Premature Ventricular Contractions (PVCs) on ECG

Introduction

Premature Ventricular Contractions (PVCs) are extra heartbeats that originate in the ventricles instead of following the normal electrical conduction pathway. They are common and often benign but can be associated with underlying heart disease.

ECG Characteristics of PVCs

  1. Wide QRS complex (typically >120 ms) since the impulse originates outside the normal conduction system.
  2. No preceding P wave or retrograde P waves since the impulse bypasses the atria.
  3. Compensatory pause – the next normal beat occurs at a normal interval from the preceding beat, leading to an irregular rhythm.
  4. Unifocal or Multifocal – If all PVCs have the same morphology, they are unifocal; if they vary in shape, they are multifocal.
  5. Bigeminy, Trigeminy, or Couplets – PVCs may appear as single beats or in repeating patterns.

Causes of PVCs

  • Benign: Stress, caffeine, nicotine, alcohol, electrolyte imbalances.
  • Cardiac conditions: Coronary artery disease, myocardial infarction, heart failure, myocarditis.
  • Systemic conditions: Hyperthyroidism, anemia, hypoxia.

Clinical Significance

  • Isolated PVCs without symptoms: Usually benign.
  • Frequent PVCs (>10% of total heartbeats): May indicate structural heart disease or increase the risk of cardiomyopathy.
  • PVCs in presence of known heart disease: Requires investigation (echocardiography, Holter monitoring, stress testing).

Treatment and Management

  • Lifestyle Changes: Reducing caffeine, alcohol, and stress.
  • Electrolyte Correction: Checking magnesium and potassium levels.
  • Medication: Beta-blockers or antiarrhythmic drugs for symptomatic patients.
  • Catheter Ablation: In cases of drug-refractory PVCs associated with left ventricular dysfunction.

When to See a Doctor

  • Frequent or symptomatic PVCs (dizziness, chest pain, palpitations).
  • PVCs associated with known heart disease.
  • PVCs that worsen with exercise.

Conclusion

PVCs are common and often benign but require attention if frequent or symptomatic. Diagnosis via ECG and Holter monitoring helps assess risk and guide treatment.

Source recommendations

1. European Society of Cardiology (ESC) Guidelines on Ventricular Arrhythmias

  1. https://academic.oup.com/eurheartj/article/43/40/3997/6675633
  2. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Ventricular-Arrhythmias-and-the-Prevention-of-Sudden-Cardiac-Death
  3. https://pubmed.ncbi.nlm.nih.gov/36017572/
  4. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2022/09/02/14/23/2022-ESC-Guidelines-for-VAs-ESC-2022
  5. https://pubmed.ncbi.nlm.nih.gov/26320108/

2. American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines on Arrhythmias

  1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193
  2. https://pubmed.ncbi.nlm.nih.gov/29097320/
  3. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000549
  4. https://pubmed.ncbi.nlm.nih.gov/16949478/
  5. https://www.acc.org/Guidelines

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