From the Guidelines
A high burden of premature ventricular contractions (PVCs) is generally considered to be greater than 10% of total heartbeats, with a burden of ≥24% being independently associated with cardiomyopathy. To determine PVC burden, a 24-hour Holter monitor is typically used, allowing for a comprehensive assessment of PVC frequency over an extended period 1. PVC burden is important because a high frequency can potentially lead to:
- Reduced heart function over time
- Increased risk of developing cardiomyopathy
- Symptoms such as palpitations, shortness of breath, or fatigue Treatment may be considered if the PVC burden is high, especially if accompanied by symptoms or reduced heart function, with options including:
- Beta-blockers
- Calcium channel blockers
- Antiarrhythmic medications
- Catheter ablation for refractory cases, which has been shown to result in normalization of EF in 82% of patients with LV dysfunction within 6 months 1. The threshold for treatment is not absolute and depends on individual factors such as symptoms, underlying heart conditions, and overall health. Regular follow-up with a cardiologist is essential for monitoring PVC burden and adjusting treatment as needed. The most recent and highest quality study suggests that a PVC burden of >10% and usually >20% is associated with LV dysfunction, and that catheter ablation can be an effective treatment option 1.
From the Research
Definition of High Burden of Premature Ventricular Contractions (PVCs)
- A high burden of PVCs is generally considered to be greater than 10% to 20% of total daily heartbeats 2, 3, 4, 5, 6
- PVC burden greater than 20% of total heartbeats may lead to cardiomyopathy and heart failure 2
- Some studies suggest that a PVC burden higher than 10% can cause symptoms such as fatigue and exertional dyspnea 2
Variability in PVC Burden
- PVC burden can vary significantly from day to day, with some patients experiencing a high burden on one day and a low burden on another 3, 4
- Extended ambulatory ECG monitoring (e.g. 14-day monitoring) may be necessary to accurately assess PVC burden and identify patients with clinically significant ectopy 3, 4
Clinical Significance of High PVC Burden
- A high PVC burden has been associated with a reduced systolic blood pressure response, which may be a marker of cardiomyopathy 6
- Patients with a high PVC burden may experience symptoms such as palpitations, chest pain, dizziness, and shortness of breath, although these symptoms are not specific to high PVC burden 5