Do PVCs Subside Over Time?
PVCs do not spontaneously subside over time in most adults; instead, they increase in frequency with age, progressing from 0.6% prevalence in those under 20 years to 2.7% in those over 50 years, with approximately 50% of all adults eventually developing PVCs regardless of heart disease status. 1
Natural History and Age-Related Progression
- PVCs become more common, not less common, as patients age, representing a progressive phenomenon rather than a self-limiting condition 1
- In healthy military populations, PVC prevalence increases nearly 5-fold from young adulthood to middle age 1
- Longer-term monitoring reveals PVCs in approximately 50% of all people with or without underlying heart disease, indicating that most individuals will eventually develop them 1
Important Exception: Pediatric Populations
- In children and adolescents, isolated monomorphic PVCs frequently resolve spontaneously, particularly those originating from the right ventricular outflow tract (RVOT) 2
- Isolated monomorphic PVCs occur in 20% of infants and 20-35% of teenagers, with many resolving without intervention 2
- The European Society of Cardiology recommends that asymptomatic children with frequent isolated PVCs and normal ventricular function should be followed without treatment, as spontaneous resolution is common 2
Risk of Progression Rather Than Resolution
Rather than subsiding, untreated PVCs carry risk of progression to more serious complications:
- Frequent PVCs (>30 per hour or >10% burden) are associated with increased cardiovascular risk and mortality in the general population 1
- Multifocal PVCs are associated with increased risk of death and nonfatal cardiovascular adverse outcomes 1
- PVC burden ≥10% can result in PVC-induced cardiomyopathy, with burdens ≥24% independently associated with cardiomyopathy development 2
- In post-MI patients, even low PVC burdens (>10 PVCs/hour or ~1% burden) predict arrhythmic events and mortality 3
Clinical Implications for Management
The progressive nature of PVCs necessitates active surveillance rather than expectant management:
- Patients with PVC burden >10% require serial echocardiography every 6-12 months to monitor for development of cardiomyopathy 3
- PVC burden >15% warrants consideration of catheter ablation even in asymptomatic patients to prevent cardiomyopathy 2
- After successful catheter ablation, 82% of patients with PVC-induced cardiomyopathy normalize their left ventricular function within 6 months, demonstrating that intervention—not time—resolves the problem 2
Critical Pitfall to Avoid
Do not reassure patients that their PVCs will "go away on their own" in adults, as this contradicts the natural history showing age-related progression 1. The only scenario where spontaneous resolution is expected is in pediatric patients with isolated monomorphic PVCs and normal cardiac structure 2.