premature ventricular complex (PVC) or depolarization (PVD), extrasystole
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Introduction
Electrocardiographic depolarizations originating from the ventricles, beginning prematurely with respect to the scheduled arrival of the next normal sinus beat.
Etiology
- abnormal automaticity within the ventricles
- reentry
- generally no structural heart disease
- increasing incidence with age
- increased frequency of PVCs, differing morphologies & complex forms
- infection
- inflammation
- myocardial ischemia
- drug toxicity, including tobacco, alcohol & caffeine
- catecholamine excess
- electrolyte imbalance
Pathology
- generally benign
Clinical manifestations
- generally asymptomatic
- patient may have feelings of skipped beats, palpitations
- palpitations may subside with exercise or at night
- cannon a waves
Diagnostic procedures
- electrocardiogram:
- wide complex QRS
- generally > 120 ms
- bizarre morphology
- T wave
Complications
- neither frequency of PVCs nor morphology has much clinical significance
- athletes with PVCs at no increased risk of sudden death[2]
- cardiomyopathy in patient with symptomatic PVCs[3]
- 30% of patients with frequent PVCs (> 10% of beats) develop cardiomyopathy[3]
- high-risk features
- syncope
- family history of premature sudden death
- structural heart disease
Management
- asymptomatic* patients with PVCs require no therapy
- in symptomatic patients, therapy is directed towards the underlying precipitating factors (i.e. infection ... see above)
- pharmacologic therapy
- adverse effects may outweigh benefits of suppressing PVCs
- arrhythmia aggravation
- proarrhythmias
- death
- Ca+2 channel blocker or beta-blocker 1st line if symptoms are clearly correlated with PVCs[3]
- adverse effects may outweigh benefits of suppressing PVCs
- radiofrequency ablation may be appropriate in patients with severe symptoms &/or cardiomyopathy not responsive to pharmacologic therapy[3][6]
* without high-risk feature
More general terms
References
- ↑ Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 141
- ↑ 2.0 2.1 Journal Watch 22(19):149, 2002 Biffi A et al, J Am Coll Cardiol 40:446, 2002 Kennedy HL, J Am Coll Cardiol 40:453, 2002
- ↑ 3.0 3.1 3.2 3.3 3.4 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018, 2022.
- ↑ Yokokawa M, Good E, Crawford T et al Recovery from left ventricular dysfunction after ablation of frequent premature ventricular complexes. Heart Rhythm. 2013 Feb;10(2):172-5 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23099051
- ↑ Lee GK, Klarich KW, Grogan M, Cha YM. Premature ventricular contraction-induced cardiomyopathy: a treatable condition. Circ Arrhythm Electrophysiol. 2012 Feb;5(1):229-36 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22334430
- ↑ 6.0 6.1 Al-Khatib SM et al. AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2017 Oct 30 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29084731 <Internet> http://circ.ahajournals.org/content/early/2017/10/30/CIR.0000000000000549