Premature Ventricular Beats

(Ventricular Premature Beats; Premature Ventricular Contractions; Ventricular Ectopic Beats)


A premature ventricular beat (PVB) is an extra heartbeat caused by abnormal electrical activity. It starts in the ventricles (the lower chambers of the heart) before a normal heartbeat occurs. PVB interferes with the heart’s normal rhythm and causes a pause before the next heartbeat.

PVBs are common, especially among the elderly. They can occur in people who are healthy, in which case they are harmless. However, when they occur after a heart attack or heart surgery, they can lead to dangerous heart rhythms.

Anatomy of the Heart

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The causes of PVBs include:

  • Physical or emotional stress
  • Physical exercise
  • Caffeine, alcohol, tobacco, and other drugs
  • Certain medications, especially those that stimulate the heart
  • Heart disease:

Risk Factors

PVB frequency increases with age and PVBs are most common in the elderly. PVBs are also more common in men. Other factors that may increase your chances of PVBs:

  • African American ethnicity
  • Heart disease
  • Use of caffeine, alcohol, tobacco, or other drugs


In many cases, there are no symptoms. When symptoms do occur they can include:

  • Feeling the heart beating (palpitations)
  • Feeling of a skipped or missed heartbeat

In people with heart disease, PVBs can cause decreased blood flow from the heart to other parts of the body. This can produce lightheadedness and fainting.


Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may be referred to a cardiologist.

Tests may include:

  • Blood tests to evaluate any substances that may cause heart rhythm problems.
  • ECG tests the electrical activity of the heart.
  • Holter monitor if the heart rhythm disturbance does not show up on an ECG. This type of monitoring is helpful because it measures heart activity over a longer period of time.
  • Echocardiogram —Ultrasound of the heart and surrounding structures.


In most cases, no treatment is needed. However, it can be helpful to reduce stress and avoid caffeine, alcohol, and tobacco. If a medication you are taking may be causing the PVBs, your doctor may change the medication or adjust the dosage.

You may need to take medication if you have significant symptoms from PVBs, have heart disease, or if the pattern of the PVBs indicates a risk of developing more serious heart rhythm problems. Beta-blockers are generally tried first since they are relatively safe medications. Antiarrhythmic medications may be used, but they may also increase the chances of developing dangerous heart rhythms. Other medications that may be used include calcium channel blockers. Talk with your doctor about the best treatment for you.


To help reduce your chances of PVBs:

  • If you smoke, talk to your doctor about how you can successfully quit
  • If you consume caffeine and/or alcohol, do so in moderation

American Heart Association

Heart Rhythm Society


Canadian Heart Rhythm Society

Heart and Stroke Foundation of Canada


Premature contractions—PACs and PVCs. American Heart Association website. Available at: Last reviewed December 2016. Accessed November 28, 2017.

Premature ventricular contractions (PVCs). EBSCO DynaMed Plus website. Available at: Updated October 27, 2017. Accessed November 28, 2017.

Selzman KA, Gettes LS. Exercise-induced premature ventricular beats: Should we do anything differently? Circulation. 2004;109(20):2374-2375.

Ventricular premature beats (VPB). Merck Manual Professional Version website. Available at: Updated September 2017. Accessed November 28, 2017.

Last reviewed November 2018 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC  Last Updated: 11/27/2017