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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

Relationship between the premature ventricular contraction prevalence and change in left ventricular ejection fraction (ΔLVEF) and left ventricular diastolic dimension (ΔLVEDd). Adapted from Niwano et al [29].
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f4-jlm-03-26: Relationship between the premature ventricular contraction prevalence and change in left ventricular ejection fraction (ΔLVEF) and left ventricular diastolic dimension (ΔLVEDd). Adapted from Niwano et al [29].

Mentions: Traditionally, PVCs have been thought to be relatively benign in the absence of structural heart disease [2,5]. Over the last decade, however, PVC-induced CMP has been a subject of great interest and the evidence for this entity is rapidly emerging. The concept of PVC-induced CMP was proposed by Duffee et al. in 1998 when pharmacological suppression of PVCs in patients with presumed idiopathic dilated CMP subsequently improved LV systolic dysfunction [27]. The exact prevalence of PVC-induced CMP is not known; it is an underappreciated cause of LV dysfunction, and it is primarily observed in older patients [28]. Niwano et al. demonstrated progressive worsening of LV function in patients with frequent PVCs (>1,000 beats/day) as measured by the LVEF and LV end-diastolic dimension over a follow-up period of 4 to 8 years (Fig. 4) [29]. Yarlagadda et al. reported the results of repetitive monomorphic ventricular ectopy ablation in 27 patients. In that study, the ventricular function improved in 7 of 8 patients with depressed ventricular function [28].


Current Concepts of Premature Ventricular Contractions.

Ahn MS - J Lifestyle Med (2013)

Relationship between the premature ventricular contraction prevalence and change in left ventricular ejection fraction (ΔLVEF) and left ventricular diastolic dimension (ΔLVEDd). Adapted from Niwano et al [29].
© Copyright Policy
Related In: Results  -  Collection

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

f4-jlm-03-26: Relationship between the premature ventricular contraction prevalence and change in left ventricular ejection fraction (ΔLVEF) and left ventricular diastolic dimension (ΔLVEDd). Adapted from Niwano et al [29].
Mentions: Traditionally, PVCs have been thought to be relatively benign in the absence of structural heart disease [2,5]. Over the last decade, however, PVC-induced CMP has been a subject of great interest and the evidence for this entity is rapidly emerging. The concept of PVC-induced CMP was proposed by Duffee et al. in 1998 when pharmacological suppression of PVCs in patients with presumed idiopathic dilated CMP subsequently improved LV systolic dysfunction [27]. The exact prevalence of PVC-induced CMP is not known; it is an underappreciated cause of LV dysfunction, and it is primarily observed in older patients [28]. Niwano et al. demonstrated progressive worsening of LV function in patients with frequent PVCs (>1,000 beats/day) as measured by the LVEF and LV end-diastolic dimension over a follow-up period of 4 to 8 years (Fig. 4) [29]. Yarlagadda et al. reported the results of repetitive monomorphic ventricular ectopy ablation in 27 patients. In that study, the ventricular function improved in 7 of 8 patients with depressed ventricular function [28].

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