The most important factor when investigating the aetiology of ventricular ectopic beats (VE’s) is to establish the possible presence of structural heart disease. Should structural heart disease be identified, treatment should firstly be aimed towards the management of this condition and only secondarily towards the arrhythmia itself. Isolated VE’s of a healthy heart are a benign phenomenon which only rarely require treatment. The mere knowledge that the symptoms are not caused by a structural heart disease is often enough to reassure the patient. However, frequent VE’s associated with heart disease (e.g. recent myocardial infarction, heart failure) and hereditary ion channel disorders (e.g. long QT syndrome, polymorphic catecholamine-sensitive ventricular tachycardia) may be predictive of serious arrhythmias and require the involvement of a cardiologist.