If no associated cardiac disease is present and if the ectopic beats are asymptomatic, no therapy is indicated. Mild symptoms or anxiety from palpitations may be allayed with reassurance to the patient of the benign nature of this arrhythmia. If PVCs are frequent (bigeminal or trigeminal pattern), electrolyte abnormalities (especially hypokalemia or hyperkalemia and hypomagnesemia), hyperthyroidism, and occult heart disease should be excluded. In addition, an echocardiogram should be performed in patients in whom a burden of PVCs of greater than 10,000 per day has been documented by ambulatory ECG monitoring. Pharmacologic treatment is indicated only for patients who are symptomatic or who develop cardiomyopathy thought to be due to a high burden of PVCs (generally greater than 10% of daily heart beats). Beta-blockers or nondihydropyridine calcium channel blockers are appropriate as first-line therapy. The class I and III antiarrhythmic agents (see Table 10–11) may be effective in reducing PVCs but are often poorly tolerated and 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 or for those patients whose burden of ectopic beats has resulted in a cardiomyopathy.