Materiały źródłowe

• #1 Premature ventricular contractions (PVCs) – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/premature-ventricular-contractions/diagnosis-treatment/drc-20376762

  Most people with premature ventricular contractions (PVCs) who don’t have heart disease won’t need treatment. If you have heart disease, PVCs can lead to more-serious heart rhythm problems (arrhythmias). Treatment depends on the underlying cause. […] A health care provider may recommend the following treatment for frequent PVCs: […] Lifestyle changes. Eliminating common premature ventricular contraction (PVC) triggers such as caffeine or tobacco may reduce the number of extra beats and lessen symptoms. […] Medications. Blood pressure medications may be prescribed to reduce the premature contractions. Those used for PVCs may include beta blockers and calcium channel blockers. Drugs to control the heart rhythm also may be prescribed if you have a type of irregular heartbeat called ventricular tachycardia or frequent PVCs that interfere with heart function.

• #2 Management of Premature Ventricular Complexes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6192796/

  Premature ventricular contractions (PVCs) are frequently encountered, and management is determined by symptoms, precipitating factors, and the presence of underlying cardiac disease. No treatment is indicated in patients with asymptomatic PVCs in absence of cardiac disease. Symptomatic patients without cardiac disease may be managed by identifying and correcting reversible causes. In patients with cardiac disease, management includes treating the underlying cardiac disease to improve both symptoms and prognosis. […] The decision of whether to treat PVCs depends on symptoms and structural heart diseases. In the absence of symptoms and structural heart disease, no treatment is needed, and reassurance is recommended. There is no evidence that suppression of PVCs with medications in this situation improves mortality.

• #3 Management of Premature Ventricular Complexes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6192796/

  Premature ventricular contractions (PVCs) are frequently encountered, and management is determined by symptoms, precipitating factors, and the presence of underlying cardiac disease. No treatment is indicated in patients with asymptomatic PVCs in absence of cardiac disease. Symptomatic patients without cardiac disease may be managed by identifying and correcting reversible causes. In patients with cardiac disease, management includes treating the underlying cardiac disease to improve both symptoms and prognosis. […] The decision of whether to treat PVCs depends on symptoms and structural heart diseases. In the absence of symptoms and structural heart disease, no treatment is needed, and reassurance is recommended. There is no evidence that suppression of PVCs with medications in this situation improves mortality.

• #4 Premature Ventricular Contraction-induced Cardiomyopathy | AER Journal

  https://www.aerjournal.com/articles/premature-ventricular-contraction-induced-cardiomyopathy?language_content_entity=en

  Premature ventricular contractions (PVCs) are very common and usually do not require treatment. However, in the clinical setting of troublesome symptoms, or when PVCs trigger polymorphic ventricular tachycardia or cause cardiomyopathy, proper treatment is critical. […] Treatment often consists of catheter ablation, although antiarrhythmic medications may also provide both reduction in PVC frequency and resolution of left ventricular dysfunction. […] The three indications for treatment are symptom control, to prevent recurrence in PVC-triggered ventricular fibrillation and to potentially reduce the effects of PVC-induced cardiomyopathy. […] The recent ventricular arrhythmia guideline document recommends catheter ablation in patients with PVC-induced cardiomyopathy for whom antiarrhythmic medications are ineffective, not tolerated, or not the patients preference.

• #5 Clinical Approach to Patients with Frequent PVCs | Sarver Heart Center

  https://heart.arizona.edu/heart-health/heart-rhythm-disorders/clinical-approach-patients-frequent-pvcs

  Premature ventricular complexes, or PVCs, are a common clinical problem. […] Patients with a high frequency of PVC ( 20-40% of all beats) may require more aggressive therapy independent of symptoms. […] PVC therapies: From a clinical perspective it is useful to divide patients with frequent PVCs into those with and those without structural heart disease: […] If medical therapy is required to decrease symptoms a trial of calcium channel blocker (diltiazem) or beta blocker is a very reasonable first step, […] If these drug trials do not result in sufficient clinical improvement we often add anti-arrhythmic drugs such as class I-C drugs (flecainide or propafenone) or class III drugs (sotalol) to suppress symptomatic PVCs […] If patient is unresponsive or intolerant to above medical therapy, catheter ablation of PVCs can be very useful.

• #6 Premature Ventricle Contractions in Heart Failure: A Closer Examination – The Cardiology Advisor

  https://www.thecardiologyadvisor.com/features/premature-ventricle-contractions-in-heart-failure-a-closer-examination/

  Premature ventricular contractions (PVCs) are early depolarizations of the myocardium, originating in the ventricle. Once regarded as benign, PVCs even in the absence of structural heart disease are now regarded as more insidious, potentially causing or contributing to cardiomyopathy and heart failure. The main question is whether and when to intervene. The 2 primary indications for intervention are whether the patient has disruptive symptoms, and the development of cardiomyopathy. The decision is complex and based on a variety of factors. Risk must be evaluated on a case-by-case basis, taking into account the frequency, location, and morphologic characteristics of the PVCs. Asymptomatic PVCs that are strung together in runs of ventricular tachycardia pose a higher risk of tachycardia-related cardiomyopathy and heart failure than symptomatic isolated PVCs. There is no consensus regarding a cutoff point above which a high PVC burden requires treatment. I would consider anyone with an untreated PVC burden of 20% at a high risk of ultimately developing a cardiomyopathy, but even someone with a PVC burden of 10% warrants regular follow up. The big controversy in this field is whether to pursue a conservative expectant approachfollow-up and monitoring, possibly with medical suppressive therapiesor to proceed directly to ablation. It is reasonable to begin with behavioral modification if structural heart disease or metabolic abnormalities have been ruled out. Patients who do not respond to behavioral interventions can be candidates for medical therapy. Beta-blockers are the cornerstone of PVC suppression because they reduce intracellular cyclic adenosine monophosphate, thereby decreasing automaticity. Nondihydropyridine calcium channel blockers are particularly effective for PVC suppression in patients without structural heart disease and considered to be the drugs of choice in treating fascicular PVCs. Antiarrhythmic drugs must be used with caution because they can also be proarrhythmic. According to Dr Cantillon, catheter ablation is safe and effective and may be curative in many cases. The number or frequency of PVCs may help determine the utility of ablation. A higher percentage of PVCs makes ablation more amenable. Radiofrequency (RF) ablation and cryoablation are both used for PVCs. PVCs are treatable and carry a good prognosis. Emerging research is changing the approach to treatment and will provide clearer guidelines regarding the critical decisions and dilemmas in the field.

• #7 Premature ventricular contractions: Reassure or refer? | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/83/7/524

  When patients present with palpitations, the primary care physician can perform the initial evaluation and treatment for premature ventricular contractions (PVCs). Many patients need only reassurance and do not need to see a cardiologist. […] Treatment of PVCs is indicated for relief of symptoms if reassurance is not sufficient. […] Patients with a very high burden (20%) are at high risk of arrhythmia-induced cardiomyopathy. In these patients, referral is prudent, as some patients may opt for more aggressive treatment of their PVCs. […] In patients with severe symptoms for whom medical management has failed, referral for consideration of catheter ablation is reasonable. […] Even if they have no symptoms or only minimal symptoms, patients with a high PVC burden require follow-up because of the association between frequent PVCs and arrhythmia-induced cardiomyopathy.

• #8 Management of Premature Ventricular Complexes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6192796/

  Premature ventricular contractions (PVCs) are frequently encountered, and management is determined by symptoms, precipitating factors, and the presence of underlying cardiac disease. No treatment is indicated in patients with asymptomatic PVCs in absence of cardiac disease. Symptomatic patients without cardiac disease may be managed by identifying and correcting reversible causes. In patients with cardiac disease, management includes treating the underlying cardiac disease to improve both symptoms and prognosis. […] The decision of whether to treat PVCs depends on symptoms and structural heart diseases. In the absence of symptoms and structural heart disease, no treatment is needed, and reassurance is recommended. There is no evidence that suppression of PVCs with medications in this situation improves mortality.

• #9 Management of Premature Ventricular Complexes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6192796/

  Premature ventricular contractions are frequently encountered and management is determined by symptoms, precipitating factors, and the presence of underlying cardiac disease. No specific medical treatment is indicated in asymptomatic PVCs or tolerable symptoms in the absence of cardiac disease; if a reversible cause of PVCs is not determined, reassurance is recommended. With symptomatic PVCs, beta blockers and electrolyte supplementation may be used. Other antiarrhythmics may be considered, but are associated with side effects.

• #10

  https://journals.lww.com/cardiologyinreview/fulltext/9900/the_significance_of_premature_ventricular.439.aspx

  The timing of initiating treatment is important to consider when approaching the management of a patient with PVCs in a structurally normal heart. […] However, prompt treatment is warranted if symptoms develop or there is a decrease in EF that is otherwise unexplained. […] Patients with idiopathic PVCs generally do not require treatment in the initial presentation. However, they do require routine surveillance through ambulatory electrocardiography and echocardiography to assess changes in PVC burden and any changes in LV systolic function or wall stress, as the emergence of symptoms warrants immediate treatment.

• #11 Premature ventricular contractions (PVCs) – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/premature-ventricular-contractions/diagnosis-treatment/drc-20376762

  Most people with premature ventricular contractions (PVCs) who don’t have heart disease won’t need treatment. If you have heart disease, PVCs can lead to more-serious heart rhythm problems (arrhythmias). Treatment depends on the underlying cause. […] A health care provider may recommend the following treatment for frequent PVCs: […] Lifestyle changes. Eliminating common premature ventricular contraction (PVC) triggers such as caffeine or tobacco may reduce the number of extra beats and lessen symptoms. […] Medications. Blood pressure medications may be prescribed to reduce the premature contractions. Those used for PVCs may include beta blockers and calcium channel blockers. Drugs to control the heart rhythm also may be prescribed if you have a type of irregular heartbeat called ventricular tachycardia or frequent PVCs that interfere with heart function.

• #12 Premature Ventricular Contractions (PVCs) and Premature Atrial Contractions (PACs) | Frankel Cardiovascular Center | Michigan Medicine

  https://www.umcvc.org/conditions-treatments/premature-ventricular-contractions-pvcs-and-premature

  In those with healthy hearts, occasional PVCs are harmless and usually resolve on their own without treatment. Some PVC symptoms can be managed through lifestyle changes limiting caffeine, tobacco and alcohol and stress, for example. […] In patients with heart problems such as heart failure or heart disease, PVCs may be a sign of a more dangerous heart rhythm to come.

• #13 Premature Ventricular Contractions Treatment Cape Town

  https://cardiorhythm.co.za/premature-ventricular-contractions/

  Premature Ventricular Contractions (PVCs) or „extra heartbeats” occur in the lower chambers (ventricles) of the heart and are a common cause of cardiac arrhythmias. […] In most cases, PVCs are infrequent and benign. In this case, treatment is recommended to improve the quality of life. However, if the PVCs are very frequent, treatment is offered not only to improve quality of life but to prevent heart failure and, in some cases, to reverse heart failure. […] If the PVCs are of a more sustained nature (ventricular tachycardia), therapy is directed not only to reduce the PVC burden but also to manage a possible underlying abnormal cardiac substrate. […] The following self-care strategies can help control premature ventricular contractions and improve your heart health: Identify PVC Try and identify what triggers the PVCs. Triggers may include stress, exercise, alcohol, certain postures or certain meals. Avoiding the triggers may significantly reduce the PVC burden and improve your symptoms.

• #14 Treatment for Premature Ventricular Contractions (PVCs)

  https://encyclopedia.nm.org/Library/HealthSheets/3,S,90565

  Your healthcare provider may give you more instructions about how to manage your PVCs, such as: Eat a heart-healthy diet. Get enough exercise. Maintain a healthy weight. Don’t drink too much alcohol or caffeine, which can set off PVCs. Learn to manage stress and fatigue, which can also set off PVCs. Get enough good quality sleep. Get treatment for your other health conditions, such as high blood pressure. Make sure to keep all your medical appointments. Check with your healthcare provider before taking any nonprescribed medicines, including herbs, supplements, and recreational drugs. These can overexcite the heart and set off PVCs.

• #15 Premature Ventricular Contractions (PVC): Symptoms, Cause, Treatment

  https://www.webmd.com/heart-disease/premature-ventricular-contractions-facts

  Premature Ventricular Contractions Treatment […] You probably don’t need medical treatment for PVCs if they don’t happen often and you don’t have heart disease or other health conditions. But some lifestyle changes may help you control them: Limit caffeine, tobacco, and alcohol; get enough sleep; and manage your stress and anxiety. […] If your PVCs are more serious or bothersome, you might need: Medication. Blood pressure medications, including beta-blockers and calcium channel blockers, are sometimes prescribed for PVCs. You might also get a drug to control heart rhythms. […] Radiofrequency catheter ablation. If lifestyle changes and medications don’t work, your doctor might recommend this procedure in which a thin, flexible tube is threaded up through an artery to your heart. The tube has a tip that uses heat to make tiny scars that block unwanted electrical signals and stop the extra heartbeats. […] If your PVCs are caused by heart disease or a problem with the structure of your heart, they may go away if those conditions are treated.

• #16 Management of Premature Ventricular Complexes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6192796/

  In the presence of symptoms without structural heart disease, reversible causes of increased ectopy should be addressed. Treatment includes correcting electrolyte abnormalities (hypokalemia, hypomagnesemia, hypercalcemia), improving respiratory status (hypercapnea, hypoxia), treating hyperthyroidism, and avoiding medications that may precipitate ectopy such as digoxin, sympathomimetics, and tricyclic antidepressants. […] With significant, persistent symptoms in the absence of structural heart disease and after failure to identify an underlying cause, medical therapy is indicated with a beta blocker, a class II antiarrhythmic. […] In the setting of PVCs with left ventricular hypertrophy from hypertension, the goal of therapy should be control of blood pressure. […] Patients with known coronary artery disease should be on beta blocker therapy due to their proven benefits on cardiovascular morbidity and mortality; this may also help suppress PVCs.

• #17 Management of Premature Ventricular Complexes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6192796/

  In the presence of symptoms without structural heart disease, reversible causes of increased ectopy should be addressed. Treatment includes correcting electrolyte abnormalities (hypokalemia, hypomagnesemia, hypercalcemia), improving respiratory status (hypercapnea, hypoxia), treating hyperthyroidism, and avoiding medications that may precipitate ectopy such as digoxin, sympathomimetics, and tricyclic antidepressants. […] With significant, persistent symptoms in the absence of structural heart disease and after failure to identify an underlying cause, medical therapy is indicated with a beta blocker, a class II antiarrhythmic. […] In the setting of PVCs with left ventricular hypertrophy from hypertension, the goal of therapy should be control of blood pressure. […] Patients with known coronary artery disease should be on beta blocker therapy due to their proven benefits on cardiovascular morbidity and mortality; this may also help suppress PVCs.

• #18 Premature Ventricular Complexes Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/158939-treatment

  Recommendations depend on the underlying cardiac disease; avoidance of caffeine, nicotine, and alcohol may reduce the frequency of PVCs. […] Patients deemed to be at high risk of sudden cardiac death may benefit from implantable cardioverter defibrillator (ICD) implantation. […] Catheter-based renal sympathetic denervation (RSD) may have a role in reducing the arrhythmic burden of ventricular arrhythmias, including PVCs, that are refractory to pharmacotherapy. […] Consultation with a cardiac electrophysiologist may be beneficial. As described above, select patients with symptomatic idiopathic PVCs may benefit from catheter ablation.

• #19 Understanding Premature Ventricular Contractions: Causes and Solutions

  https://avicennacardiology.com/manhattan/premature-ventricular-contractions

  The treatment of PVCs depends on their frequency, symptoms, and underlying cause. […] For individuals with frequent PVCs unresponsive to medications, radiofrequency catheter ablation is an effective option. This minimally invasive procedure uses heat energy to create tiny scars in the areas of the ventricles causing the extra beats, stopping the PVCs. […] Addressing conditions like high blood pressure, overactive thyroid, or CAD is crucial for managing PVCs.

• #20 Premature ventricular contractions (PVCs) – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/premature-ventricular-contractions/diagnosis-treatment/drc-20376762

  Most people with premature ventricular contractions (PVCs) who don’t have heart disease won’t need treatment. If you have heart disease, PVCs can lead to more-serious heart rhythm problems (arrhythmias). Treatment depends on the underlying cause. […] A health care provider may recommend the following treatment for frequent PVCs: […] Lifestyle changes. Eliminating common premature ventricular contraction (PVC) triggers such as caffeine or tobacco may reduce the number of extra beats and lessen symptoms. […] Medications. Blood pressure medications may be prescribed to reduce the premature contractions. Those used for PVCs may include beta blockers and calcium channel blockers. Drugs to control the heart rhythm also may be prescribed if you have a type of irregular heartbeat called ventricular tachycardia or frequent PVCs that interfere with heart function.

• #21 Premature Ventricular Contractions (PVCs)

  https://my.clevelandclinic.org/health/diseases/17381-premature-ventricular-contractions

  PVCs usually go away with medication or other minimally invasive treatments. […] Treatment for underlying heart conditions may decrease the frequency of PVCs. For example, you may take medicines to reduce blood pressure or lower your heart rate. These medicines may also reduce how often you experience PVCs. […] Sometimes, your provider offers specific PVC treatment. You only need treatment specifically for a PVC if you have frequent irregular heartbeats that could damage your heart muscle. Treatment may include: catheter ablation, a minimally invasive procedure that strategically destroys the part of your heart causing irregular heartbeats; medications, such as antiarrhythmics to decrease irregular heart rhythms, or beta-blockers or calcium channel blockers to lower blood pressure.

• #22 Management of Premature Ventricular Complexes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6192796/

  In the presence of symptoms without structural heart disease, reversible causes of increased ectopy should be addressed. Treatment includes correcting electrolyte abnormalities (hypokalemia, hypomagnesemia, hypercalcemia), improving respiratory status (hypercapnea, hypoxia), treating hyperthyroidism, and avoiding medications that may precipitate ectopy such as digoxin, sympathomimetics, and tricyclic antidepressants. […] With significant, persistent symptoms in the absence of structural heart disease and after failure to identify an underlying cause, medical therapy is indicated with a beta blocker, a class II antiarrhythmic. […] In the setting of PVCs with left ventricular hypertrophy from hypertension, the goal of therapy should be control of blood pressure. […] Patients with known coronary artery disease should be on beta blocker therapy due to their proven benefits on cardiovascular morbidity and mortality; this may also help suppress PVCs.

• #23 Premature Ventricular Complexes Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/158939-treatment

  Step 1: Beta-blockers and nondihydropyridine calcium channel blockers (eg, verapamil, diltiazem) can be used to treat symptomatic patients. […] Step 2: The use of antiarrhythmic therapy is not typically recommended and best targeted to address limiting symptoms. […] In patients without structural heart disease who have refractory symptoms and are using beta-blockers and/or calcium channel blockers, cautious use of antiarrhythmic drugs is the appropriate next step. […] More recently, results from a study by Raad et al suggest that class IC agents are effective in suppressing PVCs in patients with nonischemic cardiomyopathy (NICM) and implantable cardioverter-defibrillators (ICDs) […] Step 3: The next step in patients who cannot take flecainide or propafenone is to consider amiodarone or sotalol.

• #24

  https://journals.lww.com/cardiologyinreview/fulltext/9900/the_significance_of_premature_ventricular.439.aspx

  The 2022 European Society of Cardiology guidelines state that beta-blockers or nondihydropyridine calcium channel blockers are indicated in symptomatic patients with idiopathic PVCs from an origin other than the RVOT or the left fascicles. […] Catheter ablation is another option for treatment. Typically, accepted indications for catheter ablation are frequent PVCs that are presumed to cause LV dysfunction and the continuation of severe symptoms when antiarrhythmic drugs are not effective. […] However, the 2022 European Society of Cardiology guidelines for ventricular arrhythmias recommend catheter ablation as the first line for symptomatic idiopathic ventricular tachycardia and PVCs from the RVOT or the left fascicles. […] Catheter ablation for PVCs has been shown to be beneficial in patients with preserved LVEF, as one study showed an improvement in LV global longitudinal strain after successful ablation.

• #25

  https://journals.lww.com/cardiologyinreview/fulltext/9900/the_significance_of_premature_ventricular.439.aspx

  The 2022 European Society of Cardiology guidelines state that beta-blockers or nondihydropyridine calcium channel blockers are indicated in symptomatic patients with idiopathic PVCs from an origin other than the RVOT or the left fascicles. […] Catheter ablation is another option for treatment. Typically, accepted indications for catheter ablation are frequent PVCs that are presumed to cause LV dysfunction and the continuation of severe symptoms when antiarrhythmic drugs are not effective. […] However, the 2022 European Society of Cardiology guidelines for ventricular arrhythmias recommend catheter ablation as the first line for symptomatic idiopathic ventricular tachycardia and PVCs from the RVOT or the left fascicles. […] Catheter ablation for PVCs has been shown to be beneficial in patients with preserved LVEF, as one study showed an improvement in LV global longitudinal strain after successful ablation.

• #26 Premature Ventricular Contractions Treatment Cape Town

  https://cardiorhythm.co.za/premature-ventricular-contractions/

  Beta-blockers and calcium channel blockers may suppress the PVCs in 60% of cases. Some individuals may experience intolerable side effects from these medications, resulting in the discontinuation of the drug. […] Antiarrhythmic drugs, such as flecainide, may be used if you have ventricular tachycardia or very frequent premature ventricular contractions that interfere with your heart’s function, causing severe symptoms. […] In heart ablation therapy, radiofrequency waves are used to vaporise tiny amounts of tissue in the area of the heart where the extra beat originates. Radiofrequency catheter ablation is a treatment option for patients with symptomatic PVCs or PVCs that are frequent or prolonged and is reserved for patients who develop intolerable side effects on medication or when medication does not suppress the PVCs or for those who cannot comply with long-term drug therapy. […] Coronary revascularisation (Percutaneous or surgical) may be considered in individual cases when it is suspected that the ischaemic is driving the PVCs /ventricular tachycardia.

• #27 Management of Premature Ventricular Complexes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6192796/

  Premature ventricular contractions are frequently encountered and management is determined by symptoms, precipitating factors, and the presence of underlying cardiac disease. No specific medical treatment is indicated in asymptomatic PVCs or tolerable symptoms in the absence of cardiac disease; if a reversible cause of PVCs is not determined, reassurance is recommended. With symptomatic PVCs, beta blockers and electrolyte supplementation may be used. Other antiarrhythmics may be considered, but are associated with side effects.

• #28 Premature Ventricular Complexes Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/158939-treatment

  Step 1: Beta-blockers and nondihydropyridine calcium channel blockers (eg, verapamil, diltiazem) can be used to treat symptomatic patients. […] Step 2: The use of antiarrhythmic therapy is not typically recommended and best targeted to address limiting symptoms. […] In patients without structural heart disease who have refractory symptoms and are using beta-blockers and/or calcium channel blockers, cautious use of antiarrhythmic drugs is the appropriate next step. […] More recently, results from a study by Raad et al suggest that class IC agents are effective in suppressing PVCs in patients with nonischemic cardiomyopathy (NICM) and implantable cardioverter-defibrillators (ICDs) […] Step 3: The next step in patients who cannot take flecainide or propafenone is to consider amiodarone or sotalol.

• #29 Diagnosis and Treatment of Idiopathic Premature Ventricular Contractions: A Stepwise Approach Based on the Site of Origin

  https://www.mdpi.com/2075-4418/11/10/1840

  For patients who have symptomatic PVCs that are unresponsive to a beta-blocker or calcium channel blocker, or in whom those drugs are poorly tolerated and are not good candidates for CA (because of frailty or multifocal PVCs), treatment with additional AAD such as flecainide, propafenone, sotalol and amiodarone may be considered to reduce the frequency of PVCs and improve symptoms. […] However, in the last two decades, with progressive improvement in mapping techniques and CA outcomes, CA has become a first-line therapeutic option especially, when a PVC CMP is suspected. […] In a clinical scenario when it is suspected that a high PVCs burden (>15–25%) may play a significant role in LV dysfunction, CA can help to improve LVEF. […] Medical therapy should be considered as first-line therapy in patients in whom ablation is more complex and leads to a higher risk of procedural complications, but in general, CA has a strong recommendation in symptomatic patients who do not tolerate or do not prefer long-term AAD.

• #30 Premature Ventricular Complexes Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/158939-treatment

  Step 1: Beta-blockers and nondihydropyridine calcium channel blockers (eg, verapamil, diltiazem) can be used to treat symptomatic patients. […] Step 2: The use of antiarrhythmic therapy is not typically recommended and best targeted to address limiting symptoms. […] In patients without structural heart disease who have refractory symptoms and are using beta-blockers and/or calcium channel blockers, cautious use of antiarrhythmic drugs is the appropriate next step. […] More recently, results from a study by Raad et al suggest that class IC agents are effective in suppressing PVCs in patients with nonischemic cardiomyopathy (NICM) and implantable cardioverter-defibrillators (ICDs) […] Step 3: The next step in patients who cannot take flecainide or propafenone is to consider amiodarone or sotalol.

• #31 What Can We Do if Recommended Medical Therapy and Catheter Ablation for Frequent Premature Ventricular Contractions Fail?

  https://www.innovationsincrm.com/cardiac-rhythm-management/2011/july/100-catheter-ablation-frequent-premature-ventricular

  The long-term treatment of PVCs is highly controversial. […] The same guidelines recommend that ablation of asymptomatic PVCs may be considered when PVCs are very frequent, to avoid or treat tachycardia-induced cardiomyopathy. Radiofrequency catheter ablation (RFCA) can successfully eliminate PVCs and improve cardiac function. […] Propafenone is an antiarrhythmic drug and is widely used in Europe and the USA for the management of ventricular arrhythmias. […] Studies with propafenone in ventricular arrhythmia have primarily involved its effect on the frequency of PVCs; it abolishes about 80% of ectopic beats, with drug efficacy directly related to the daily dose administered. […] This case report determine that propafenone may be considered when antiarrhythmic drugs of first choice and RFCA have failed.

• #32 Premature Ventricular Contraction-induced Cardiomyopathy | AER Journal

  https://www.aerjournal.com/articles/premature-ventricular-contraction-induced-cardiomyopathy?language_content_entity=en

  Although very limited data exist to guide treatment, catheter ablation is highly effective (particularly for outflow-tract PVCs) and complications are unusual. […] Treatment with flecainide or propafenone decreased mean PVC burden from 36.2 3.5 to 10.0 2.4 % (p0.001) with a resultant increase in mean LV ejection fraction from 37.4 2.0 to 49.0 1.9 % (p0.001). […] Successful treatment, particularly when provided relatively early in the disease process, allows recovery of LV dysfunction.

• #33 What Can We Do if Recommended Medical Therapy and Catheter Ablation for Frequent Premature Ventricular Contractions Fail?

  https://www.innovationsincrm.com/cardiac-rhythm-management/2011/july/100-catheter-ablation-frequent-premature-ventricular

  The long-term treatment of PVCs is highly controversial. […] The same guidelines recommend that ablation of asymptomatic PVCs may be considered when PVCs are very frequent, to avoid or treat tachycardia-induced cardiomyopathy. Radiofrequency catheter ablation (RFCA) can successfully eliminate PVCs and improve cardiac function. […] Propafenone is an antiarrhythmic drug and is widely used in Europe and the USA for the management of ventricular arrhythmias. […] Studies with propafenone in ventricular arrhythmia have primarily involved its effect on the frequency of PVCs; it abolishes about 80% of ectopic beats, with drug efficacy directly related to the daily dose administered. […] This case report determine that propafenone may be considered when antiarrhythmic drugs of first choice and RFCA have failed.

• #34 Premature ventricular contractions (PVCs) – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/premature-ventricular-contractions/diagnosis-treatment/drc-20376762

  Radiofrequency catheter ablation. If lifestyle changes and medications don’t help reduce the PVCs, a catheter procedure may be done to stop the extra beats. In this procedure, a health care provider threads one or more thin, flexible tubes (catheters) through an artery, usually in the groin, and guides them to the heart. Sensors (electrodes) on the tip of the catheter use heat (radiofrequency) energy to create tiny scars in the heart to block irregular electrical signals and restore the heart rhythm.

• #35 Diagnosis and Treatment of Idiopathic Premature Ventricular Contractions: A Stepwise Approach Based on the Site of Origin

  https://www.mdpi.com/2075-4418/11/10/1840

  For patients who have symptomatic PVCs that are unresponsive to a beta-blocker or calcium channel blocker, or in whom those drugs are poorly tolerated and are not good candidates for CA (because of frailty or multifocal PVCs), treatment with additional AAD such as flecainide, propafenone, sotalol and amiodarone may be considered to reduce the frequency of PVCs and improve symptoms. […] However, in the last two decades, with progressive improvement in mapping techniques and CA outcomes, CA has become a first-line therapeutic option especially, when a PVC CMP is suspected. […] In a clinical scenario when it is suspected that a high PVCs burden (>15–25%) may play a significant role in LV dysfunction, CA can help to improve LVEF. […] Medical therapy should be considered as first-line therapy in patients in whom ablation is more complex and leads to a higher risk of procedural complications, but in general, CA has a strong recommendation in symptomatic patients who do not tolerate or do not prefer long-term AAD.

• #36 Premature ventricular contractions – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/premature-ventricular-contractions/

  Most individuals do not require treatment unless they have an underlying condition (e.g., myocarditis, electrolyte abnormalities). […] Antiarrhythmic drugs or, in some cases, catheter ablation should be considered for individuals with frequent PVCs that cause significant symptoms, as they are at risk for sudden cardiac death. […] Treat underlying diseases (e.g., CAD, myocarditis, heart failure). […] Treat electrolyte abnormalities (e.g., hypokalemia, hypomagnesemia). […] Specific treatment, i.e., antiarrhythmic drugs, and/or catheter ablation […] Most patients do not require any treatment. […] Beta blockers, CCBs, or catheter ablation are considered first-line strategies for treating PVCs. The optimal approach should be based on shared decision-making. […] Indications for catheter ablation include:

• #37 Premature ventricular contractions – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/premature-ventricular-contractions/

  Symptomatic patients who prefer nonpharmacological treatment […] Frequent PVCs (PVC burden 510%) in patients with reduced LVEF […] Lack of response to or intolerance of first-line pharmacotherapy. […] Catheter ablation has higher success rates in patients with monomorphic PVCs than in patients with polymorphic PVCs.

• #38 Premature Ventricular Contraction-induced Cardiomyopathy | AER Journal

  https://www.aerjournal.com/articles/premature-ventricular-contraction-induced-cardiomyopathy?language_content_entity=en

  Premature ventricular contractions (PVCs) are very common and usually do not require treatment. However, in the clinical setting of troublesome symptoms, or when PVCs trigger polymorphic ventricular tachycardia or cause cardiomyopathy, proper treatment is critical. […] Treatment often consists of catheter ablation, although antiarrhythmic medications may also provide both reduction in PVC frequency and resolution of left ventricular dysfunction. […] The three indications for treatment are symptom control, to prevent recurrence in PVC-triggered ventricular fibrillation and to potentially reduce the effects of PVC-induced cardiomyopathy. […] The recent ventricular arrhythmia guideline document recommends catheter ablation in patients with PVC-induced cardiomyopathy for whom antiarrhythmic medications are ineffective, not tolerated, or not the patients preference.

• #39

  https://journals.lww.com/cardiologyinreview/fulltext/9900/the_significance_of_premature_ventricular.439.aspx

  The 2022 European Society of Cardiology guidelines state that beta-blockers or nondihydropyridine calcium channel blockers are indicated in symptomatic patients with idiopathic PVCs from an origin other than the RVOT or the left fascicles. […] Catheter ablation is another option for treatment. Typically, accepted indications for catheter ablation are frequent PVCs that are presumed to cause LV dysfunction and the continuation of severe symptoms when antiarrhythmic drugs are not effective. […] However, the 2022 European Society of Cardiology guidelines for ventricular arrhythmias recommend catheter ablation as the first line for symptomatic idiopathic ventricular tachycardia and PVCs from the RVOT or the left fascicles. […] Catheter ablation for PVCs has been shown to be beneficial in patients with preserved LVEF, as one study showed an improvement in LV global longitudinal strain after successful ablation.

• #40 Premature ventricular contractions (PVCs) – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/premature-ventricular-contractions/diagnosis-treatment/drc-20376762

  Radiofrequency catheter ablation. If lifestyle changes and medications don’t help reduce the PVCs, a catheter procedure may be done to stop the extra beats. In this procedure, a health care provider threads one or more thin, flexible tubes (catheters) through an artery, usually in the groin, and guides them to the heart. Sensors (electrodes) on the tip of the catheter use heat (radiofrequency) energy to create tiny scars in the heart to block irregular electrical signals and restore the heart rhythm.

• #41 Premature Ventricular Contractions (PVCs): Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/heart/arrhythmias/premature-ventricular-contractions-pvcs/treatment

  Unless the condition worsens, treatment may not be necessary for individuals with premature ventricular contractions. But when treatment becomes necessary, an examination by a cardiologist is recommended. […] Medication treatment for other heart-related conditions may also eliminate the symptoms of PVC. […] If the symptoms brought on by premature ventricular contractions become too frequent or bothersome, treatment may be necessary to prevent the PVCs from affecting the hearts muscles. Some PVC treatments could include: […] Beta blockers or calcium channel blockers, normally used to treat high blood pressure, are sometimes used to control PVCs. Other medications called antiarrhythmics are specifically designed to control irregular heart rhythms if not effective or well tolerated. […] Catheter ablation-This minimally invasive procedure targets the heart area. It causes irregular heartbeats by using hot or cold energy to treat the heart tissue where the arrhythmia is taking place.

• #42 Diagnosis and Treatment of Idiopathic Premature Ventricular Contractions: A Stepwise Approach Based on the Site of Origin

  https://www.mdpi.com/2075-4418/11/10/1840

  In patients with recurrent ventricular fibrillation triggered by PVCs often the SOO lies in the Purkinije network. In such cases, CA is a standardized approach to avoid further malignant arrhythmic events. […] Compared to PVCs originating from the RVOT, ablation of PVCs originating from the LVOT is more complex and can involve greater procedural risk due to nearby anatomical structures such as coronary arteries or aortic valve cusps. […] In particular ablative treatment of PVCs originating from the papillary muscles requires greater catheter stability, with the need for frequent use of the intracardiac echo and a higher risk of recurrence with the necessity of redo procedures in about 30% of the cases.

• #43 Premature Ventricular Complexes Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/158939-treatment

  Management in these patients Various strategies, both invasive and noninvasive, predict prognosis in patients with PVCs post-MI. […] Treatment should include limiting transient ischemia. Optimal treatment for congestive heart failure (CHF), CAD, or both should be instituted. Maintain electrolyte balance. Blood pressure control should be obtained because LV hypertrophy is associated with increased PVCs. […] Catheter ablation can eradicate PVCs, but there are higher risks associated with the procedure (eg, disabling symptoms, LV systolic dysfunction, PVC-induced VF), including proximity to vital structures (coronary arteries, conduction system) and an intramural origin. […] Consider ablation therapy in the following: Patients with frequent, symptomatic, and monomorphic PVCs refractory to medical therapy, Patients who choose to avoid long-term medical therapy, Patients with ventricular arrhythmia storm that is consistently provoked by VPBs of a similar morphology.

• #44 Premature Ventricular Complexes Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/158939-treatment

  Highly symptomatic and refractory cases of PVCs especially from RVOT are appropriate for ablation therapy, with success rates over 70%. […] The selection of an endocardial versus an epicardial approach to target ventricular arrhythmia depends on the patients underlying disease substrate, as well as the location of the arrhythmogenic substrate within the myocardial wall, which can be best assessed with a cardiac MRI. […] In a 2024 European tertiary care center study of real-world data from 120 patients who underwent catheter ablation for ventricular tachycardias (VTs) and PVCs, Schlatzer et al found acute success rates of 94.2% for VTs and 92.2% for PVCs, and complications rates of 10.1% and 7.8%, respectively. […] In a 2024 retrospective (2019-2020) report, a multicenter study by Mugnai et al found a „zero fluoroscopy” catheter ablation of PVCs approach to be safe in 131 patients.

• #45 Premature Ventricular Contraction (PVC) Treatment Miami, Florida

  https://www.theafibclinic.com/other-arrhythmia/premature-ventricular-contractions-pvc/

  Another form of abnormal rhythms originating from the ventricles (bottom chambers of the heart) occur in the form of PVC (premature ventricular contractions). PVC are extra heart beats caused by a firing of electrical impulse that originates a premature heart contraction. This condition can be observed in patients with pre-existing heart disease (scar tissue or heart failure), but often also may occur in patient with no structural abnormalities in the heart. […] In those patient with symptoms a catheter ablation procedure intended to localize the site of abnormal cell firing in the ventricles to precisely deliver radiofrequency energy through a catheter (ablation) to eliminate the abnormal cells causing the PVC. Most procedures are successful in controlling the PVC and patient experience significant symptoms relief and get back their active life. […] New technology available allows our team of experts in arrhythmia treatment to safely perform hundreds of PVC ablation procedures a year with very low complication rates and without the use of ionizing radiation, guided by GPS-like computer systems and intracardiac ultrasound.

• #46 Diagnosis and Treatment of Idiopathic Premature Ventricular Contractions: A Stepwise Approach Based on the Site of Origin

  https://www.mdpi.com/2075-4418/11/10/1840

  In patients with recurrent ventricular fibrillation triggered by PVCs often the SOO lies in the Purkinije network. In such cases, CA is a standardized approach to avoid further malignant arrhythmic events. […] Compared to PVCs originating from the RVOT, ablation of PVCs originating from the LVOT is more complex and can involve greater procedural risk due to nearby anatomical structures such as coronary arteries or aortic valve cusps. […] In particular ablative treatment of PVCs originating from the papillary muscles requires greater catheter stability, with the need for frequent use of the intracardiac echo and a higher risk of recurrence with the necessity of redo procedures in about 30% of the cases.

• #47 Premature Ventricular Complexes Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/158939-treatment

  Highly symptomatic and refractory cases of PVCs especially from RVOT are appropriate for ablation therapy, with success rates over 70%. […] The selection of an endocardial versus an epicardial approach to target ventricular arrhythmia depends on the patients underlying disease substrate, as well as the location of the arrhythmogenic substrate within the myocardial wall, which can be best assessed with a cardiac MRI. […] In a 2024 European tertiary care center study of real-world data from 120 patients who underwent catheter ablation for ventricular tachycardias (VTs) and PVCs, Schlatzer et al found acute success rates of 94.2% for VTs and 92.2% for PVCs, and complications rates of 10.1% and 7.8%, respectively. […] In a 2024 retrospective (2019-2020) report, a multicenter study by Mugnai et al found a „zero fluoroscopy” catheter ablation of PVCs approach to be safe in 131 patients.

• #48 Diagnosis and Treatment of Idiopathic Premature Ventricular Contractions: A Stepwise Approach Based on the Site of Origin

  https://www.mdpi.com/2075-4418/11/10/1840

  In patients with recurrent ventricular fibrillation triggered by PVCs often the SOO lies in the Purkinije network. In such cases, CA is a standardized approach to avoid further malignant arrhythmic events. […] Compared to PVCs originating from the RVOT, ablation of PVCs originating from the LVOT is more complex and can involve greater procedural risk due to nearby anatomical structures such as coronary arteries or aortic valve cusps. […] In particular ablative treatment of PVCs originating from the papillary muscles requires greater catheter stability, with the need for frequent use of the intracardiac echo and a higher risk of recurrence with the necessity of redo procedures in about 30% of the cases.

• #49 Premature Ventricular Complexes Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/158939-treatment

  Highly symptomatic and refractory cases of PVCs especially from RVOT are appropriate for ablation therapy, with success rates over 70%. […] The selection of an endocardial versus an epicardial approach to target ventricular arrhythmia depends on the patients underlying disease substrate, as well as the location of the arrhythmogenic substrate within the myocardial wall, which can be best assessed with a cardiac MRI. […] In a 2024 European tertiary care center study of real-world data from 120 patients who underwent catheter ablation for ventricular tachycardias (VTs) and PVCs, Schlatzer et al found acute success rates of 94.2% for VTs and 92.2% for PVCs, and complications rates of 10.1% and 7.8%, respectively. […] In a 2024 retrospective (2019-2020) report, a multicenter study by Mugnai et al found a „zero fluoroscopy” catheter ablation of PVCs approach to be safe in 131 patients.

• #50 Premature Ventricular Complexes Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/158939-treatment

  Recommendations depend on the underlying cardiac disease; avoidance of caffeine, nicotine, and alcohol may reduce the frequency of PVCs. […] Patients deemed to be at high risk of sudden cardiac death may benefit from implantable cardioverter defibrillator (ICD) implantation. […] Catheter-based renal sympathetic denervation (RSD) may have a role in reducing the arrhythmic burden of ventricular arrhythmias, including PVCs, that are refractory to pharmacotherapy. […] Consultation with a cardiac electrophysiologist may be beneficial. As described above, select patients with symptomatic idiopathic PVCs may benefit from catheter ablation.

• #51 Management of Premature Ventricular Complexes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6192796/

  PVCs in the setting of myocardial ischemia or previous infarction is associated with increased mortality; suppression of PVCs with antiarrhythmics other than beta blockers has not demonstrated any survival benefit. […] In the presence cardiac disease such as cardiac ischemia, infarction, or heart failure and symptoms from PVCs, optimal medical therapy including beta-blockers and ACE inhibitors may improve symptoms. Amiodarone and ablation may be considered for refractory symptoms in all patients. […] In addition to medical therapy for ventricular ectopy in the setting of systolic heart failure, an implantable cardioverter-defibrillator (ICD) may be an option for primary prevention of sudden cardiac death in patients with an ejection fraction of less than or equal to 35 percent with NYHA class II or III heart failure.

• #52 Frequent ventricular extrasystoles: significance, prognosis and treatment

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-9/Frequent-ventricular-extrasystoles-significance-prognosis-and-treatment

  An implantable cardioverter defibrillator may be indicated if risk stratification criteria are met. […] Catheter ablation may be considered in some patients as adjunctive treatment. […] Most of the remaining patients exhibit no severe clinical symptoms, and so the condition of those patients with frequent PVCs without any overt symptoms is believed to be relatively benign.

• #53 Premature Ventricular Complexes Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/158939-treatment

  Recommendations depend on the underlying cardiac disease; avoidance of caffeine, nicotine, and alcohol may reduce the frequency of PVCs. […] Patients deemed to be at high risk of sudden cardiac death may benefit from implantable cardioverter defibrillator (ICD) implantation. […] Catheter-based renal sympathetic denervation (RSD) may have a role in reducing the arrhythmic burden of ventricular arrhythmias, including PVCs, that are refractory to pharmacotherapy. […] Consultation with a cardiac electrophysiologist may be beneficial. As described above, select patients with symptomatic idiopathic PVCs may benefit from catheter ablation.

• #54 LLTS to Treat Premature Ventricular Contractions

  https://ctv.veeva.com/study/llts-to-treat-premature-ventricular-contractions

  This randomized control trial is designed to explore the effect of low-level tragus stimulation in patients with frequent premature ventricular contractions. […] At present, the clinical treatment of PVCs is still based on drugs, such as beta-blockers, mexiletine, propafenone, etc., and their effectiveness varies greatly among individuals. […] The status of catheter ablation in the treatment of ventricular premature beats continuous improvement, but this is an invasive operation and relatively expensive, which limits its wide application in clinical practice. […] Recent studies have shown that the autonomic nervous system plays an important role in the occurrence and maintenance of ventricular arrhythmia. […] Moreover, inhibiting sympathetic nerve activity, including anesthesia, sympathetic nerve block, sympathetic nerve denervation, etc., can effectively reduce the onset and burden of ventricular arrhythmia.

• #55 LLTS to Treat Premature Ventricular Contractions

  https://ctv.veeva.com/study/llts-to-treat-premature-ventricular-contractions

  Low-level tragus stimulation (LLTS) is an emerging method of regulating autonomic nerves. […] The current trial is designed to explore the effect of low-level tragus stimulation in patients with frequent premature ventricular contractions. […] Active LLTSs are performed using a transcutaneous vagus nerve stimulation device (Parasym device, Parasym Health, London, United Kingdom) with an ear clip attached to the tragus of the right ear.

• #56 JMIR Cardio – Cognitive Behavioral Therapy for Symptom Preoccupation Among Patients With Premature Ventricular Contractions: Nonrandomized Pretest-Posttest Study

  https://cardio.jmir.org/2024/1/e53815

  Background: Premature ventricular contractions (PVCs) are a common cardiac condition often associated with disabling symptoms and impaired quality of life (QoL). Current treatment strategies have limited effectiveness in reducing symptoms and restoring QoL for patients with PVCs. […] The aim of this study was to evaluate the effect of a PVC-specific CBT protocol targeting symptom preoccupation in patients with symptomatic idiopathic PVCs. […] The PVC-CBT intervention consisted of 10 weekly face-to-face sessions with a clinical psychologist (BEL) delivered via videoconference in conjunction with online text-based modules accessed through a secure web-based platform. […] The PVC-CBT was designed to target symptom preoccupation (ie, fear and hypervigilance toward cardiac-related symptoms and avoidance behavior) and included the following interventions: (1) education on PVCs and common psychological reactions to PVC symptoms, and the role of control and avoidance behavior in maintaining fear and hypervigilance of PVC symptoms; (2) interoceptive exposure to physical sensations similar to PVC symptoms by performing physical exercises such as increasing the heart rate and inducing palpitations by running on the spot or inducing dyspnea by excessive breathing to reduce the fear of symptoms and hypervigilance; (3) self-observation of cardiac symptoms, thoughts, feelings, and behavioral impulses to reduce fear and hypervigilance, serving as a form of interoceptive exposure technique; (4) in vivo exposure to avoided activities that were anticipated to elicit or potentially exacerbate PVC symptoms (such as vigorous exercise) or situations in which PVC symptoms are unwanted (such as engaging in leisure activities or driving); and (5) strategies on how to refrain from behaviors that serve to control symptoms, such as pulse checking, and how to handle worry when conducting exposure exercises. […] The promising findings of this pilot study, with large improvements in the outcome measures, high treatment adherence, and reported satisfaction with treatment as well as the limited report of adverse events, encourage further research into the efficacy of CBT in patients with symptomatic PVCs.

• #57 Management of Premature Ventricular Complexes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6192796/

  PVCs in the setting of myocardial ischemia or previous infarction is associated with increased mortality; suppression of PVCs with antiarrhythmics other than beta blockers has not demonstrated any survival benefit. […] In the presence cardiac disease such as cardiac ischemia, infarction, or heart failure and symptoms from PVCs, optimal medical therapy including beta-blockers and ACE inhibitors may improve symptoms. Amiodarone and ablation may be considered for refractory symptoms in all patients. […] In addition to medical therapy for ventricular ectopy in the setting of systolic heart failure, an implantable cardioverter-defibrillator (ICD) may be an option for primary prevention of sudden cardiac death in patients with an ejection fraction of less than or equal to 35 percent with NYHA class II or III heart failure.

• #58 Management of Premature Ventricular Complexes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6192796/

  PVCs in the setting of myocardial ischemia or previous infarction is associated with increased mortality; suppression of PVCs with antiarrhythmics other than beta blockers has not demonstrated any survival benefit. […] In the presence cardiac disease such as cardiac ischemia, infarction, or heart failure and symptoms from PVCs, optimal medical therapy including beta-blockers and ACE inhibitors may improve symptoms. Amiodarone and ablation may be considered for refractory symptoms in all patients. […] In addition to medical therapy for ventricular ectopy in the setting of systolic heart failure, an implantable cardioverter-defibrillator (ICD) may be an option for primary prevention of sudden cardiac death in patients with an ejection fraction of less than or equal to 35 percent with NYHA class II or III heart failure.

• #59 Premature Ventricular Complexes: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/761148-treatment

  Premature ventricular complexes (PVCs) (also known as ventricular premature complexes [VPCs]) are ectopic impulses originating from an area distal to the His Purkinje system. PVCs are the most common ventricular arrhythmia. Assessment and treatment of PVCs is challenging and complex, and these are highly dependent on the clinical context. The prognostic significance of PVCs is variable and, again, best interpreted in the context of the underlying cardiac condition. […] The treatment paradigm in the 1970s and 1980s was to eliminate PVCs in patients after MI. The Cardiac Arrhythmia Suppression Trial (CAST) and other arrhythmia suppression studies have demonstrated that eliminating PVCs with available antiarrhythmic drugs increases the risk of death to patients without providing any measurable benefit.

• #60 Premature Ventricular Complexes Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/158939-treatment

  Management in these patients Various strategies, both invasive and noninvasive, predict prognosis in patients with PVCs post-MI. […] Treatment should include limiting transient ischemia. Optimal treatment for congestive heart failure (CHF), CAD, or both should be instituted. Maintain electrolyte balance. Blood pressure control should be obtained because LV hypertrophy is associated with increased PVCs. […] Catheter ablation can eradicate PVCs, but there are higher risks associated with the procedure (eg, disabling symptoms, LV systolic dysfunction, PVC-induced VF), including proximity to vital structures (coronary arteries, conduction system) and an intramural origin. […] Consider ablation therapy in the following: Patients with frequent, symptomatic, and monomorphic PVCs refractory to medical therapy, Patients who choose to avoid long-term medical therapy, Patients with ventricular arrhythmia storm that is consistently provoked by VPBs of a similar morphology.

• #61 Premature Ventricular Complexes: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/761148-treatment

  Frequent PVCs, especially when they occur in a bigeminal pattern, can cause or contribute to tachycardia-induced cardiomyopathy, which reversed by elimination of the PVCs through catheter ablation. […] However, the extent to which this can be generalized to larger populations remains uncertain. Caution is in order, primarily because prior attempts at pharmacologic suppression were associated with unexpected and deleterious outcomes. […] In a study that evaluated the prognostic value of PVC burden in 1767 individuals with persistent atrial fibrillation (AF), Yen et al reported a significant association of 24-hour PVC burden and the presence of consecutive PVCs, with an independent association with all-cause and cardiovascular mortality in the presence of persistent AF.

• #62 Premature Ventricular Contraction-induced Cardiomyopathy | AER Journal

  https://www.aerjournal.com/articles/premature-ventricular-contraction-induced-cardiomyopathy?language_content_entity=en

  Premature ventricular contractions (PVCs) are very common and usually do not require treatment. However, in the clinical setting of troublesome symptoms, or when PVCs trigger polymorphic ventricular tachycardia or cause cardiomyopathy, proper treatment is critical. […] Treatment often consists of catheter ablation, although antiarrhythmic medications may also provide both reduction in PVC frequency and resolution of left ventricular dysfunction. […] The three indications for treatment are symptom control, to prevent recurrence in PVC-triggered ventricular fibrillation and to potentially reduce the effects of PVC-induced cardiomyopathy. […] The recent ventricular arrhythmia guideline document recommends catheter ablation in patients with PVC-induced cardiomyopathy for whom antiarrhythmic medications are ineffective, not tolerated, or not the patients preference.

• #63 Premature Ventricular Contraction-induced Cardiomyopathy | AER Journal

  https://www.aerjournal.com/articles/premature-ventricular-contraction-induced-cardiomyopathy?language_content_entity=en

  Although very limited data exist to guide treatment, catheter ablation is highly effective (particularly for outflow-tract PVCs) and complications are unusual. […] Treatment with flecainide or propafenone decreased mean PVC burden from 36.2 3.5 to 10.0 2.4 % (p0.001) with a resultant increase in mean LV ejection fraction from 37.4 2.0 to 49.0 1.9 % (p0.001). […] Successful treatment, particularly when provided relatively early in the disease process, allows recovery of LV dysfunction.

• #64 Diagnosis and Treatment of Idiopathic Premature Ventricular Contractions: A Stepwise Approach Based on the Site of Origin

  https://www.mdpi.com/2075-4418/11/10/1840

  For patients who have symptomatic PVCs that are unresponsive to a beta-blocker or calcium channel blocker, or in whom those drugs are poorly tolerated and are not good candidates for CA (because of frailty or multifocal PVCs), treatment with additional AAD such as flecainide, propafenone, sotalol and amiodarone may be considered to reduce the frequency of PVCs and improve symptoms. […] However, in the last two decades, with progressive improvement in mapping techniques and CA outcomes, CA has become a first-line therapeutic option especially, when a PVC CMP is suspected. […] In a clinical scenario when it is suspected that a high PVCs burden (>15–25%) may play a significant role in LV dysfunction, CA can help to improve LVEF. […] Medical therapy should be considered as first-line therapy in patients in whom ablation is more complex and leads to a higher risk of procedural complications, but in general, CA has a strong recommendation in symptomatic patients who do not tolerate or do not prefer long-term AAD.

• #65 Premature Ventricular Contractions (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/premature-ventricular-contractions.html

  Most kids with PVCs have healthy hearts and do not need special care. If your child has heart problems or gets PVCs often, your cardiologist may prescribe medicine to make them happen less often. […] For a few kids who have heart disease and PVCs, a heart procedure called an ablation can help. Ablation destroys or scars a tiny area of tissue where the early heartbeat starts.

• #66 Evaluation of Premature Ventricular Contractions in Children with Structurally Normal Hearts: A Single-Center Study – The Journal of Pediatric Research

  https://jpedres.org/articles/evaluation-of-premature-ventricular-contractions-in-children-with-structurally-normal-hearts-a-single-center-study/doi/jpr.galenos.2024.60094

  Premature ventricular contractions are a prevalent arrhythmia in children, with the majority of cases exhibiting normal cardiac function and no anatomical abnormalities. […] Medical treatment was given to 40 patients (66.7%). Beta-blockers (52.2%) were the most commonly prescribed drugs. […] According to all patients follow-up Holter electrocardiography results, a 61.6% decrease in premature ventricular contraction rates was observed. […] Premature ventricular contractions in children generally have a good prognosis. Most cases are asymptomatic, and regardless of the origin, spontaneous regression rates over time are quite substantial. […] It is not recommended to pursue routine medical therapy to reduce the frequency of PVCs. […] In our study, some of the patients received medical treatment. Contrary to the literature, although medical treatment was initiated at a high rate to treat PVCs, there was no significant difference in the healing rates of PVCs between the groups that were given and those that were not given medical treatment.

• #67 Evaluation of Premature Ventricular Contractions in Children with Structurally Normal Hearts: A Single-Center Study – The Journal of Pediatric Research

  https://jpedres.org/articles/evaluation-of-premature-ventricular-contractions-in-children-with-structurally-normal-hearts-a-single-center-study/doi/jpr.galenos.2024.60094

  Beta-blockers are the most commonly used antiarrhythmic drugs to reduce PVCs according to the literature. […] In our study, unlike the information in the current literature, it was determined that propafenone had a more successful clinical response than other medical treatments. […] In none of our patients during follow-up, malignant arrhythmia or sudden cardiac death were observed. However, we could not detect the prevalence of PVC-induced cardiomyopathy as check-up ECHO evaluation was not performed. […] There may be no need for medical treatment to reduce the frequency of PVCs.

• #68 Premature Ventricular Contraction (PVC) in Children | UpBeat.org – powered by the Heart Rhythm Society

  https://upbeat.org/pediatrics/premature-ventricular-contraction-pvc-in-children

  Premature ventricular contractions, more commonly known as PVCs are extra heartbeats that arise from one of the two bottom chambers of the heart (left or right ventricle). […] Many individuals with PVCs will not require treatment. For those that do require treatment this may be in the form of medications, lifestyle modifications, and or catheter ablation. […] Your EP team may prescribe medication for treatment. Medication is not a cure but can decrease the number or frequency of episodes which can help to control symptoms. In most cases, these medications are taken daily. […] Understanding common triggers for PVCs and eliminating these triggers through lifestyle modifications can prevent or decrease the frequency of PVCs. […] An EP study and catheter ablation can be curative procedure for PVCs depending on the type of PVCs an individual may have.

• #69 Evaluation and Management of Premature Ventricular Complexes – PubMed

  https://pubmed.ncbi.nlm.nih.gov/32339046/

  Premature ventricular complexes (PVCs) are extremely common, found in the majority of individuals undergoing long-term ambulatory monitoring. […] Either medical treatment or catheter ablation are considered first-line therapies in most patients with PVCs associated with symptoms or a reduced left ventricular ejection fraction, and patient preference plays a role in determining which to try first. If medical treatment is selected, either -blockers or nondihydropyridine calcium channel blockers are reasonable drugs in patients with normal ventricular systolic function. […] Catheter ablation is the most efficacious approach to eradicate PVCs but may confer increased upfront risks.

• #70 Diagnosis and Treatment of Idiopathic Premature Ventricular Contractions: A Stepwise Approach Based on the Site of Origin

  https://www.mdpi.com/2075-4418/11/10/1840

  Premature ventricular contractions (PVCs) in the absence of structural heart disease (SHD), or inherited ion channelopathies, are referred to as idiopathic and are among the most common arrhythmias encountered in everyday clinical practice. […] They generally have a favorable prognosis and can be effectively treated with radiofrequency catheter ablation (CA). […] This review aims to present an overview on the current approach to PVCs, starting from the twelve-lead ECG analysis to clinical manifestations and prognosis, and therapeutic strategies including CA. […] In patients with symptomatic PVCs, β-blockers or non-dihydropyridine calcium channel blockers are considered the first-line treatments. […] These drugs have a long track record of safety in structurally normal hearts, and β-blockers are useful in patients with coronary artery disease or reduced LV function.

• #71

  https://journals.lww.com/cardiologyinreview/fulltext/9900/the_significance_of_premature_ventricular.439.aspx

  The 2022 European Society of Cardiology guidelines state that beta-blockers or nondihydropyridine calcium channel blockers are indicated in symptomatic patients with idiopathic PVCs from an origin other than the RVOT or the left fascicles. […] Catheter ablation is another option for treatment. Typically, accepted indications for catheter ablation are frequent PVCs that are presumed to cause LV dysfunction and the continuation of severe symptoms when antiarrhythmic drugs are not effective. […] However, the 2022 European Society of Cardiology guidelines for ventricular arrhythmias recommend catheter ablation as the first line for symptomatic idiopathic ventricular tachycardia and PVCs from the RVOT or the left fascicles. […] Catheter ablation for PVCs has been shown to be beneficial in patients with preserved LVEF, as one study showed an improvement in LV global longitudinal strain after successful ablation.

• #72 Diagnosis and Treatment of Idiopathic Premature Ventricular Contractions: A Stepwise Approach Based on the Site of Origin

  https://www.mdpi.com/2075-4418/11/10/1840

  For patients who have symptomatic PVCs that are unresponsive to a beta-blocker or calcium channel blocker, or in whom those drugs are poorly tolerated and are not good candidates for CA (because of frailty or multifocal PVCs), treatment with additional AAD such as flecainide, propafenone, sotalol and amiodarone may be considered to reduce the frequency of PVCs and improve symptoms. […] However, in the last two decades, with progressive improvement in mapping techniques and CA outcomes, CA has become a first-line therapeutic option especially, when a PVC CMP is suspected. […] In a clinical scenario when it is suspected that a high PVCs burden (>15–25%) may play a significant role in LV dysfunction, CA can help to improve LVEF. […] Medical therapy should be considered as first-line therapy in patients in whom ablation is more complex and leads to a higher risk of procedural complications, but in general, CA has a strong recommendation in symptomatic patients who do not tolerate or do not prefer long-term AAD.

• #73 Premature Ventricular Complexes Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/158939-treatment

  Management in these patients Various strategies, both invasive and noninvasive, predict prognosis in patients with PVCs post-MI. […] Treatment should include limiting transient ischemia. Optimal treatment for congestive heart failure (CHF), CAD, or both should be instituted. Maintain electrolyte balance. Blood pressure control should be obtained because LV hypertrophy is associated with increased PVCs. […] Catheter ablation can eradicate PVCs, but there are higher risks associated with the procedure (eg, disabling symptoms, LV systolic dysfunction, PVC-induced VF), including proximity to vital structures (coronary arteries, conduction system) and an intramural origin. […] Consider ablation therapy in the following: Patients with frequent, symptomatic, and monomorphic PVCs refractory to medical therapy, Patients who choose to avoid long-term medical therapy, Patients with ventricular arrhythmia storm that is consistently provoked by VPBs of a similar morphology.

• #74 Management of Premature Ventricular Complexes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6192796/

  PVCs in the setting of myocardial ischemia or previous infarction is associated with increased mortality; suppression of PVCs with antiarrhythmics other than beta blockers has not demonstrated any survival benefit. […] In the presence cardiac disease such as cardiac ischemia, infarction, or heart failure and symptoms from PVCs, optimal medical therapy including beta-blockers and ACE inhibitors may improve symptoms. Amiodarone and ablation may be considered for refractory symptoms in all patients. […] In addition to medical therapy for ventricular ectopy in the setting of systolic heart failure, an implantable cardioverter-defibrillator (ICD) may be an option for primary prevention of sudden cardiac death in patients with an ejection fraction of less than or equal to 35 percent with NYHA class II or III heart failure.

• #75 Premature Ventricular Complexes Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/158939-treatment

  Management in these patients Various strategies, both invasive and noninvasive, predict prognosis in patients with PVCs post-MI. […] Treatment should include limiting transient ischemia. Optimal treatment for congestive heart failure (CHF), CAD, or both should be instituted. Maintain electrolyte balance. Blood pressure control should be obtained because LV hypertrophy is associated with increased PVCs. […] Catheter ablation can eradicate PVCs, but there are higher risks associated with the procedure (eg, disabling symptoms, LV systolic dysfunction, PVC-induced VF), including proximity to vital structures (coronary arteries, conduction system) and an intramural origin. […] Consider ablation therapy in the following: Patients with frequent, symptomatic, and monomorphic PVCs refractory to medical therapy, Patients who choose to avoid long-term medical therapy, Patients with ventricular arrhythmia storm that is consistently provoked by VPBs of a similar morphology.

• #76 Management of Premature Ventricular Complexes

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6192796/

  Premature ventricular contractions are frequently encountered and management is determined by symptoms, precipitating factors, and the presence of underlying cardiac disease. No specific medical treatment is indicated in asymptomatic PVCs or tolerable symptoms in the absence of cardiac disease; if a reversible cause of PVCs is not determined, reassurance is recommended. With symptomatic PVCs, beta blockers and electrolyte supplementation may be used. Other antiarrhythmics may be considered, but are associated with side effects.

• #77 Premature Ventricular Contraction-induced Cardiomyopathy | AER Journal

  https://www.aerjournal.com/articles/premature-ventricular-contraction-induced-cardiomyopathy?language_content_entity=en

  Premature ventricular contractions (PVCs) are very common and usually do not require treatment. However, in the clinical setting of troublesome symptoms, or when PVCs trigger polymorphic ventricular tachycardia or cause cardiomyopathy, proper treatment is critical. […] Treatment often consists of catheter ablation, although antiarrhythmic medications may also provide both reduction in PVC frequency and resolution of left ventricular dysfunction. […] The three indications for treatment are symptom control, to prevent recurrence in PVC-triggered ventricular fibrillation and to potentially reduce the effects of PVC-induced cardiomyopathy. […] The recent ventricular arrhythmia guideline document recommends catheter ablation in patients with PVC-induced cardiomyopathy for whom antiarrhythmic medications are ineffective, not tolerated, or not the patients preference.

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