From the Guidelines
Yes, it is possible to have truly benign premature ventricular contractions (PVCs), especially in individuals with structurally normal hearts and no underlying cardiac disease. Most PVCs are completely benign and do not require treatment, as they may be felt as skipped beats, palpitations, or fluttering sensations in the chest, but they don't pose a risk to health or longevity 1. If PVCs are infrequent (less than 1% of total heartbeats), occur as isolated beats rather than runs, and don't cause significant symptoms, they generally don't require medication or intervention. However, if PVCs become frequent (more than 10-15% of total heartbeats), occur in patterns like bigeminy or trigeminy, or are associated with underlying heart disease, they may warrant further evaluation.
Some key points to consider when evaluating PVCs include:
- The frequency of PVCs, with more than 2000 per 24 hours potentially indicating underlying cardiac disease 1
- The presence of underlying heart disease, such as ischemic heart disease or left ventricular dysfunction, which may increase the risk of adverse outcomes associated with PVCs 1
- The response of PVCs to exercise, with suppression of PVCs during exercise suggesting a benign condition 1
- The presence of other arrhythmias, such as nonsustained ventricular tachycardia (NSVT), which may increase the risk of adverse outcomes 1
In general, lifestyle modifications like reducing caffeine, alcohol, and stress can help manage benign PVCs if they cause discomfort. Annual cardiological evaluation is required in athletes with PVCs >2000 per 24 hours to monitor for early evidence of development of PVC-induced cardiomyopathy 1. Overall, while most PVCs are benign, it is essential to evaluate each individual's specific condition to determine the best course of action.
From the Research
Definition and Prevalence of Benign PVCs
- Premature ventricular contractions (PVCs) are early depolarizations of the myocardium originating in the ventricle, with an estimated prevalence of 40% to 75% in the general population on 24- to 48-hour Holter monitoring 2.
- PVCs are relatively common, occurring in 3%-20% of the general population, and are often found during work-up of palpitations or incidentally on routine electrocardiographic testing 3.
Clinical Characteristics and Beta-Blocker Responses
- Frequent PVCs can lead to symptoms, such as cardiomyopathy and increased mortality, and beta-blockers are recommended as first-line therapy to reduce PVC burden 4.
- However, the response to beta-blockers is unpredictable, and patients with different PVC diurnal-variability patterns may have distinct clinical profiles and predict drug response 4.
Association with Left-Ventricular Systolic Dysfunction
- PVCs are frequently observed with left ventricular (LV) systolic dysfunction, and the prevalence of these associated conditions in the general population remains unknown 5.
- The prevalence of PVC burden of 5.1%-10% and >10% was 4% and 5%, respectively, in the population undergoing Holter monitoring, and age was significantly different between PVC groups 5.
Arrhythmic Risk in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy
- A high burden of PVCs at disease diagnosis has been associated with an overall higher risk of ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy (ARVC) 6.
- Changes in parameters derived from each Holter examination performed during follow-up are associated with the risk of sustained ventricular arrhythmias within 12 months of disease diagnosis 6.
Benign PVCs
- PVCs are usually considered benign but can be a sign of underlying cardiac disease and cause significantly impairing symptoms 3.
- In the absence of structural heart disease, PVCs have been thought to be relatively benign, but they represent increased risk of sudden death in structural heart disease, especially in ischemic heart disease 2.