From the Guidelines
PVCs occurring 8% of the time generally do not require treatment if the patient is asymptomatic and has no underlying structural heart disease. For symptomatic patients, first-line treatment typically includes beta-blockers such as metoprolol (25-100 mg twice daily) or calcium channel blockers like verapamil (120-360 mg daily in divided doses) 1. If symptoms persist, antiarrhythmic medications such as flecainide (50-200 mg twice daily) or amiodarone (200 mg daily after loading) may be considered, but require careful monitoring due to potential side effects 1. Lifestyle modifications are also important, including reducing caffeine and alcohol intake, managing stress, and treating any underlying conditions like hypertension or sleep apnea.
Key Considerations
- PVC burden of 8% is considered moderate; clinical concern typically increases when PVCs exceed 10-15% of total heartbeats, as this level may lead to cardiomyopathy over time 1.
- Regular cardiac monitoring is recommended to track any changes in PVC frequency or the development of more serious arrhythmias 1.
- The presence of PVCs on 2 minutes of monitoring of middle-aged patients in the ARIC study was associated with increased risk of both ischemic heart disease events and mortality, with or without prevalent ischemic heart disease 1.
Treatment Options
- Beta-blockers: metoprolol (25-100 mg twice daily) 1
- Calcium channel blockers: verapamil (120-360 mg daily in divided doses) 1
- Antiarrhythmic medications: flecainide (50-200 mg twice daily) or amiodarone (200 mg daily after loading) 1
Lifestyle Modifications
- Reducing caffeine and alcohol intake
- Managing stress
- Treating any underlying conditions like hypertension or sleep apnea 1
From the Research
PVCs Prevalence and Significance
- PVCs occur in 3%-20% of the general population 2
- They are usually considered benign but can be a sign of underlying cardiac disease and cause significantly impairing symptoms 2
- PVCs in the structurally normal heart are usually benign, but in the presence of structural heart disease (SHD), they may indicate increased risk of sudden death 3
PVCs Burden and Outcomes
- High PVC burden may induce cardiomyopathy and left ventricular (LV) dysfunction or worsen underlying cardiomyopathy 3
- A study found that 44% of patients with frequent idiopathic PVCs and preserved LVEF experienced a reduction in PVC burden to <1% at a median of 15.4 months 4
- Another study found that patients with PVCs had a significantly higher all-cause and cardiovascular mortality compared to those without PVCs 5
Diagnostic and Therapeutic Considerations
- Identification of PVC burden is important, since cardiomyopathy and LV dysfunction can reverse after catheter ablation or pharmacological suppression 3
- Radiofrequency catheter ablation (RFCA) has been used for the ablation of PVCs or ventricular tachycardia (VT) and has a success rate of 90.38% for PVCs originating from the left ventricular outflow tract (LVOT) 6
- A 12-lead ECG can be used to diagnose PVCs and differentiate between those originating from the RVOT and LVOT 6