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Key Features

  • Ventricular premature beats or PVCs are isolated beats typically originating from the outflow tract or His-Purkinje regions of ventricular tissue

  • In most patients, the presence of PVCs is a benign finding; however, they may trigger ventricular tachycardia or ventricular fibrillation, especially in patients with underlying heart disease

Clinical Findings

  • Patient may or may not sense the irregular beat

  • Exercise generally abolishes premature beats in normal hearts, and the rhythm becomes regular

  • Wide QRS complexes, differing in morphology from normal beats and usually not preceded by a P wave

  • Fully compensatory pause (no change in PP interval) usually

  • Bigeminy and trigeminy

    • Arrhythmias in which every second or third beat is premature

    • Confirm a reentry mechanism for the ectopic beat

Diagnosis

  • Ambulatory ECG monitoring may reveal more frequent and complex ventricular premature beats than occur in a single routine ECG

  • An echocardiogram should be performed when Holter monitoring has documented more than 10,000 PVCs per day

Treatment

  • If no associated cardiac disease is present and if the ectopic beats are asymptomatic, no therapy is indicated

  • Patients with mild symptoms or anxiety from palpitations can be reassured about the benign nature of this arrhythmia

  • If ectopic beats are frequent, the following should be excluded:

    • Electrolyte abnormalities (especially hypokalemia or hyperkalemia and hypomagnesemia)

    • Hyperthyroidism

    • – Occult heart disease

  • Pharmacologic treatment is indicated only for patients who are symptomatic or in whom cardiomyopathy develops (thought to be due to high burden of PVCs [generally > 10% of daily heart beats])

  • β-Blockers or non-dihydropyridine calcium channel blockers are appropriate as first-line therapy

  • Class I and III antiarrhythmic agents

    • May be effective in reducing ventricular premature beats

    • Poorly tolerated

    • Can be proarrhythmic in up to 5% of patients

  • Catheter ablation is a well-established therapy for symptomatic individuals

    • Who do not respond to medication

    • Whose burden of ectopic beats has resulted in a cardiomyopathy

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