From the Guidelines
Premature Ventricular Contraction (PVC) is a common cardiac arrhythmia that occurs when there is an early electrical impulse originating in the ventricles, causing the heart to contract prematurely, and it is often associated with increased risk of adverse cardiovascular outcomes, particularly if frequent or multifocal, as seen in studies such as 1.
Definition and Prevalence
PVCs are defined as early electrical impulses originating in the ventricles, causing the heart to contract prematurely. They are common and increase in frequency with age, with studies showing that they occur in about 50% of all people with or without heart disease on longer-term monitoring 1.
Clinical Significance
The presence of PVCs on 2 minutes of monitoring has been associated with increased risk of both ischemic heart disease events and mortality, with or without prevalent ischemic heart disease 1. Frequent PVCs, usually >15% of the total number of beats, may produce a reversible form of LV dysfunction, and catheter ablation can be an effective treatment for PVC-induced cardiomyopathy 1.
Risk Factors and Associations
PVCs have been associated with increased risk of stroke, and multifocal PVCs are associated with increased risk of death and nonfatal cardiovascular adverse outcomes 1. The detection of PVCs, particularly if multifocal and frequent, is generally considered a risk factor for adverse cardiovascular outcomes, and such patients are generally evaluated to ensure they do not have underlying conditions that warrant further treatment to reduce risk.
Management and Treatment
Treatment of PVCs with antiarrhythmic medications has not been shown to reduce mortality, and in the post-MI population, treatment with class I sodium channel–blocking medications increases the risk of death 1. Therefore, management of PVCs should focus on identifying and treating underlying conditions, and catheter ablation may be considered for patients with frequent PVCs and reversible LV dysfunction, as seen in studies such as 1.
From the Research
Definition and Characteristics of Premature Ventricular Contraction (PVC)
- Premature ventricular contractions (PVCs) are arrhythmias that can range from asymptomatic and benign to symptomatic, frequent, and capable of inducing cardiomyopathy 2.
- PVCs are early depolarizations of the myocardium originating in the ventricle 3.
- They are common, with an estimated prevalence of 40% to 75% in the general population on 24- to 48-hour Holter monitoring 3.
Clinical Presentation and Prognosis
- The clinical presentation of PVCs can vary from being extremely benign to very severe (malignant) 4.
- Benign PVCs include those that are asymptomatic or induce very mild symptoms, such as palpitations, lightheadedness, chest discomfort, or the sensation of skipped beats 4.
- The malignant variety may present as syncope or sudden cardiac death 4.
- PVCs can be associated with an increased risk of stroke and sudden cardiac death, especially in patients with underlying structural heart disease 2.
Diagnosis and Treatment
- The diagnosis of PVCs is based on electrocardiogram (ECG) morphology and other diagnostic tests, such as Holter monitoring 3.
- Treatment options for PVCs include medical management, catheter ablation, and implantable cardioverter defibrillator therapy 2, 5, 3.
- The choice of treatment depends on the underlying heart disease, the frequency and severity of symptoms, and the presence of other risk factors 3.