proposed that frequent idiopathic ventricular premature can cause tachycardia cardiomyopathy, and proposed that ventricular premature load of more than 15%, and some even proposed that >24% is an indication for catheter ablation. Second, ventricular premature beats in coronary artery disease: ventricular premature in acute myocardial ischemia should be actively treated for myocardial ischemia and electrolyte disturbances. β-blockers can reduce sympathetic excitability and decrease the incidence of triggering malignant ventricular arrhythmias. If ventricular prematureness triggers hemodynamically unstable malignant arrhythmias, amiodarone combination therapy can be considered. Antiarrhythmic drug therapy is not recommended for asymptomatic ventricular premature in the setting of old infarction except for β-blockers. However, those with frequent and consecutive post-infarction ventricular premature with significantly decreased EF are at increased risk of sudden cardiac death and should be actively intervened to improve the long-term prognosis. (1) Pharmacological treatment: including antiarrhythmic drugs and antiarrhythmic upstream drugs. The former are mainly β-blockers and amiodarone; the latter are upstream drugs that have no direct cardiac electrophysiological effect but can improve cardiac remodeling and prevent or reduce the occurrence of ventricular arrhythmias, including ACEI, ARB, statins, spironolactone, magnesium preparations, unsaturated fatty acids and vitamin C, etc. (2) Catheter ablation: For patients with frequent ventricular arrhythmias with significant symptoms, ineffective drug therapy, or unwillingness to take long-term medications. It has been found that catheter ablation of frequent ventricular premature in patients with ischemic cardiomyopathy can improve left ventricular ejection fraction and reverse left heart function, but the critical value of ventricular premature load is uncertain. (3) Indirect therapeutic measures such as revascularization. In patients with severe myocardial ischemia, revascularization can help reduce episodes of ventricular arrhythmias, including premature ventricular contractions, such as percutaneous balloon dilation, stent angioplasty (PCI), and coronary artery bypass surgery. In patients with post-infarction ventricular wall tumor formation, ventricular wall tumor resection can help in the treatment of ventricular arrhythmias. Ventricular premature beats in heart failure: Ventricular premature beats in patients with severe cardiac insufficiency can increase the rate of sudden death, so it is important to find and correct the underlying factors leading to ventricular arrhythmias, such as improving hypoxia, correcting electrolyte disturbances, and hemodynamic reconstruction. Drug therapy includes (1) Upstream drug therapy: including ACEI, ARB, β-blockers, spironolactone, diuretics, etc., which can help reduce the occurrence of ventricular arrhythmias. (2) Anti-arrhythmic drug therapy: Patients with heart failure with ventricular premature without obvious symptoms do not need to be given anti-arrhythmic drug therapy. For patients with frequent and symptomatic ventricular premature, β-blockers can be used, and if necessary, amiodarone should be used or combined with them, but Ic drugs should not be used. Catheter ablation: For patients with monomorphic ventricular premature who are not treated with frequent medications, catheter ablation can be tried in a few patients under the condition that cardiac function allows. IV. Ventricular premature contractions in children Studies have shown that children with normal cardiac structure are less likely to have frequent ventricular premature contractions. As children grow, ventricular prematureities of left ventricular origin tend to disappear, whereas ventricular prematureities of right ventricular origin are more often present. Therefore, children with ventricular prematurity of left ventricular origin do not require intense intervention, including pharmacologic therapy and catheter ablation. In children with ventricular prematureness of right ventricular origin, long-term follow-up, including monitoring of left heart function, is warranted, with particular vigilance for ventricular prematureness in right ventricular cardiomyopathy. V. Ventricular prematureness due to ion channelopathy Patients with Brugada syndrome with a single focal ventricular prematureness can trigger the development of polymorphic ventricular tachycardia or ventricular fibrillation. Studies have confirmed that quinidine can reduce electrical storm episodes, but whether it can reduce mortality remains to be proven. In this group of patients, the only effective means of preventing sudden death is ICD therapy. In patients with long QT syndrome and catecholamine-sensitive polymorphic ventricular tachycardia, β-blockers are currently the main treatment. Although ICD therapy clearly reduces mortality, the complications associated with ICD therapy limit its use because most of these patients are children or young adults. The literature reports that only 3-5% of such patients are treated with ICDs.