A Review of the Potential Pathogenicity and Management of Frequent Premature Ventricular Contractions

Abstract

Very frequent premature ventricular complexes (PVCs) may be a reversible cause of dilated cardiomyopathy. Literature on this largely unrecognized entity has increased in the last 15 years. This paper reviews the literature on the consequences of frequent PVCs on myocardial function and management of PVC-associated cardiomyopathy. The authors reviewed articles published in English before June 2015 describing pathophysiology, risk factors, symptoms, time course, treatment, and outcome of cardiomyopathy associated with PVCs. The search was conducted using Medline and Embase. Keywords included: cardiomyopathy, catheter ablation, antiarrhythmic drug (AAD), pathophysiology, and ventricular premature contractions or synonyms. PVC-associated cardiomyopathy is associated with a high burden of PVC (over 20% of heartbeats). Other risk factors include electrophysiological characteristics, such as PVC QRS width, presence of ventricular tachycardia, retrograde P waves, interpolation, polymorphic PVCs, and longer coupling intervals. Symptoms include palpitations, light-headedness, dyspnea, cough, and dysphagia. The systolic dysfunction and chamber dilatation progress over a few years. Once the PVCs are suppressed by radiofrequency ablation or AADs, the cardiomyopathy usually resolves within 6 months. The pathophysiology remains unknown, but hypotheses mainly include ventricular dyssynchrony resulting in hemodynamic disturbances and abnormalities in calcium handling and oxygen consumption. PVC-associated cardiomyopathy remains a largely unrecognized entity. It is a reversible cause of dilated cardiomyopathy that results from abnormal calcium and oxygen handling within the myocyte, dyssynchrony, and hemodynamic compromise from inefficient heartbeats. Suppression of the PVCs improves myocardial function, cardiac chamber sizes, and patient's symptoms.

JCS/JHRS 2019 guideline on non‐pharmacotherapy of cardiac arrhythmias

“…When a PVC triggers polymorphic VT or VF, 1092,1093 catheter ablation of the PVC can prevent the occurrence of polymorphic VT or VF 552,1105,1123,1124 . Frequent PVCs can cause cardiac dysfunction, and ablation can improve cardiac dysfunction and the associated symptoms 1125‐1128 . CRT plays an important role in the treatment of heart failure; however, the effect of CRT is reduced when the biventricular pacing rate decreases because of frequent PVCs/NSVTs.…”

“…It remains to be determined whether idiopathic PVCs or NSVTs cause heart failure (PVC‐induced cardiomyopathy) or, conversely, if arrhythmia appears as a symptom of heart failure 1125,1126 . Cardiac function is known to decrease in patients with frequent PVCs (approximately ≥10 000 beats/day, or approximately ≥10% of the total number of heart beats) 1127,1128,1130,1134‐1136 .…”

JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias

“…552,1103,1121,1122 Frequent PVCs can cause cardiac dysfunction, and ablation can improve cardiac dysfunction and the associated symptoms. [1123][1124][1125][1126] CRT plays an important role in the treatment of heart failure; however, the effect of CRT is reduced when the biventricular pacing rate decreases because of frequent PVCs/NSVTs. Therefore, ablation of the PVCs/NSVTs improves cardiac function by increasing the biventricular pacing rate.…”

“…It remains to be determined whether idiopathic PVCs or NSVTs cause heart failure (PVC-induced cardiomyopathy) or, conversely, if arrhythmia appears as a symptom of heart failure. 1123,1124 Cardiac function is known to decrease in patients with frequent PVCs (approximately ≥10,000 beats/day, or approximately ≥10% of the total number of heart beats). 1125,1126,1128,[1132][1133][1134] Other risk factors for PVCinduced cardiomyopathy include the duration of symptoms due to PVCs, such as a longer duration of palpitations, or, conversely, asymptomatic PVCs, [1133][1134][1135] PVCs with a wide QRS width, 1136,1137 PVCs originating from the epicardium, 1135 a large number of interpolated PVCs, 1138 a wide variation in the coupling interval, 1139 and a short coupling interval of PVCs followed by early atrial contraction.…”

A Fast Multimodal Ectopic Beat Detection Method Applied for Blood Pressure Estimation Based on Pulse Wave Velocity Measurements in Wearable Sensors

“…Whereas strobes of SVEBs and, especially VEBs, have a perceptible impact on the cardiac output and can develop into life threatening tachycardias, sporadic occurring extrasystoles usually do not play a significant role and can be considered as a harmless myocardial event that is also experienced in the healthy subject [ 2 ]. With respect to automatic signal processing methods on the other hand, even single ectopic beats can indeed have a crucial influence that needs to be accounted for, especially when tight heart rate timings are involved.…”