Ventricular extrasystoles are a type of arrhythmias that develops as a result of the appearance of additional foci of excitation in the myocardium. As a result, irregular heartbeats appear, disrupting the normal functioning of the organ and leading to a deterioration in blood flow. For clinical purposes of patient observation, treatment and further prognosis, the 1975 Lown classification of ventricular premature beats is best suited.
Classification principle
There are many factors that characterize a particular disease. As for extrasystoles, the following signs are distinguished:
- the number of ectopic sites (mono-, polytopic);
- form of arrhythmia (mono-, polymorphic);
- frequency of occurrence (rare, moderately frequent, frequent);
- localization (right, left ventricular);
- regularity of contractions (ordered, disordered);
- periodicity (spontaneous, regular).
In accordance with these parameters, many options were proposed: according to Bigger, Mayerburg. However, the Lown-Wolf classification turned out to be the most practical and in demand. Ventricular extrasystole according to Lown is determined using the so-called gradations, each of which is assigned one digit:
- 0 - no arrhythmias in the last 24 hours of observation;
- I - no more than 30 arrhythmias are recorded during an hour of monitoring, monotopic and monomorphic;
- II - more than 30 per hour of the same type;
- III - polymorphic extrasystoles appear;
- IVŠ° - paired monomorphic;
- IVb - paired polymorphic;
- V - the presence of ventricular tachycardia (extrasystoles that occur more than 3 times in a row) is characteristic.
The use of gradations for the treatment of extrasystole
Indicating the degree of arrhythmia in the formulation of the diagnosis is very important. The treatment tactics that the doctor chooses will depend on this.
So, the presence of extrasystoles of the first grade in the patient indicates the functional nature of the arising incorrect contractions. About 60-70% of people experience a similar phenomenon, and this is considered an absolute norm. The only thing that is required is a periodic ECG check. Nevertheless, if you have any symptoms of cardiovascular pathologies, you should undergo additional examination, as this may be one of the first signs of the disease.
If the second grade is found without hemodynamic disturbance, non-drug treatment is indicated: auto-training, psychotherapy, avoidance of risk factors. If there are concomitant symptoms or the appearance of polymorphic foci (third grade) is noticed, an appropriate course of antiarrhythmic drugs is required.
Finally, the fourth, fifth, as well as the third degree refractory to conservative therapy, especially in hemodynamic disorders, require surgical treatment. In this case, such surgical interventions as catheter radiofrequency ablation or implantation of a pacemaker may be indicated.
This classification is also used to build a forecast. Threatening ventricular premature beats of 3-5th gradation according to Lown are considered. These are the so-called malignant arrhythmias. They are characterized by a high risk of sudden death. In this case, the patient should be transferred to the intensive care unit.
The localization of foci is also important. The prognosis is less favorable in the presence of left ventricular arrhythmias.
Extrasystole against the background of other heart diseases: the role of classification
It should be noted that the above prognostic signs are correct only in the absence of concomitant diseases such as myocarditis, valvular defects or coronary heart disease. Often they themselves are the causes of the appearance of irregular heartbeats.
Extrasystoles of the 3rd, 4th, 5th gradations can lead to significant hemodynamic disturbances. Cardiac output decreases, blood supply to the coronary vessels and the brain deteriorates. All this forms a vicious circle, which contributes to the further progression of coronary artery disease. Also, the presence of this pathology is an indication for a significant change in treatment tactics.
In general, the presence of ischemic disease (especially a postponed myocardial infarction) significantly worsens the prognosis for a patient even with arrhythmias of the 2nd or 3rd grade according to Lown.
Conclusions
Ventricular premature beats is a common heart disease in which myocardial automatism is impaired. If individual extraordinary contractions are functional in nature and may be present in healthy people, an increase in frequency and the appearance of several foci indicates an organic type of lesion.
For the purposes of differential diagnosis, prognosis and choice of treatment, a simple and effective Laun classification was proposed, which has been successfully used since 1975 to the present day.
