From the Guidelines
A run of PVCs is known as ventricular tachycardia (VTach) when it consists of three or more consecutive PVCs at a rate typically greater than 100 beats per minute. PVCs are common and increase in frequency with age, with studies showing that they are present in about 50% of all people with or without heart disease on longer term monitoring 1. The presence 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.
Key Points
- PVCs are single, early beats originating from the ventricles, while VTach is defined as three or more consecutive PVCs at a rapid rate, typically greater than 100 beats per minute.
- The distinction between PVCs and VTach is important because isolated PVCs or even couplets are generally less concerning than true VTach, which can be life-threatening.
- VTach requires immediate medical attention as it can lead to hemodynamic compromise and potentially deteriorate into ventricular fibrillation and cardiac arrest.
- Treatment approaches differ significantly between occasional PVCs and VTach, with VTach often necessitating emergency interventions like defibrillation, IV antiarrhythmics, and potentially long-term management with implantable cardioverter-defibrillators in certain cases, as noted in the 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death 1.
Considerations
- The detection of PVCs, particularly if multifocal and frequent, is generally considered a risk factor for adverse cardiovascular outcomes.
- 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.
- Beta blockers may be considered in certain cases, but the treatment of VTach is generally focused on emergency interventions and long-term management with implantable cardioverter-defibrillators in certain cases.
From the Research
Definition of VTach
- A run of PVCs is known as ventricular tachycardia (VTach) or non-sustained ventricular tachycardia (NSVT) 2, 3.
Characteristics of VTach
- VTach is a marker of electrocardiomyopathy and can increase the risk for sustained ventricular tachycardia, ventricular fibrillation, and sudden cardiac death 2.
- NSVT is frequently encountered and can be a sign of underlying cardiac disease 3, 4.
Treatment and Management
- Medical therapy, including beta-blockers and class III anti-arrhythmic agents, can be effective in managing VTach 2, 5, 6.
- Implantable cardiac defibrillators (ICD) are indicated in certain patients with VTach or NSVT 2, 3, 6.
- Radiofrequency ablation (RFA) is the preferred, definitive treatment in patients with certain subtypes of PVCs/NSVT 2.