• Clinical science

Premature ventricular contractions

Summary

Premature ventricular contractions (PVCs) are extra, abnormal heartbeats caused by ectopic foci within the ventricles. PVCs are very common and most individuals are asymptomatic, but select patients may present with symptoms such as dizziness or palpitations. Typical ECG findings of PVCs include broad QRS complexes, compensatory pauses, and axis deviation, and may be random or have consistent patterns, such as couplets or bigeminy. Most patients do not require treatment. However, any underlying condition, e.g., myocarditis, must be managed appropriately. Patients with frequent PVCs that cause significant symptoms should receive antiarrhythmic drugs or possibly catheter ablation, as they are at risk for sudden cardiac death.

Etiology

  • Idiopathic
  • Cardiovascular disease (e.g., CAD, myocarditis)
  • Electrolyte imbalances (e.g., hypokalemia, hypomagnesemia)
  • Side effect of certain drugs (e.g., digoxin, psychiatric medications)
  • Caffeine; , alcohol

References:[1]

Classification

  • Monomorphic PVC: Each PVC has the same configuration → identical origin
  • Polymorphic PVC: PVCs have different configurations → multiple foci

References:[1]

Clinical features

References:[1]

Diagnostics

If patient suspected of PVCs → evaluate with ECG → if confirmed, rule out underlying disease (e.g., echocardiography, exercise treadmill stress test) with further procedures

ECG findings

  • Common ECG characteristics
    • QRS duration ≥ 120 ms with a block-like QRS morphology
    • PVCs are often followed by a compensatory pause
  • May be random or adhere to a specific pattern, including:
    • Single PVC
    • Couplet: two PVCs in a row
    • Triplet: three PVCs in a row
    • Bigeminy: one extrasystole after every single sinus beat
    • Trigeminy: one extrasystole after every two sinus beats

PVCs are a common incidental finding on routine ECGs. The detection of them does not require any further workup in patients who are asymptomatic!

Additional procedures

References:[1]

Treatment

  • Most patients do not require any treatment
  • Treat any underlying disease (e.g., CAD, myocarditis)
  • Only treat frequent and significantly symptomatic PVCs

References:[1]

last updated 04/15/2020
{{uncollapseSections(['10a2UQ', 'e0axUQ', 'U0ab2Q', 'f0ak2Q', 'S0ay2Q', 'R0alfQ'])}}