From the Guidelines
Occasional ventricular premature complexes (VPCs) are generally not life-threatening in a 50-year-old man with mild chest discomfort, but the chest discomfort warrants medical evaluation. VPCs are common heart rhythm disturbances where extra heartbeats originate from the ventricles rather than the normal pacemaker. In individuals without significant heart disease, isolated or occasional VPCs typically don't require specific treatment, as supported by the 2017 international recommendations for electrocardiographic interpretation in athletes 1. However, the presence of chest discomfort alongside VPCs should prompt a medical assessment to rule out coronary artery disease or other cardiac conditions.
The evaluation may include:
- An ECG to assess the heart's electrical activity
- An echocardiogram to evaluate the heart's structure and function
- A stress test to assess the heart's response to exercise
- Possibly 24-hour Holter monitoring to assess the frequency and pattern of VPCs, as recommended by the 2015 eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities 1
If VPCs are infrequent and the cardiac evaluation is otherwise normal, reassurance and lifestyle modifications like reducing caffeine, alcohol, and stress may be sufficient. More frequent VPCs or those associated with symptoms might require treatment with beta-blockers like metoprolol (25-100 mg twice daily) or calcium channel blockers. The chest discomfort itself needs separate evaluation as it could represent angina or another cardiac condition requiring specific treatment. According to the 2018 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death, treatment of PVCs with antiarrhythmic medications has not been shown to reduce mortality and may even increase the risk of death in certain populations 1.
From the Research
Occasional Ventricular Premature Complex (VPC) in a 50-year-old Man
- An occasional VPC in a 50-year-old man with mild chest discomfort is generally not life-threatening if the heart is structurally normal 2, 3.
- However, the presence of underlying structural heart disease (SHD) may increase the risk of sudden death 2, 4.
- The frequency and pattern of VPCs, as well as the presence of underlying heart disease, are important factors in determining the risk of sudden cardiac death 4, 5.
Risk Factors for VPCs
- Increasing age, taller height, higher blood pressure, history of heart disease, less physical activity, and smoking are predictors of a greater PVC frequency 3, 6.
- Diabetes mellitus, hypertension, and current or past smoking are also independently associated with VPC frequency 6.
- On the other hand, physical activity and lipid-lowering therapy are associated with a lower VPC frequency 6.
Diagnosis and Evaluation
- The history, physical examination, and 12-lead ECG are critical to the diagnosis and evaluation of a PVC 3.
- An echocardiogram is indicated in the presence of symptoms or particularly frequent PVCs, and cardiac magnetic resonance imaging is helpful when the evaluation suggests the presence of associated structural heart disease 2, 3.
- Ambulatory monitoring is required to assess PVC frequency 3.
Treatment
- Patients with no or mild symptoms, a low PVC burden, and normal ventricular function may be best served with simple reassurance 3.
- Either medical treatment or catheter ablation are considered first-line therapies in most patients with PVCs associated with symptoms or a reduced left ventricular ejection fraction 3, 5.
- β-blockers or nondihydropyridine calcium channel blockers are reasonable drugs in patients with normal ventricular systolic function 3.