From the Guidelines
PVCs are a concern when they are frequent, symptomatic, or occur in patients with underlying heart disease, as they may lead to PVC-induced cardiomyopathy or indicate underlying heart conditions. The primary concern with frequent PVCs is their potential to weaken the heart muscle over time. According to the 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death 1, frequent PVCs, defined as at least 1 PVC on a 12-lead ECG or >30 PVCs per hour, are associated with increased cardiovascular risk and mortality.
Key Concerns with PVCs
- Frequent PVCs may lead to PVC-induced cardiomyopathy, a reversible form of left ventricular (LV) dysfunction 1
- PVCs may indicate underlying heart conditions such as coronary artery disease, heart failure, or cardiomyopathy
- Symptoms of PVCs may include palpitations, skipped beats, dizziness, shortness of breath, or chest discomfort
Management of PVCs
- For symptomatic patients, beta-blockers like metoprolol (25-100mg twice daily) or calcium channel blockers like verapamil (120-360mg daily) may be prescribed 1
- In cases of very frequent PVCs or those causing cardiomyopathy, antiarrhythmic medications such as amiodarone or catheter ablation might be considered 1
- Patients should avoid triggers like caffeine, alcohol, and stress
Recommendations for PVC-Induced Cardiomyopathy
- Catheter ablation is useful for patients who require arrhythmia suppression for symptoms or declining ventricular function suspected to be due to frequent PVCs 1
- Pharmacological treatment, such as beta blockers or amiodarone, is reasonable to reduce recurrent arrhythmias and improve symptoms and LV function in patients with PVC-induced cardiomyopathy 1
From the Research
Concerns of PVCs
The concerns of Premature Ventricular Complexes (PVCs) can be summarized as follows:
- 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 2
- High PVC burden may induce cardiomyopathy and left ventricular (LV) dysfunction or worsen underlying cardiomyopathy 2, 3
- PVCs may be a marker of underlying pathophysiologic process such as myocarditis 2
- Increasing age, a taller height, a higher blood pressure, a history of heart disease, performance of less physical activity, and smoking each predict a greater PVC frequency 3
- PVCs are commonly asymptomatic but can also result in palpitations, dyspnea, presyncope, and fatigue 3
- An increased PVC frequency may be a risk factor for heart failure and death 3
Risk Factors and Complications
Some of the risk factors and complications associated with PVCs include:
- Structural heart disease (SHD) 2, 3
- Cardiomyopathy and left ventricular (LV) dysfunction 2, 3
- Myocarditis 2
- Heart failure and death 3
- Left ventricular dysfunction 4
Diagnosis and Treatment
The diagnosis and treatment of PVCs involve:
- History, physical examination, and 12-lead ECG 3
- Ambulatory monitoring to assess PVC frequency 3
- Echocardiogram and cardiac magnetic resonance imaging to evaluate structural heart disease 2, 3
- Lifestyle modification, medical treatment, and catheter ablation as treatment options 2, 3, 4
- Beta-blockers or nondihydropyridine calcium channel blockers as first-line medical therapies 3
- Class I and III antiarrhythmic drugs as alternative medical therapies 4
- Catheter ablation as a curative therapy for PVCs/VT originating from the left ventricular outflow tract (LVOT) 5