Current Concepts of Premature Ventricular Contractions

Min-Soo Ahn, Min-Soo Ahn

Abstract

Premature ventricular contractions (PVCs) are early depolarizations of the myocardium originating in the ventricle. PVCs are common with an estimated prevalence of 40% to 75% in the general population on 24- to 48-hour Holter monitoring. Traditionally, they have been thought to be relatively benign in the absence of structural heart disease but they represent increased risk of sudden death in structural heart disease. Especially in ischemic heart disease, the frequency and complexity of PVCs is associated with mortality. Implantable cardioverter defibrillator therapy is indicated in patients with nonsustained ventricular tachycardia (NSVT) due to prior myocardial infarction, left ventricular ejection fraction less than or equal to 40%, and inducible ventricular fibrillation or sustained ventricular tachycardia at electrophysiological study. In congestive heart failure, PVCs did not provide significant incremental prognostic information beyond readily available clinical variables. Consequently, NSVT should not guide therapeutic interventions. Recently, the concept of PVC-induced cardiomyopathy was proposed when pharmacological suppression of PVCs in patients with presumed idiopathic dilated cardiomyopathy subsequently showed improved left ventricular systolic dysfunction. For the treatment PVCs, it is important to consider underlying heart disease, the frequency of the PVCs and the frequency and severity of symptoms.

Keywords: Cardiomyopathy; Nonsustained ventricular tachycardia; Premature ventricular contractions.

Figures

Fig. 1.
Fig. 1.
Example of premature ventricular complex.
Fig. 2.
Fig. 2.
6-month survival of patients by premature ventricular contractions (PVCs) per hour. Adapted from Maggioni et al [9].
Fig. 3.
Fig. 3.
ROC curves of multivariate logistic regression models. Multivariate model including only clinical variables (age, NYHA class, ejection fraction, systolic blood pressure, cause of heart failure, and treatment group) is denoted by solid line, whereas model including number of episodes of NSVT in addition to clinical variables is denoted by dashed line. Adapted from Teerlink et al [20].
Fig. 4.
Fig. 4.
Relationship between the premature ventricular contraction prevalence and change in left ventricular ejection fraction (ΔLVEF) and left ventricular diastolic dimension (ΔLVEDd). Adapted from Niwano et al [29].

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