Premature Ventricular Contractions or PVC – What Are They and What to Do?

Premature Ventricular Contractions, or PVCs, are irregular heartbeats, also known as arrhythmias, in the ventricles – the lower two chambers of the heart. These phenomena are called “premature” because they occur earlier than the next normal heartbeat in the heart’s sinus rhythm. Because the heartbeat-initiating electrical signal comes from the ventricles rather than the sinoatrial (SA) node (the heart’s natural pacemaker), it can result in several symptoms and sensations.

What Sensations Can PVCs Cause?

• Fluttering
• Skipped heartbeat
• Strong or forceful heartbeat
• A pause followed by what feels like a strong heartbeat or thumping in the chest

Are PVCs Dangerous?

Occasional or paroxysmal PVCs are common and usually harmless (but still should be checked out); but frequent PVCs can be a problem requiring treatment, depending on overall heart health and the symptoms patients experience.

In individuals with a structurally normal heart and no significant symptoms, frequent PVCs are often benign. Many people experience PVCs as occasional “skipped beats” or fluttering in the chest, especially during periods of stress, fatigue, or after consuming a good deal of caffeine or alcohol. In such cases, PVCs are generally considered a normal variation of heart rhythm and may not pose an immediate danger. Even when PVCs occur frequently, defined as 10,000 or more per day, they may not require treatment if the heart’s structure and function are fine.

When Treatment is Necessary

There are instances when frequent PVCs may be dangerous or lead to complications. The primary concern arises when PVCs occur in patients with underlying heart disease. For example, individuals with cardiomyopathy, coronary artery disease, or a history of heart attack are at higher risk. In these patients, frequent PVCs can act as a trigger for more serious arrhythmias such as ventricular tachycardia (VT) or, in rare cases, sudden cardiac death (SCD).

Another potential complication is a condition called PVC-induced cardiomyopathy. In people with very frequent PVCs, subjectively, more than 10–15% of total daily heartbeats, the heart can become weakened over time and cause heart failure. This type of heart failure is unusual because it is often reversible.

The presence of bothersome symptoms is another critical factor. While some individuals with frequent PVCs are asymptomatic, others may experience palpitations, chest discomfort, lightheadedness, shortness of breath, and fainting. These symptoms may indicate a more serious underlying arrhythmia or heart condition.

Common Causes of PVCs

• Stress or anxiety
• Caffeine, alcohol, or tobacco use
• Electrolyte imbalances (e.g., potassium or magnesium)
• Medications, especially stimulants
• Heart disease, especially after a heart attack
• Sleep apnea
• Thyroid disorders

How We Diagnose PVCs:

Dr. Tordini may recommend diagnostic tests to determine the risk associated with frequent PVCs, including:

• Electrocardiogram (ECG or EKG) – While very useful, these single recordings may miss the PVC if a patient is not actively experiencing them.
• Holter monitors or event recorders can be worn for continuous heart rhythm monitoring. Holter monitors can be worn for a few days, while event recorders can last weeks or months.
• Echocardiogram to check heart function and structure.

Stress tests or cardiac MRI may sometimes be needed to see underlying diseases that might not be apparent on more routine imaging.

Treatment for PVCs

Lifestyle modifications
Regardless of the severity of the PVC’s, patients will be asked to reduce caffeine, stress, and weight, where indicated. Improved exercise can help prevent de Novo arrhythmias and reduce the risk and severity of future episodes.

Medications
Beta-blockers or antiarrhythmics are used in cases where lifestyle changes haven’t worked.

Procedural Solutions
Heart function can improve with appropriate treatment, such catheter ablation / pulsed-field ablation (a procedure that treats heart tissue causing the PVCs).

 

Dr. Tordini is a part of Florida Medical Clinic Orlando Health