Effectiveness of medical therapy for treatment of idiopathic frequent premature ventricular complexes

Abstract

Introduction:The relative effectiveness of medical therapy compared with a conservative approach of monitoring in patients with idiopathic frequent premature ventricular complexes (PVCs) is uncertain. We evaluated the effectiveness of medical versus conservative therapy for frequent PVCs.Methods: Patients with frequent PVCs (≥5%) were prospectively enrolled in this cohort study between 2016 and 2020. In patients with normal cardiac function and no structural heart disease, those receiving medical therapy were compared with controls without therapy. Patients were followed longitudinally for change in PVC burden and with serial echocardiography.Results: Overall, 120 patients met inclusion criteria (mean: 56.5 ± 14.6 years, 54.2% female) with 53 on beta-blockers or calcium channel blockers (BBs/CCBs), 27 on Class I or III antiarrhythmic drugs (AADs), and 40 patients treated conservatively. Median initial PVC burden ranged from 15.5% to 20.6%. The median relative reduction of PVCs was 32.7%, 30.5%, and 81.3%, in the conservative therapy, BBs/CCBs, and AADs cohorts, respectively. AADs had greater PVC reduction compared with BBs/CCBs (p = 0.017) and conservative therapy (p = 0.045). PVC reduction to <1% was comparable across groups at 35.0%, 17.0%, 33.3%, respectively. Four patients (4/120, 3.3%) developed left ventricular dysfunction. Rates of adverse drug reactions and medication discontinuation were similar between groups, with no serious adverse events noted. Conclusion:In patients with idiopathic frequent PVCs, BB, and CCB have limited effectiveness in PVC reduction. Class I and III AADs have superior effectiveness for medical therapy in symptomatic patients, but only achieved complete PVC resolution suppression in one-third of patients.

Idiopathic premature ventricular complexes treatment: Comparison of flecainide, propafenone, and sotalol

“…However, the sample size of this study limited the ability to make conclusions about the relative effectiveness of individual class I and III drugs. 10 In regard to the adverse drug reactions, we identified a rather low rate (9.2%), without special impact on the patient treatment.…”

“…In a recent prospective study comparing the effectiveness and safety of BBs, non‐dihydropyridine CCBs, Class I and III antiarrhythmics to conservative therapy, AADs had only modest efficacy (56% of patients had significant reduction of PVC burden after treatment), being in line with our findings. However, the sample size of this study limited the ability to make conclusions about the relative effectiveness of individual class I and III drugs 10 . In another study comparing relative efficacy of CA versus AADs in reduction of PVCs, CA showed better results (93%) than AADs (49%).…”

“…However, the sample size of this study limited the ability to make conclusions about the relative effectiveness of individual class I and III drugs. 10 In another study comparing relative efficacy of CA versus AADs in reduction of PVCs, CA showed better results (93%) than AADs (49%). Class I and III AADs were more effective (82%) than BB (36%, p < .001) or CCBs (43%, p < .001).…”

Pro‐arrhythmia with antiarrhythmic drugs in patients with idiopathic ventricular arrhythmia: A common problem with vague definitions and complex interactions

“…Pro-arrhythmia with antiarrhythmic drugs in patients with idiopathic ventricular arrhythmia: A common problem with vague definitions and complex interactions Beta-blockers, I c (flecainide/propafenone) antiarrhythmic drugs (AADs) or both are preferred first choice therapeutic options in patients with idiopathic ventricular arrhythmias (IVAs) with limited efficacy in both adult and pediatric populations. 1,2 Universally accepted, well-described definitions for therapeutic efficacy and pro-arrhythmia with AADs among patients with IVAs are lacking. Assessment of therapeutic efficacy solely based on symptoms can be misleading.…”

Reply to “Pro‐arrhythmia with antiarrhythmic drugs in patients with idiopathic ventricular arrhythmia: A common problem with vague definitions and complex interactions”

“…In our prior work, 3 published in this journal and referenced by Drs. Hasdemir and Payzin, we were also limited by using only 24‐h ambulatory monitors to assess PVC burden.…”