What is the cause of premature ventricular contraction (PVC)?

From the Guidelines

Premature ejection, specifically premature ventricular complexes (PVCs), should not be treated with antiarrhythmic medications as they have not been shown to reduce mortality and may increase the risk of death in certain populations, such as post-myocardial infarction patients or those with reduced left ventricular ejection fraction (LVEF) 1. The presence of PVCs is common and increases with age, with approximately 50% of people with or without heart disease experiencing PVCs on longer-term monitoring 1. Frequent PVCs, defined as at least 1 PVC on a 12-lead ECG or more than 30 PVCs per hour, are associated with increased cardiovascular risk and mortality 1. Some key points to consider in the management of premature ejection include:

• The detection of PVCs, particularly if multifocal and frequent, is generally considered a risk factor for adverse cardiovascular outcomes 1
• Patients with PVCs should be evaluated to ensure they do not have underlying conditions, such as ischemic heart disease or left ventricular dysfunction, that warrant further treatment to reduce risk 1
• Beta blockers may be a treatment option for certain patients with PVCs, although the evidence is not explicitly stated in the provided guideline 1
• The use of antiarrhythmic medications, such as class I sodium channel-blocking medications, has been shown to increase the risk of death in certain populations and should be avoided 1.

From the Research

Definition and Prevalence of Premature Ejaculation

• Premature ejaculation (PE) is a common male sexual disorder, defined as ejaculation occurring without control, on or shortly after penetration, and before the person wishes it, causing marked distress or interpersonal difficulty 2.
• The prevalence of premature ejaculation in Australia may range from 21-31% 3.
• PE can be either lifelong and present since first sexual experiences (primary), or acquired (secondary), beginning later 4.

Diagnosis and Assessment

• The Diagnostic and Statistical Manual of Mental Disorders defines PE as "ejaculation occurring, without control, on or shortly after penetration and before the person wishes it, causing marked distress or interpersonal difficulty" 2.
• An intravaginal ejaculatory latency time (IELT) of <2 min, or ejaculation occurring before penetration, has been considered consistent with PE 2.

Treatment Options

• Management involves both the patient and his partner, with therapeutic options suiting both partners and being appropriate to their habit in planning and frequency of intercourse 2.
• Treatments include behavioral and pharmacological interventions, such as:
  • Topical anaesthetics (e.g. lidocaine/prilocaine spray) 4, 5.
  • Selective serotonin reuptake inhibitors (SSRIs) (e.g. paroxetine, fluoxetine, sertraline, citalopram) 4, 6.
  • Phosphodiesterase-5 (PDE5) inhibitors (e.g. vardenafil, tadalafil) 4.
  • Tramadol 4.
  • Behavioral therapies (e.g. stop-start technique) 4.

Efficacy and Safety of Treatments

• Several interventions have been shown to significantly improve IELT, including topical anaesthetics, SSRIs, PDE5 inhibitors, and tramadol 4.
• Improvements in sexual satisfaction and other outcomes have been evident for SSRIs, PDE5 inhibitors, and tramadol 4.
• Treatment-related adverse events have been reported with most pharmacological interventions 4.