How should premature beats be treated

Premature beats are a relatively common disease at present. Premature beats are generally divided into several types, and most of them do not require special treatment. Considering the special condition of the patient and frequent attacks, the patient's heart function will not be comfortable, and the digestive function and gastrointestinal function will have problems due to premature beats. Therefore, how patients with premature beats should be treated in normal times has become a matter of concern for many people.

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The treatment principles should be determined based on the presence or absence of organic heart disease, whether it affects cardiac output, and the possibility of developing serious arrhythmias.

Most premature beats without organic heart disease do not require special treatment. Those with symptoms should reassure themselves. Sedatives and beta-blockers can be tried for premature beats induced by tension, excessive excitement, or exercise.

For patients with frequent attacks, obvious symptoms or organic heart disease, it is advisable to find out the causes and triggers of premature beats as soon as possible and give corresponding treatment for the causes and triggers. At the same time, the potential fatality should be correctly identified, and the causes and symptomatic treatment should be actively treated.

In addition to etiological treatment, antiarrhythmic drugs can be used for treatment. Atrial and atrioventricular junction premature beats are mostly treated with Class Ⅰa, Ⅰc, Ⅱ, and Ⅳ drugs that act on the atria and atrioventricular junction, while ventricular premature beats are mostly treated with Class Ⅰ and Ⅲ drugs that act on the ventricles (see the drug classification above, and also see Chapter 7 "Introduction to Clinical Pharmacology"). Potentially fatal premature ventricular contractions often require emergency intravenous medication.

Class Ib is preferred. Intravenous lidocaine is still often the first choice in the early stages of acute myocardial infarction. Beta-blockers are often used to treat myocardial infarction unless there are contraindications. Class I drugs are contraindicated in patients with primary or secondary long QT syndrome. For primary patients, beta-blockers, phenytoin, or carbamazepine can be used as an alternative. For secondary cases, the cause should be removed and treatment should be with isoproterenol or atrial or ventricular pacing.

Recent studies (CAST 1989) suggest that antiarrhythmic therapy increases the risk of mortality. Even if patients with heart disease control ventricular premature beats, there is no evidence that it reduces the rate of sudden death (except for the use of beta-blockers after myocardial infarction). Therefore, the pros and cons of using antiarrhythmic drugs should be weighed.

There have been large series of multicenter trials and long-term follow-up in China on patients with non-myocardial infarction arrhythmias (mainly premature beats). The use of propafenone and moricizine for supraventricular arrhythmias and propafenone, moricizine, and mexiletine for ventricular arrhythmias have shown certain therapeutic effects, and no serious cardiac events have been found. However, close follow-up monitoring of the effects and possible adverse reactions is still required during the use of the medication. Patients with heart failure should be especially cautious.