eMedicine Specialties > Cardiology > Arrhythmias

Ventricular Premature Complexes: Follow-up

Author: Jatin Dave, MD, MPH, Instructor, Department of Medicine, Department of Internal Medicine, Division of Aging, Harvard Medical School; Staff Physician, Brigham and Women's Hospital
Coauthor(s): Revat Lakhia, MD, Visiting Staff, Department of Internal Medicine, Brigham and Women's Hospital; Graduate Student in Public Health, Department of Health Science, West Chester University of Pennsylvania; Shivkumar H Jha, MD, Chief Resident, Department of Psychiatry, St Elizabeth's Medical Center, Tufts University School of Medicine; Fellow, Brain Imaging Center, McLean Hospital, Harvard Medical School
Contributor Information and Disclosures

Updated: Aug 24, 2009

Follow-up

Further Inpatient Care

Further care depends on the underlying condition and the treatment selected.

Deterrence/Prevention

For symptomatic VPCs, patients should avoid aggravating factors (eg, stress, caffeine-containing products).

Patient Education

For symptomatic VPCs, patient education and reassurance are necessary.

Miscellaneous

Medicolegal Pitfalls

Deciding when to treat VPCs is difficult because not all patients with VPCs are at risk of sudden death and treatment is associated with risk.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author John Michael Gaziano, MD, MPH to the development and writing of this article.



More on Ventricular Premature Complexes

Overview: Ventricular Premature Complexes
Differential Diagnoses & Workup: Ventricular Premature Complexes
Treatment & Medication: Ventricular Premature Complexes
Follow-up: Ventricular Premature Complexes
Multimedia: Ventricular Premature Complexes
References
[ CLOSE WINDOW ]

References

  1. Jouven X, Zureik M, Desnos M, Courbon D, Ducimetière P. Long-term outcome in asymptomatic men with exercise-induced premature ventricular depolarizations. N Engl J Med. Sep 21 2000;343(12):826-33. [Medline].

  2. [Guideline] Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, et al. [Guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Executive summary]. Rev Esp Cardiol. Dec 2006;59(12):1328. [Medline].

  3. Alpert MA, Mukerji V, Bikkina M, et al. Pathogenesis, recognition, and management of common cardiac arrhythmias. Part I: Ventricular premature beats and tachyarrhythmias. South Med J. Jan 1995;88(1):1-21. [Medline].

  4. Andersson S, Osterlind PO, Holmboe G, Windblad B. Twenty-four-hour electrocardiography in a healthy elderly population. Gerontology. 1988;34(3):139-44. [Medline].

  5. Bikkina M, Larson MG, Levy D. Prognostic implications of asymptomatic ventricular arrhythmias: the Framingham Heart Study. Ann Intern Med. Dec 15 1992;117(12):990-6. [Medline].

  6. Bourke JP, Richards DA, Ross DL, et al. Routine programmed electrical stimulation in survivors of acute myocardial infarction for prediction of spontaneous ventricular tachyarrhythmias during follow-up: results, optimal stimulation protocol and cost-effective screening. J Am Coll Cardiol. Sep 1991;18(3):780-8. [Medline].

  7. Brodsky M, Wu D, Denes P, et al. Arrhythmias documented by 24 hour continuous electrocardiographic monitoring in 50 male medical students without apparent heart disease. Am J Cardiol. Mar 1977;39(3):390-5. [Medline].

  8. Burkart F, Pfisterer M, Kiowski W, et al. Effect of antiarrhythmic therapy on mortality in survivors of myocardial infarction with asymptomatic complex ventricular arrhythmias: Basel Antiarrhythmic Study of Infarct Survival (BASIS). J Am Coll Cardiol. Dec 1990;16(7):1711-8. [Medline].

  9. Buxton AE, Lee KL, DiCarlo L, et al. Electrophysiologic testing to identify patients with coronary artery disease who are at risk for sudden death. Multicenter Unsustained Tachycardia Trial Investigators. N Engl J Med. Jun 29 2000;342(26):1937-45. [Medline].

  10. Buxton AE, Marchlinski FE, Flores BT, et al. Nonsustained ventricular tachycardia in patients with coronary artery disease: role of electrophysiologic study. Circulation. Jun 1987;75(6):1178-85. [Medline].

  11. Cairns JA, Connolly SJ, Roberts R, Gent M. Randomised trial of outcome after myocardial infarction in patients with frequent or repetitive ventricular premature depolarisations: CAMIAT. Canadian Amiodarone Myocardial Infarction Arrhythmia Trial Investigators. Lancet. Mar 8 1997;349(9053):675-82. [Medline].

  12. Dickinson DF, Scott O. Ambulatory electrocardiographic monitoring in 100 healthy teenage boys. Br Heart J. Feb 1984;51(2):179-83. [Medline].

  13. DiMarco JP, Philbrick JT. Use of ambulatory electrocardiographic (Holter) monitoring. Ann Intern Med. Jul 1 1990;113(1):53-68. [Medline].

  14. Epstein AE, Hallstrom AP, Rogers WJ, et al. Mortality following ventricular arrhythmia suppression by encainide, flecainide, and moricizine after myocardial infarction. The original design concept of the Cardiac Arrhythmia Suppression Trial (CAST). JAMA. Nov 24 1993;270(20):2451-5. [Medline].

  15. Farrell TG, Bashir Y, Cripps T, et al. Risk stratification for arrhythmic events in postinfarction patients based on heart rate variability, ambulatory electrocardiographic variables and the signal-averaged electrocardiogram. J Am Coll Cardiol. Sep 1991;18(3):687-97. [Medline].

  16. Frolkis JP, Pothier CE, Blackstone EH. Frequent Ventricular Ectopy after Exercise as a Predictor of Death. The New England Journal of Medicine. 2003;348:781-790. [Full Text].

  17. Furukawa T, Rozanski JJ, Moroe K, et al. Predictors of sustained ventricular tachycardia inducibility in patients with nonsustained ventricular tachycardia and chronic coronary artery disease. Am Heart J. May 1989;117(5):1050-9. [Medline].

  18. Gomes JA, Winters SL, Martinson M, et al. The prognostic significance of quantitative signal-averaged variables relative to clinical variables, site of myocardial infarction, ejection fraction and ventricular premature beats: a prospective study. J Am Coll Cardiol. Feb 1989;13(2):377-84. [Medline].

  19. Hallstrom AP, Bigger JT Jr, Roden D, et al. Prognostic significance of ventricular premature depolarizations measured 1 year after myocardial infarction in patients with early postinfarction asymptomatic ventricular arrhythmia. J Am Coll Cardiol. Aug 1992;20(2):259-64. [Medline].

  20. Holmes J, Kubo SH, Cody RJ, Kligfield P. Arrhythmias in ischemic and nonischemic dilated cardiomyopathy: prediction of mortality by ambulatory electrocardiography. Am J Cardiol. Jan 1 1985;55(1):146-51. [Medline].

  21. Kennedy HL, Whitlock JA, Sprague MK, et al. Long-term follow-up of asymptomatic healthy subjects with frequent and complex ventricular ectopy. N Engl J Med. Jan 24 1985;312(4):193-7. [Medline].

  22. Klein RC, Machell C. Use of electrophysiologic testing in patients with nonsustained ventricular tachycardia: prognostic and therapeutic implications. J Am Coll Cardiol. Jul 1989;14(1):155-61; discussion 162-3. [Medline].

  23. Kowey PR, Waxman HL, Greenspon A, et al. Value of electrophysiologic testing in patients with previous myocardial infarction and nonsustained ventricular tachycardia. Philadelphia Arrhythmia Group. Am J Cardiol. Mar 1 1990;65(9):594-8. [Medline].

  24. Kuchar DL, Thorburn CW, Sammel NL. Prediction of serious arrhythmic events after myocardial infarction: signal-averaged electrocardiogram, Holter monitoring and radionuclide ventriculography. J Am Coll Cardiol. Mar 1987;9(3):531-8. [Medline].

  25. Lown B, Wolf M. Approaches to sudden death from coronary heart disease. Circulation. Jul 1971;44(1):130-42. [Medline].

  26. Maggioni AP, Zuanetti G, Franzosi MG, et al. Prevalence and prognostic significance of ventricular arrhythmias after acute myocardial infarction in the fibrinolytic era. GISSI-2 results. Circulation. Feb 1993;87(2):312-22. [Medline].

  27. Mason JW. A comparison of electrophysiologic testing with Holter monitoring to predict antiarrhythmic-drug efficacy for ventricular tachyarrhythmias. Electrophysiologic Study versus Electrocardiographic Monitoring Investigators. N Engl J Med. Aug 12 1993;329(7):445-51. [Medline].

  28. Pedretti R, Etro MD, Laporta A, et al. Prediction of late arrhythmic events after acute myocardial infarction from combined use of noninvasive prognostic variables and inducibility of sustained monomorphic ventricular tachycardia. Am J Cardiol. May 15 1993;71(13):1131-41. [Medline].

  29. Pogwizd SM. Focal mechanisms underlying ventricular tachycardia during prolonged ischemic cardiomyopathy. Circulation. Sep 1994;90(3):1441-58. [Medline].

  30. Raungratanaamporn O, Bhuripanyo K, Krittayaphong R, et al. Radiofrequency catheter ablation for frequent premature ventricular contractions: a preliminary report of 15 cases. J Med Assoc Thai. Feb 1998;81(2):98-102. [Medline].

  31. Richards DA, Byth K, Ross DL, Uther JB. What is the best predictor of spontaneous ventricular tachycardia and sudden death after myocardial infarction?. Circulation. Mar 1991;83(3):756-63. [Medline].

  32. Ruberman W, Weinblatt E, Goldberg JD, et al. Ventricular premature complexes and sudden death after myocardial infarction. Circulation. Aug 1981;64(2):297-305. [Medline].

  33. Sobotka PA, Mayer JH, Bauernfeind RA, et al. Arrhythmias documented by 24-hour continuous ambulatory electrocardiographic monitoring in young women without apparent heart disease. Am Heart J. Jun 1981;101(6):753-9. [Medline].

  34. Teo KK, Yusuf S, Furberg CD. Effects of prophylactic antiarrhythmic drug therapy in acute myocardial infarction. An overview of results from randomized controlled trials. JAMA. Oct 6 1993;270(13):1589-95. [Medline].

  35. The Cardiac Arrhythmia Suppression Trial II Investigators. Effect of the antiarrhythmic agent moricizine on survival after myocardial infarction. The Cardiac Arrhythmia Suppression Trial II Investigators. N Engl J Med. Jul 23 1992;327(4):227-33. [Medline].

  36. Wilber DJ, Olshansky B, Moran JF, Scanlon PJ. Electrophysiological testing and nonsustained ventricular tachycardia. Use and limitations in patients with coronary artery disease and impaired ventricular function. Circulation. Aug 1990;82(2):350-8. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

ventricular premature complexes, ventricular extrasystole, ventricular ectopic beats, benign ventricular arrhythmia, missed beats, VPC, PVC, premature ventricular complex, VPD, ventricular premature depolarization, VPB, ventricular premature beat, ventricular arrhythmia, beta-blockers, myocardial infarction, MI, postmyocardial infarction, post-MI, congestive heart failure, CHF, coronary artery disease, CAD, ventricular ectopy, ventricular tachycardia, VT

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Jatin Dave, MD, MPH, Instructor, Department of Medicine, Department of Internal Medicine, Division of Aging, Harvard Medical School; Staff Physician, Brigham and Women's Hospital
Disclosure: Nothing to disclose.

Coauthor(s)

Revat Lakhia, MD, Visiting Staff, Department of Internal Medicine, Brigham and Women's Hospital; Graduate Student in Public Health, Department of Health Science, West Chester University of Pennsylvania
Revat Lakhia, MD is a member of the following medical societies: Medical Council of India
Disclosure: Nothing to disclose.

Shivkumar H Jha, MD, Chief Resident, Department of Psychiatry, St Elizabeth's Medical Center, Tufts University School of Medicine; Fellow, Brain Imaging Center, McLean Hospital, Harvard Medical School
Shivkumar H Jha, MD is a member of the following medical societies: American Psychiatric Association, International Society for Heart Research, and Society for Neuroscience
Disclosure: Nothing to disclose.

Medical Editor

Robert E Fowles, MD, Clinical Professor of Medicine, University of Utah College of Medicine; Consulting Staff, Intermountain Medical Center and LDS Hospital; Director and Consulting Staff, Department of Cardiology, Salt Lake Clinic
Robert E Fowles, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, and American Heart Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Brian Olshansky, MD, Professor of Medicine, Department of Internal Medicine, University of Iowa College of Medicine
Brian Olshansky, MD is a member of the following medical societies: American Autonomic Society, American College of Cardiology, American College of Chest Physicians, American College of Physicians, American College of Sports Medicine, American Federation for Clinical Research, American Heart Association, Cardiac Electrophysiology Society, Heart Rhythm Society, and New York Academy of Sciences
Disclosure: Guidant/Boston Scientific Honoraria Speaking and teaching; Medtronic Honoraria Speaking and teaching; Guidant/Boston Scientific Consulting fee Consulting; Reliant Grant/research funds Other; Novartis Honoraria Speaking and teaching; Novartis Consulting fee Consulting

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

Michael E Zevitz, MD, Assistant Professor of Medicine, Finch University of the Health Sciences, The Chicago Medical School; Consulting Staff, Private Practice
Michael E Zevitz, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Medical Association, and Michigan State Medical Society
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.