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Current Concepts of Premature Ventricular Contractions.

Ahn MS - J Lifestyle Med (2013)

Bottom Line: Especially in ischemic heart disease, the frequency and complexity of PVCs is associated with mortality.In congestive heart failure, PVCs did not provide significant incremental prognostic information beyond readily available clinical variables.Recently, the concept of PVC-induced cardiomyopathy was proposed when pharmacological suppression of PVCs in patients with presumed idiopathic dilated cardiomyopathy subsequently showed improved left ventricular systolic dysfunction.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.

ABSTRACT
Premature ventricular contractions (PVCs) are early depolarizations of the myocardium originating in the ventricle. PVCs are common with an estimated prevalence of 40% to 75% in the general population on 24- to 48-hour Holter monitoring. Traditionally, they have been thought to be relatively benign in the absence of structural heart disease but they represent increased risk of sudden death in structural heart disease. Especially in ischemic heart disease, the frequency and complexity of PVCs is associated with mortality. Implantable cardioverter defibrillator therapy is indicated in patients with nonsustained ventricular tachycardia (NSVT) due to prior myocardial infarction, left ventricular ejection fraction less than or equal to 40%, and inducible ventricular fibrillation or sustained ventricular tachycardia at electrophysiological study. In congestive heart failure, PVCs did not provide significant incremental prognostic information beyond readily available clinical variables. Consequently, NSVT should not guide therapeutic interventions. Recently, the concept of PVC-induced cardiomyopathy was proposed when pharmacological suppression of PVCs in patients with presumed idiopathic dilated cardiomyopathy subsequently showed improved left ventricular systolic dysfunction. For the treatment PVCs, it is important to consider underlying heart disease, the frequency of the PVCs and the frequency and severity of symptoms.

No MeSH data available.


Related in: MedlinePlus

6-month survival of patients by premature ventricular contractions (PVCs) per hour. Adapted from Maggioni et al [9].
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f2-jlm-03-26: 6-month survival of patients by premature ventricular contractions (PVCs) per hour. Adapted from Maggioni et al [9].

Mentions: In 1975, Schulze et al. reported results from the first post-infarction studies of left ventricular (LV) dysfunction, ventricular arrhythmias, and death that used radionuclide methods to measure left ventricular ejection fraction (LVEF) and 24 hr electrocardiogram (ECGs) to assess ventricular arrhythmias. All eight deaths in their 81 patients occurred in the group with high-grade ventricular arrhythmias and LVEF below 40% [6,7]. In a multicenter postmyocardial infarction study, 766 patients with acute myocardial infarction had their LVEFs measured by radionuclide methods and a 24 hr ECG analyzed by sensitive and specific methods. Out of these 766 patients, 86 deaths occurred during the 3 year follow-up period. When the variables were analyzed separately, there were strong associations between death and LVEF, frequency of VPCs, or repetitiveness of VPCs [8]. In the GISSI trial, Twenty-four-hour Holter recordings obtained before discharge from the hospital in 8,676 post-myocardial infarction patients were analyzed for the presence of ventricular arrhythmias. The presence of more than 10 PVBs per hour or of complex ventricular arrhythmias was significantly associated with a higher mortality risk regardless of the presence of LV dysfunction (Fig. 2) [9]. In December 1990, investigators initiated prophylactic Multicenter Automatic Defibrillator Implantation Trial (MADIT) in which high-risk patients with coronary heart disease and asymptomatic unsustained ventricular tachycardia (a run of 3 to 30 ventricular ectopic beats at a rate>120 beats per minute) were randomly assigned to receive an implantable cardioverter defibrillator (ICD) or conventional medical therapy. The prophylactic therapy with an implanted defibrillator led to improved survival as compared with conventional medical therapy [10]. The Multicenter Unsustained Tachycardia Trial was initiated in 1989 to test the hypothesis that antiarrhythmic therapy guided by electrophysiologic testing can reduce the risks of sudden death and cardiac arrest among patients with coronary artery disease, LV dysfunction, and spontaneous NSVT. The results of this study established that high risk patients with asymptomatic, NSVT, and inducible sustained ventricular tachyarrhythmia have substantial mortality due to arrhythmia. The rate of death among patients with inducible sustained tachyarrhythmia was reduced by the use of defibrillators [11]. ICD therapy is indicated in patients with NSVT due to prior myocardial infarction, LVEF less than or equal to 40%, and inducible ventricular fibrillation or sustained VT at electrophysiological study [12].


Current Concepts of Premature Ventricular Contractions.

Ahn MS - J Lifestyle Med (2013)

6-month survival of patients by premature ventricular contractions (PVCs) per hour. Adapted from Maggioni et al [9].
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4390755&req=5

f2-jlm-03-26: 6-month survival of patients by premature ventricular contractions (PVCs) per hour. Adapted from Maggioni et al [9].
Mentions: In 1975, Schulze et al. reported results from the first post-infarction studies of left ventricular (LV) dysfunction, ventricular arrhythmias, and death that used radionuclide methods to measure left ventricular ejection fraction (LVEF) and 24 hr electrocardiogram (ECGs) to assess ventricular arrhythmias. All eight deaths in their 81 patients occurred in the group with high-grade ventricular arrhythmias and LVEF below 40% [6,7]. In a multicenter postmyocardial infarction study, 766 patients with acute myocardial infarction had their LVEFs measured by radionuclide methods and a 24 hr ECG analyzed by sensitive and specific methods. Out of these 766 patients, 86 deaths occurred during the 3 year follow-up period. When the variables were analyzed separately, there were strong associations between death and LVEF, frequency of VPCs, or repetitiveness of VPCs [8]. In the GISSI trial, Twenty-four-hour Holter recordings obtained before discharge from the hospital in 8,676 post-myocardial infarction patients were analyzed for the presence of ventricular arrhythmias. The presence of more than 10 PVBs per hour or of complex ventricular arrhythmias was significantly associated with a higher mortality risk regardless of the presence of LV dysfunction (Fig. 2) [9]. In December 1990, investigators initiated prophylactic Multicenter Automatic Defibrillator Implantation Trial (MADIT) in which high-risk patients with coronary heart disease and asymptomatic unsustained ventricular tachycardia (a run of 3 to 30 ventricular ectopic beats at a rate>120 beats per minute) were randomly assigned to receive an implantable cardioverter defibrillator (ICD) or conventional medical therapy. The prophylactic therapy with an implanted defibrillator led to improved survival as compared with conventional medical therapy [10]. The Multicenter Unsustained Tachycardia Trial was initiated in 1989 to test the hypothesis that antiarrhythmic therapy guided by electrophysiologic testing can reduce the risks of sudden death and cardiac arrest among patients with coronary artery disease, LV dysfunction, and spontaneous NSVT. The results of this study established that high risk patients with asymptomatic, NSVT, and inducible sustained ventricular tachyarrhythmia have substantial mortality due to arrhythmia. The rate of death among patients with inducible sustained tachyarrhythmia was reduced by the use of defibrillators [11]. ICD therapy is indicated in patients with NSVT due to prior myocardial infarction, LVEF less than or equal to 40%, and inducible ventricular fibrillation or sustained VT at electrophysiological study [12].

Bottom Line: Especially in ischemic heart disease, the frequency and complexity of PVCs is associated with mortality.In congestive heart failure, PVCs did not provide significant incremental prognostic information beyond readily available clinical variables.Recently, the concept of PVC-induced cardiomyopathy was proposed when pharmacological suppression of PVCs in patients with presumed idiopathic dilated cardiomyopathy subsequently showed improved left ventricular systolic dysfunction.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.

ABSTRACT
Premature ventricular contractions (PVCs) are early depolarizations of the myocardium originating in the ventricle. PVCs are common with an estimated prevalence of 40% to 75% in the general population on 24- to 48-hour Holter monitoring. Traditionally, they have been thought to be relatively benign in the absence of structural heart disease but they represent increased risk of sudden death in structural heart disease. Especially in ischemic heart disease, the frequency and complexity of PVCs is associated with mortality. Implantable cardioverter defibrillator therapy is indicated in patients with nonsustained ventricular tachycardia (NSVT) due to prior myocardial infarction, left ventricular ejection fraction less than or equal to 40%, and inducible ventricular fibrillation or sustained ventricular tachycardia at electrophysiological study. In congestive heart failure, PVCs did not provide significant incremental prognostic information beyond readily available clinical variables. Consequently, NSVT should not guide therapeutic interventions. Recently, the concept of PVC-induced cardiomyopathy was proposed when pharmacological suppression of PVCs in patients with presumed idiopathic dilated cardiomyopathy subsequently showed improved left ventricular systolic dysfunction. For the treatment PVCs, it is important to consider underlying heart disease, the frequency of the PVCs and the frequency and severity of symptoms.

No MeSH data available.


Related in: MedlinePlus