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Education in Heart
Management of premature ventricular complexes
  1. Koji Higuchi,
  2. Mandeep Bhargava
  1. Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr Mandeep Bhargava, Cardiovascular Medicine Desk J2-2, Cleveland Clinic, Cleveland, OH 44195, USA; bhargam{at}ccf.org

https://doi.org/10.1136/heartjnl-2020-318628

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    Learning objectives

    • Care pathways for management of premature ventricular complexes (PVCs) including screening for structural heart disease, PVC burden, cause and effect relation with left ventricular dysfunction when present.

    • Site of origin for common PVCs.

    • Role of pharmacological therapy and catheter ablation.

    • Risk stratification for sudden cardiac death.

    Introduction

    Premature ventricular complexes (PVCs) are the most common arrhythmias in daily practice. At the cellular level, ventricular myocytes spontaneously depolarise to create an extrasystole ‘out of sync’ with the cardiac cycle.1 The prevalence depends on the characteristics and comorbidities of the population, the method by which the population is studied and the duration of observation. PVCs have been described in 1% of clinically normal people on standard electrocardiography (EKG) and 40%–75% of healthy people assessed by short-term ambulatory monitoring.2 Atherosclerosis Risk in Communities, a large population-based study of 15 792 Americans aged 45–65 years, demonstrated a higher prevalence of PVCs with age, structural heart disease (SHD), hypertension, African–American ethnicity, male sex and lower education.3

    PVCs are generally benign in patients without SHD.4 5 However, PVCs can be a trigger for life-threating arrhythmias such as ventricular tachycardia (VT) and ventricular fibrillation (VF) causing sudden cardiac death (SCD), especially in patients post-myocardial infarction (MI). Risk stratification for PVCs varies in specific populations with underlying cardiac disease, family history, genetic variants and sometimes coupling interval. The differing implications with these variables is the basis of this review.

    Symptoms

    The symptoms of PVCs are variable. Patients often have palpitations described as fluttering, pounding, skipping beats or often a strange sensation in the neck. Others may have fatigue, shortness of breath or change of stamina and endurance. The increased stroke volume of the post-PVC beat may cause chest discomfort. Non-sustained or sustained episodes of VT may be associated with presyncope or syncope.

    In contrast, many patients are …

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    Footnotes

    • Twitter @MandeepBhargava

    • Contributors KH and MB contributed to the preparation of the manuscript. MB is the senior and corresponding author who has made all the critical revisions of the intellectual content, approved and edited the final version, and made all the questions and explanations.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

    • Provenance and peer review Commissioned; internally peer reviewed.

    • Author note References which include a * are considered to be key references.