What Are Premature Ventricular Complexes (PVCs)?

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A premature ventricular complex (PVC, or premature ventricular contraction) is an extra electrical impulse arising from one of the heart's ventricles. This extra impulse happens before the next normal heartbeat has a chance to occur.

Over the years, the chief concern about PVCs has been the idea that they may directly increase a person's risk for sudden death from cardiac arrest. More recent evidence indicates that PVCs may be indirectly associated with an increased risk of heart disease.

This overview helps sort out what that means for you and covers how these cardiac arrhythmias are evaluated and treated.

Impact of PVCs on Your Health

Among the many different types of cardiac arrhythmias, few have created as much consternation and confusion among both physicians and patients as this one.

In various doctors' offices, and at various points in history, PVCs have been regarded as either a harbinger of impending death or as completely benign phenomena that require no attention whatsoever.

The modern approach is somewhere in between these two extremes.

Research suggests that PVCs themselves may not increase the risk of sudden death very much (if at all) in a structurally normal heart. In addition, the association between PVCs and sudden death may be an indirect one.

People with frequent PVCs are more likely to have or develop significant heart disease. There is evidence that if PVCs are persistent and very frequent (more than 15% of all heartbeats), they can sometimes lead to PVC-induced cardiomyopathy.

However, while PVCs may be associated with increased cardiac risk, in most cases, they are probably not the cause of the increased risk.

The clinical significance of PVCs can vary from one person to the next. Even among people with symptomatic PVCs, their very presence is not inherently indicative or predictive of anything.

PVC Symptoms

Fortunately, many people with PVCs do not feel them at all.

Those who do experience PVC symptoms may notice one or more of the following:

  • Shortness of breath
  • Lightheadedness
  • Fatigue
  • Palpitations (an unusual awareness of the heartbeat)

These palpitations are often described as "skipped beats" or a "pounding heart." In some people, these symptoms can be difficult to tolerate.

Some may feel fine during the day, when they are active and distracted, and then suddenly begin to feel PVC symptoms when they retire for the night and external stimuli are removed.

Whether or not you perceive symptoms from your PVCs is related to many factors. Some people are just naturally more sensitive to any unusual events that occur in their body than others.

Causes

The causes of PVCs aren't always clear.

Certain triggers—like antihistamines, nicotine, anxiety, or exercise—can cause momentary palpitations. An injury to the heart can also make the cells of the ventricles electrically unstable.

While caffeine is often invoked as a cause of PVCs, studies have failed to show that PVCs are produced by caffeinated products.

Diagnosis

If you have PVCs, your doctor may want to perform a cardiac evaluation, looking for previously unknown heart disease and assessing your risk of developing heart disease in the future.

Premature Ventricular Complexes Diagnosis
Verywell / Cindy Chung

The heart diseases commonly associated with PVCs include coronary artery disease (CAD) and heart failure due to dilated cardiomyopathy. PVCs are also frequently seen with hypertrophic cardiomyopathy and heart valve disease.

In general, an echocardiogram is a good way to screen for most of these cardiac conditions, although your doctor may also want to perform a nuclear stress test or cardiac MRI to check more rigorously for CAD.

In addition, you and your doctor should go through a formal risk assessment including evaluating your diet, weight, smoking history, exercise habits, cholesterol and triglyceride levels, blood pressure, and blood glucose evaluation.

People with very frequent PVCs may need repeat monitoring.

PVCs are relatively common. In fact, around 50% of people with or without heart disease will have at least one PVC during a 24-hour Holter monitor study. Those who have more than three PVCs in a row are said to have non-sustained ventricular tachycardia (NSVT).

Treatment

Treating PVCs is not a straightforward matter, as their impact can vary from person to person.

The bulk of evidence today suggests that PVCs usually aren't inherently dangerous. In fact, studies have shown that suppressing PVCs with antiarrhythmic drugs may actually increase the risk of death in certain patients, indicating that the drug is more dangerous than the PVC.

That doesn't mean that PVCs are to be ignored, especially if the PVCs are interfering with the normal function of the heart, or are causing significant symptoms. In such cases, a beta blocker or calcium channel blocker may be effective in reducing symptoms adequately. 

If beta blockers and calcium channel blockers are ineffective, antiarrhythmic drugs, especially Tambocor (flecainide), Rhythmol SR (propafenone), or Pacerone (amiodarone), can be quite effective in getting rid of PVCs.

However, Tambocor and Rhythmol SR should be avoided in anyone with underlying heart disease, as they increase mortality in these people. Pacerone is uniquely prone to cause disturbing or dangerous side effects and should be used very reluctantly for any non-life-threatening arrhythmia. 

Radiofrequency ablation, a specialized form of cardiac catheterization, can be effective in eliminating or greatly reducing PVCs in people who are having severe symptoms from this arrhythmia. This procedure should be considered as an option in cases where getting rid of the PVCs is deemed to be important, and where the only other option would be using potentially dangerous antiarrhythmic drugs. 

Treatment Considerations

Treatment would generally be indicated if it achieves two foundational aims:

  • First and foremost, to reduce the risk of developing cardiovascular disease, including the risk of sudden death
  • Secondly, to reduce any symptoms of PVCs that may be interfering with a person's ability to function

These are two entirely different goals, and as doctors and patients make decisions about treating PVCs, each of these treatment goals needs to be addressed independently. 

A Word From Verywell

PVCs are very common, even among people who are perfectly healthy. Still, PVCs may cause symptoms, and they may indicate that some form of undiagnosed heart disease is present. So, finding PVCs should, at the very least, trigger a broader cardiac evaluation.

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