The Ubiquitous Premature Ventricular Complex

Abstract

Premature ventricular complexes (PVCs) are one of the most commonly encountered arrhythmias and are ubiquitous in clinical practice, both in the outpatient and inpatient settings. They are often discovered incidentally in asymptomatic patients, however, can cause myriad symptoms acutely and chronically. Long thought to be completely benign, PVCs have been historically disregarded without pursuing any further evaluation. Newer data have revealed that a high burden of PVCs with specific characteristics can significantly increase a patient's risk of developing PVC-induced cardiomyopathy. The aim of this literature review is to provide further clarification on the identification of high-risk PVCs, subsequent workup, and the currently available treatment options. PVCs arise from an ectopic focus within the ventricles. Patients with PVCs can be either asymptomatic or have severe disabling symptoms. The diagnostic workup for PVCs includes electrocardiogram (ECG) and 24-h Holter monitor to assess the QRS morphology and its frequency. A transthoracic echocardiogram (TTE) is done to look for structural heart disease and cardiomyopathy. Management of PVCs should be focused on identifying and treating the underlying causes, such as electrolyte abnormalities, substance use, and underlying structural heart disease. Beta-blockers are first-line therapy for symptomatic PVCs. Nondihydropyridine calcium channel blockers, classic antiarrhythmic agents, and amiodarone can be considered as second-line agents. Patients who are unable to tolerate medical therapy should undergo catheter ablation of the PVC focus to prevent PVCinduced cardiomyopathy. PVCs are common in clinical practice, and it is vital to identify patients at higher risk for PVC-induced cardiomyopathy to facilitate early intervention. Patients with no evidence of structural heart disease and infrequent PVCs should be monitored closely, while those who are symptomatic should be treated medically. For those who have failed medical therapy, catheter ablation of the PVCs focus is recommended. Catheter ablation has been shown to reduce PVCs burden and improve left ventricular ejection fraction (LVEF) in those with PVC-induced cardiomyopathy.

Evaluation of patients with high burden of premature ventricular contractions by comprehensive transthoracic echocardiography

“…In this descriptive pilot study, additional echocardiographic parameters that are commonly not included in routine examination were able to unmask possible signs of subtle myocardial pathology in patients with a high PVC burden and a normal echocardiogram. Evaluation of PVC patients with transthoracic echocardiography (TTE) is recommended in current guidelines and recently published reviews [24] , [25] , [26] , [27] . Guidelines from American Heart Association/American College of Cardiology assign echocardiography in ventricular arrhythmia-evaluation a level 1B class of recommendation.…”

Diagnostic yield is dependent on monitoring duration. Insights from a full-disclosure mobile cardiac telemetry system

“…PVCs were defined as wide-QRS premature beats (duration greater than 120 ms) that were not preceded by a P wave and were followed by a complete pause before the next regular heartbeat [8]. Frequent PVCs were defined as ≥10 000 PVCs/24 hours [9]. Sustained ventricular tachycardia was defined as a ventricular tachycardia >100 bpm lasting at least 30 seconds [10].…”

Endo-epicardial mapping and radiofrequency catheter ablation of the ventricular arrhythmia of the left ventricle anterobasal zone (summit)

“…JOURNAL OF ARRHYTHMOLOGY, № 2 (100), 2020 турного поражения сердца [3,4]. Хотя многие из них могут быть эффективно вылечены радиочастотной катетерной аблацией, ЖЭ, исходящие из антеросептальной зоны (саммит ЛЖ), наиболее передней части ЛЖ, остаются сложной проблемой для РЧА.…”