From the Guidelines
Excessive premature ventricular contractions (PVCs) can lead to increased cardiovascular risk, mortality, and adverse outcomes, including ischemic heart disease events, stroke, and cardiomyopathy. According to the 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death 1, frequent PVCs, defined as the presence of at least 1 PVC on a 12-lead ECG or >30 PVCs per hour, are associated with increased cardiovascular risk and mortality. The detection of PVCs, particularly if multifocal and frequent, is generally considered a risk factor for adverse cardiovascular outcomes.
Some key points to consider:
- Frequent PVCs can cause cardiomyopathy, a condition where the heart muscle weakens and enlarges, potentially resulting in heart failure 1.
- PVCs may trigger more dangerous arrhythmias, especially in people with pre-existing heart conditions.
- Patients may experience symptoms like palpitations, dizziness, shortness of breath, and fatigue.
- Treatment becomes necessary when PVCs are symptomatic or exceed certain thresholds, typically involving medications like beta-blockers (metoprolol 25-200 mg daily) or calcium channel blockers (verapamil 120-360 mg daily) 1.
- For resistant cases, catheter ablation may be recommended, as it is useful for patients who require arrhythmia suppression for symptoms or declining ventricular function suspected to be due to frequent PVCs 1.
The development of complications depends on PVC burden, underlying heart health, and individual risk factors, making regular cardiac monitoring important for those with frequent PVCs. It is essential to evaluate patients with frequent PVCs to ensure they do not have underlying conditions that warrant further treatment to reduce risk 1.
From the FDA Drug Label
In post-myocardial infarction patients with asymptomatic PVCs and non-sustained ventricular tachycardia, flecainide therapy was found to be associated with a 5.1% rate of death and non-fatal cardiac arrest, compared with a 2.3% rate in a matched placebo group. New or exacerbated ventricular arrhythmias which occurred in 7% of 1330 patients with PVCs, non-sustained or sustained VT In some patients, flecainide treatment has been associated with episodes of unresuscitatable VT or ventricular fibrillation (cardiac arrest). New or worsened CHF occurred in 6.3% of 1046 patients with PVCs, non-sustained or sustained VT.
Excessive PVCs can lead to:
- Death
- Non-fatal cardiac arrest
- Ventricular tachycardia (VT)
- Ventricular fibrillation
- Congestive heart failure (CHF) 2
From the Research
Excessive PVCs Complications
Excessive premature ventricular complexes (PVCs) can lead to several complications, including:
- PVC-induced cardiomyopathy, which can result in left ventricular dysfunction or worsen underlying cardiomyopathy 3, 4, 5, 6
- Increased risk of sudden death in patients with structural heart disease (SHD) 4
- Worsening of underlying cardiomyopathy 4, 5
- Heart failure and death, as an increased PVC frequency may be a risk factor for these outcomes 6
- Reversal of cardiomyopathy and left ventricular dysfunction after catheter ablation or pharmacological suppression of PVCs 3, 4, 5
Risk Factors and Predictors
Several factors can predict a greater PVC frequency, including:
- Increasing age 6
- Taller height 6
- Higher blood pressure 6
- History of heart disease 6
- Less physical activity 6
- Smoking 6
Diagnostic and Therapeutic Considerations
The diagnosis and evaluation of PVCs involve:
- History and physical examination 6
- 12-lead ECG 6
- Echocardiogram, indicated in the presence of symptoms or frequent PVCs 6
- Cardiac magnetic resonance imaging, helpful when associated structural heart disease is suspected 6
- Ambulatory monitoring to assess PVC frequency 6 Treatment options include:
- Simple reassurance for patients with no or mild symptoms, low PVC burden, and normal ventricular function 6
- Medical treatment, such as β-blockers or nondihydropyridine calcium channel blockers, for patients with symptoms or reduced left ventricular ejection fraction 6
- Catheter ablation, the most efficacious approach to eradicate PVCs, but may confer increased upfront risks 6