Premature Ventricular Beats Are NOT a Contraindication to General Anesthesia
Premature ventricular contractions (PVCs), including frequent PVCs and nonsustained ventricular tachycardia, do not contraindicate general anesthesia and are not associated with increased risk of perioperative myocardial infarction or cardiac death. 1
Evidence-Based Rationale
PVCs Do Not Increase Perioperative Cardiac Risk
Asymptomatic ventricular arrhythmias, including couplets and nonsustained ventricular tachycardia, are not associated with increased cardiac complications after noncardiac surgery. 1
While frequent PVCs and nonsustained ventricular tachycardia are risk factors for developing intraoperative and postoperative arrhythmias, they do not increase the risk of nonfatal MI or cardiac death in the perioperative period. 1
Ventricular arrhythmias usually do not require therapy unless they result in hemodynamic compromise or are associated with significant structural heart disease or inherited electrical disorders. 1
What Requires Investigation
The presence of PVCs in the preoperative setting should prompt investigation into:
- Underlying cardiopulmonary disease 1
- Ongoing myocardial ischemia or MI 1
- Drug toxicity 1
- Metabolic derangements 1
This investigation depends on the nature and acuity of the arrhythmia and the patient's history. 1
When to Refer to Cardiology
Patients who develop sustained or nonsustained ventricular tachycardia during the perioperative period may require referral to a cardiologist for:
Anesthetic Considerations
Choice of Anesthetic Technique
Both volatile-based anesthetic agents and total intravenous anesthesia are reasonable for general anesthesia with no apparent difference in associated cardiovascular events (including MI and ischemia). 2
Where neuraxial anesthesia is feasible, either neuraxial or general anesthesia is reasonable with no apparent difference in cardiovascular events. 2
Management of Intraoperative PVCs
If PVCs develop during general anesthesia and require treatment, flecainide (0.2 mg/kg/min up to maximum 2 mg/kg) has been shown effective, though it may cause transient hypotension and cardiac conduction disturbances. 3
Diltiazem (0.1 mg/kg IV) can eliminate spontaneous PVCs during halothane anesthesia, but should be used cautiously in patients with sick sinus syndrome, AV block, or those on beta-blockers. 4
Common Pitfalls to Avoid
Do not delay or cancel surgery solely based on the presence of PVCs. The key is determining whether they represent underlying pathology requiring investigation rather than treating them as an absolute contraindication. 1
Do not assume all PVCs are benign. While isolated PVCs are not contraindications, they warrant evaluation for structural heart disease, particularly if they are new-onset, symptomatic, or associated with hemodynamic compromise. 1