From the Guidelines
Rare ventricular ectopy is generally considered benign in patients without structural heart disease, but it is crucial to evaluate and monitor individuals with frequent or symptomatic PVCs to rule out underlying cardiac abnormalities. For most people, occasional PVCs that occur less than 1% of total heartbeats don't require treatment or cause for concern 1. However, if PVCs are accompanied by symptoms like dizziness, chest pain, or shortness of breath, or if they occur frequently (more than 2000 per 24 hours), medical evaluation is recommended 1.
Key Considerations
- Lifestyle modifications can help reduce PVCs, including limiting caffeine, alcohol, and nicotine, managing stress, getting adequate sleep, and staying hydrated.
- For symptomatic patients with frequent PVCs, medications like beta-blockers or calcium channel blockers may be prescribed.
- PVCs can sometimes indicate underlying heart conditions, so if you have risk factors like hypertension, diabetes, or previous heart disease, even rare PVCs should be evaluated by a healthcare provider 1.
Evaluation and Monitoring
- The extent of evaluation for PVCs is controversial, but at a minimum, an ambulatory Holter monitor, echocardiogram, and exercise stress test should be performed 1.
- If the Holter and echocardiogram are normal and the PVCs suppress with exercise, no further evaluation is recommended for an asymptomatic athlete.
- Additional evaluation may include contrast-enhanced cardiac MRI and more invasive electrophysiology study for athletes with more than 2000 PVCs per 24 hours or with episodes of non-sustained ventricular tachycardia 1.
From the Research
Rare Ventricular Ectopy
- Rare ventricular ectopy, also known as premature ventricular contraction (PVC), is generally considered to be a benign condition in individuals without underlying heart disease 2, 3, 4.
- Studies have shown that ventricular ectopy is not uncommon in healthy individuals and is rarely of high density or repetitive 2.
- In patients without organic heart disease, ventricular ectopy is often not a cause for concern and does not require treatment 3, 4, 5.
- However, in patients with underlying heart disease, frequent and repetitive ventricular ectopy can be a marker of increased risk for arrhythmia-induced syncope or sudden death 2.
Risk Stratification
- Individual risk stratification is important in deciding whether and how to treat patients with ventricular ectopy 2.
- Patients with presyncope or syncope and structural heart disease who demonstrate frequent and repetitive ventricular ectopy are considered to be at high risk 2.
- In patients with heart disease, treatment should be directed at the underlying heart disease rather than the ventricular ectopy itself 4.
Treatment
- Antiarrhythmic therapy is not necessary for asymptomatic ventricular ectopy in patients without organic heart disease 3, 4, 5.
- Treatment of ventricular ectopy should be based on the presence of symptoms and the underlying cardiac status of the patient 3, 5.
- In patients with heart disease and severe symptoms resulting from ventricular ectopy, electrophysiological assessment and specific antiarrhythmic therapy may be required 4.