What is a Premature Ventricular Contraction (PVC) on an Electrocardiogram (ECG)?

From the Guidelines

PVC on an ECG stands for Premature Ventricular Contraction, which is an extra heartbeat originating from the ventricles that occurs earlier than the normal heartbeat. On an electrocardiogram (ECG), PVCs appear as wide, bizarre-shaped QRS complexes without preceding P waves, followed by a compensatory pause. PVCs are common and often benign, especially in healthy individuals, but can sometimes indicate underlying heart disease when frequent or occurring in patterns, as noted in the 2018 guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death 1. Symptoms may include palpitations, a feeling of skipped beats, or no symptoms at all. Isolated PVCs typically don't require treatment, but frequent PVCs might be managed with lifestyle modifications, such as reducing caffeine, alcohol, and stress, or with beta-blockers like metoprolol, as suggested by various studies 1.

Key Considerations

• PVCs are common, especially with increasing age, and are found in about 50% of all people with or without heart disease on longer term monitoring 1.
• The presence of PVCs on a 12-lead ECG or more than 30 PVCs per hour is associated with increased cardiovascular risk and mortality 1.
• Evaluation for underlying structural heart disease is crucial, especially in athletes or individuals with frequent or multifocal PVCs, and may include ambulatory Holter monitoring, echocardiogram, and exercise stress testing 1.
• Management should focus on addressing underlying conditions and may include lifestyle modifications or medication, with the goal of reducing morbidity, mortality, and improving quality of life.

Management Approach

• For athletes with PVCs, a comprehensive evaluation including ECG, ambulatory rhythm monitoring, exercise stress testing, and echocardiography is recommended 1.
• The decision to participate in competitive sports should be based on the underlying diagnosis, documented efficacy of arrhythmia treatment, and a shared decision-making approach 1.
• In general, the management of PVCs should prioritize reducing the risk of adverse cardiovascular outcomes, while also considering the impact on the individual's quality of life, as emphasized by the most recent guidelines and studies 1.

From the Research

Definition and Presentation of PVCs on ECG

• Premature ventricular contractions (PVCs) are arrhythmias that can present with a range of symptoms, from asymptomatic and benign to symptomatic, frequent, and capable of inducing cardiomyopathy 2.
• PVCs are recognized as a clinically significant arrhythmia and can be a sign of underlying cardiac disease, such as coronary artery disease, hypertension, or left ventricular hypertrophy 2, 3.
• They can cause significantly impairing symptoms, including palpitations, and can be identified incidentally on routine electrocardiographic testing 3.

ECG Characteristics of PVCs

• PVCs are characterized by an early electrical impulse originating in the ventricles, which can disrupt the normal heart rhythm 3.
• On an ECG, PVCs can appear as a premature beat with a widened QRS complex, often followed by a compensatory pause 4.
• The presence and frequency of PVCs can be assessed using 24-hour Holter monitoring, which can provide information on the burden of PVCs and their impact on cardiac function 4, 5.

Clinical Significance of PVCs on ECG

• PVCs can be associated with an increased risk of stroke and sudden cardiac death, particularly in patients with underlying cardiac disease 2.
• The presence of PVCs on an ECG can indicate the need for further evaluation and treatment, including medical therapy, catheter ablation, or implantation of a cardioverter-defibrillator 2, 6.
• The diurnal variability of PVCs, as assessed by Holter monitoring, can provide incremental value in guiding clinical management and predicting response to beta-blocker therapy 5.