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premature ventricular complex (PVC) or depolarization (PVD), extrasystole

Electrocardiographic depolarizations originating from the ventricles, beginning prematurely with respect to the scheduled arrival of the next normal sinus beat. Etiology: 1) abnormal automaticity within the ventricles 2) reentry 3) generally no structural heart disease 4) increasing incidence with age 5) increased frequency of PVCs, differing morphologies & complex forms a) infection b) inflammation c) myocardial ischemia d) drug toxicity, including tobacco, alcohol & caffeine e) catecholamine excess f) electrolyte imbalance Pathology: - generally benign Clinical manifestations: 1) generally asymptomatic 2) patient may have feelings of skipped beats, palpitations - palpitations may subside with exercise or at night 3) cannon a waves Special laboratory: - electrocardiogram: 1) wide complex QRS a) generally > 120 ms b) bizarre morphology 2) T wave a) increased amplitude b) polarity opposite to QRS Complications: 1) neither frequency of PVCs nor morphology has much clinical significance 2) athletes with PVCs at no increased risk of sudden death [2] 3) cardiomyopathy in patient with symptomatic PVCs [3] - 30% of patients with frequent PVCs (> 10% of beats) develop cardiomyopathy [3] 4) high-risk features - syncope - family history of premature sudden death - structural heart disease Management: 1) asymptomatic* patients with PVCs require no therapy 2) in symptomatic patients, therapy is directed towards the underlying precipitating factors (i.e. infection ... see above) 3) pharmacologic therapy a) adverse effects may outweigh benefits of suppressing PVCs 1] arrhythmia aggravation 2] proarrhythmias 3] death b) Ca+2 channel blocker or beta-blocker 1st line if symptoms are clearly correlated with PVCs [3] 4) radiofrequency ablation may be appropriate in patients with severe symptoms &/or cardiomyopathy not responsive to pharmacologic therapy [3,6] * without high-risk feature

General

ventricular arrhythmia premature electrocardiography complex

Figures/Diagrams

EKG: AF, PVC, anterior infarct

References

  1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 141
  2. 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. Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018, 2022.
  4. 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: 23099051
  5. 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: 22334430
  6. 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 PMID: 29084731 http://circ.ahajournals.org/content/early/2017/10/30/CIR.0000000000000549