From the Guidelines
Bigeminy, or premature ventricular contractions (PVCs), are generally benign but may be a sign of underlying heart disease. The presence of multiple PVCs, particularly those occurring at a frequency of >2000 per 24 hours, may indicate an increased risk of cardiovascular events and mortality 1.
Risks Associated with Bigeminy
- Underlying heart disease: Bigeminy may be a sign of underlying structural or electrical heart disease, such as arrhythmogenic right ventricular cardiomyopathy (ARVC), hypertrophic cardiomyopathy, or coronary artery disease 1.
- Cardiovascular events: Frequent PVCs have been associated with an increased risk of cardiovascular events, including ischemic heart disease, heart failure, and stroke 1.
- Sudden cardiac death: Although rare, bigeminy may be a risk factor for sudden cardiac death, particularly in individuals with underlying heart disease or other risk factors 1.
Treatment Options for Bigeminy
- Evaluation: A thorough evaluation, including a 12-lead ECG, exercise stress test, and echocardiogram, is necessary to rule out underlying heart disease 1.
- Monitoring: Ambulatory Holter monitoring or longer-term monitoring with a leadless ambulatory recorder may be used to assess the frequency and pattern of PVCs 1.
- Lifestyle modifications: In some cases, lifestyle modifications, such as reducing stress and avoiding stimulants, may be recommended to help manage bigeminy 1.
- Medications: Beta blockers may be used to reduce the frequency of PVCs, but antiarrhythmic medications are generally not recommended due to the risk of adverse effects 1.
- Further testing: In cases where bigeminy is frequent or associated with other symptoms, further testing, such as cardiac MRI or electrophysiology study, may be necessary to rule out underlying heart disease 1.
From the Research
Risks Associated with Bigeminy (Premature Ventricular Contractions, PVCs)
- Bigeminy, particularly ventricular bigeminy, can be a sign of underlying heart conditions such as coronary artery disease, hypertension, or left ventricular hypertrophy 2.
- The presence of PVCs is independently linked to an increased risk of stroke and sudden cardiac death 2.
- PVCs can also induce cardiomyopathy, especially in patients with frequent PVCs 2, 3.
- Malignant PVCs can provoke life-threatening arrhythmias, including ventricular fibrillation, which is a primary cause of sudden cardiac death in patients with and without structural heart disease 3.
Treatment Options for Bigeminy (PVCs)
- Medical management is the first line of therapy for PVCs, and understanding the medical treatment options is necessary for practitioners to help patients determine the best course of action 2.
- Therapeutic options include medical therapy, such as ranolazine, which has been shown to be effective in reducing PVCs in patients with symptomatic PVCs due to triggered ectopy 4.
- Catheter ablation is also a treatment option, particularly in patients with left ventricular dysfunction, and has been shown to be more effective and potentially curable 3.
- In some cases, implantation of an artificial pacemaker may be appropriate, especially in patients with bigeminy associated with delayed impulse conduction 5.
Considerations for Treatment
- The treatment of PVCs should take into account the patient's symptom status, PVC burden, and the presence of structural heart disease 3.
- The risks and benefits of different treatment strategies should be weighed, and the patient's individual needs and circumstances should be considered 2.
- Early recognition and effective treatment of malignant PVCs are crucial to prevent adverse clinical outcomes and improve long-term prognosis 3.