Complex ves I49.3

The first classification of ventricular extrasystoles was established by Bernhard Lown in 1971 and named after him as the "Lown classification" (Weber 2018).

Ventricular extrasystole (VES) is the term used to describe bundle branch block-like deformed QRS complexes without a preceding P wave (Weil 2025).

The term "complex VES" includes extrasystoles that belong to the so-called low classification 3 - 5 (Weil 2025). Strictly speaking, the low classification only applies to CHD (Weil 2025) and is rarely used nowadays (Braun 2022).

Complex VES thus includes polymorphic VES, couplets, non-sustained VT (Herold 2023), VES volleys, premature VES, R to T phenomenon, ventricular tachycardia (Weil 2025).

In addition to the complex VES, there are also complex SVES such as volleys, pairs, which can be precursors of atrial fibrillation (Weil 2025).

Ventricular extrasystoles can result from premature depolarization caused by abnormally increased ventricular excitation. As a rule, these are myocytes that are already damaged, e.g. due to myocardial infarction, any form of heart disease or manifest heart failure. Only in exceptional cases is the focus of ventricular extrasystoles found in completely healthy myocardium (Christ 2019).

The propagation of the excitation does not follow the normal path in VES, which leads to an atypically deformed and widened QRS complex (Christ 2019).

The majority of VES are perceived as asymptomatic by the patient. However, they can also be perceived as heart palpitations (Christ 2019).

Complex VES can lead to syncope and a general reduction in performance (Ludwig 2020).

If complex VES occur, it is recommended to perform an echocardiography and a stress test (Weil 2025).

If complex VES occur in a person with organic heart disease (e.g. after myocardial infarction or left ventricular heart failure), these are often harbingers of a dangerous ventricular tachyarrhythmia up to ventricular fibrillation (Herold 2023).

Warning signs are:

• Bigeminus
• couplets
• volleys
• Frequent polytopic (polymorphic) VES
• R on T phenomenon (Herold 2023)

• Asymptomatic patients:

These should not be treated with class I antiarrhythmic drugs. Although class I antiarrhythmic drugs are able to suppress complex VES, they cannot reduce mortality (Weil 2025).

If the patient's left ventricular function is unremarkable and asymptomatic VES is present in > 10 %, only annual cardiologic checks should be performed (Weil 2025).

• Symptomatic patients:

In symptomatic patients, possibly amiodarone in combination with beta-blockers (Weil 2025).

Regular long-term ECGs are required to monitor the therapy (Weil 2025).

Frequent complex VES indicate an increased risk of ventricular fibrillation (Ludwig 2020).

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