From the Guidelines
Premature ventricular contractions (PVCs) can arise from both cardiac and non-cardiac causes, including structural heart diseases, electrophysiological abnormalities, metabolic disturbances, and stimulant use. The cardiac causes of PVCs include:
- Structural heart diseases such as coronary artery disease, cardiomyopathy, myocarditis, valvular heart disease, congenital heart defects, and previous myocardial infarction 1
- Electrophysiological abnormalities like long QT syndrome, Brugada syndrome, and arrhythmogenic right ventricular dysplasia 1 The non-cardiac causes of PVCs include:
- Metabolic disturbances such as electrolyte imbalances like hypokalemia, hypomagnesemia, hypocalcemia 1
- Hyperthyroidism, anemia, and stimulant use including caffeine, alcohol, nicotine, and recreational drugs like cocaine or amphetamines 1
- Certain medications can induce PVCs, particularly sympathomimetics, digoxin, tricyclic antidepressants, and some antiarrhythmics 1
- Other contributors include stress, anxiety, lack of sleep, and excessive physical exertion 1 PVCs occur when an ectopic focus in the ventricles fires before the normal electrical impulse from the sinoatrial node, disrupting the heart's normal rhythm. Management depends on identifying and addressing the underlying cause, with treatment ranging from lifestyle modifications to medication or ablation procedures in symptomatic cases 1.
From the FDA Drug Label
In post-myocardial infarction patients with asymptomatic PVCs and non-sustained ventricular tachycardia, flecainide therapy was found to be associated with a 5.1% rate of death and non-fatal cardiac arrest, compared with a 2.3% rate in a matched placebo group. New or worsened arrhythmias which occurred in 1% of 108 patients with PSVT and in 7% of 117 patients with PAF; and new or exacerbated ventricular arrhythmias which occurred in 7% of 1330 patients with PVCs, non-sustained or sustained VT New or worsened CHF occurred in 6.3% of 1046 patients with PVCs, non-sustained or sustained VT.
The cardiac causes of premature ventricular contractions (PVCs) include:
- Post-myocardial infarction
- Non-sustained ventricular tachycardia
- Sustained ventricular tachycardia (VT)
- Congestive heart failure (CHF)
- Coronary artery disease
- Cardiac arrest
- Myocardial infarction
The noncardiac causes of PVCs are not explicitly mentioned in the provided drug labels 2 2.
From the Research
Cardiac Causes of Premature Ventricular Contractions
- Structural heart disease (SHD) 3, 4, 5
- Ischemic heart disease 4
- Congestive heart failure 4
- Myocarditis 5
- Cardiomyopathy (including tachycardia-induced cardiomyopathy) 3, 6, 5
- Left ventricular dysfunction 6, 5
Noncardiac Causes of Premature Ventricular Contractions
- Electrolyte imbalance 5
- Lifestyle factors (requiring lifestyle modification) 5
- Certain medications or substances (not specified in the provided studies)