Ventricular Premature Complexes Treatment & Management
- Author: Jatin Dave, MD, MPH; Chief Editor: Jeffrey N Rottman, MD more...
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. The approach to VPCs depends on the frequency of VPCs, attributable symptoms, the presence or absence of underlying structural heart disease, and the estimated risk of sudden cardiac death.
Absence of significant structural heart disease (eg, normal ventricular function, no coronary or valvular heart disease)
Asymptomatic VPCs require no therapy.
For symptomatic VPCs, recommended treatment usually involves patient education and reassurance, avoidance of aggravating factors (eg, stress, caffeine-containing products), and anxiolytic drugs if education and avoidance of aggravating factors are ineffective. Beta-blockers and nondihydropyridine calcium channel blockers (eg, verapamil, diltiazem) can be used to treat symptomatic patients. Beta-blockers with intrinsic sympathomimetic activity may be particularly helpful.[18, 19] The use of antiarrhythmic therapy is not typically recommended and best targeted to address limiting symptoms. The risk of the drug (including the risk of arrhythmic death from proarrhythmia) must be weighed against the benefits of VPC suppression.
In patients who are symptomatic on beta-blockers and/or calcium channel blockers, consider cautious use of amiodarone. Because interest in VPC supression decreased when it was shown to be typically deleterious in patients with coronary artery disease, this literature is not current, and specifically the role of newer class III antiarrhythmic like dofetilide and azimilide for VPCs is unclear at present.
Presence of underlying heart disease (eg, VPCs in patients post-MI)
Management in these patients Various strategies, both invasive and noninvasive, predict prognosis in patients with VPCs post-MI.
The most powerful combination of noninvasive prognostic variables that identify patients in whom invasive strategies are suitable includes the presence of 2 or more of the following variables, (1) LV EF less than 0.40, (2) ventricular late potentials (on signal-averaged ECG), and (3) repetitive VPCs.
Treatment should include limiting transient ischemia.
Optimal treatment for congestive heart failure (CHF), CAD, or both should be instituted.
Maintain electrolyte balance.
Blood pressure control should be obtained because LV hypertrophy is associated with increased VPCs.
The 2006 ACC/AHA/ESC guideline recommends that ablation therapy should be considered in the following :
Patients with frequent, symptomatic, and monomorphic VPCs refractory to medical therapy
Patients who choose to avoid long-term medical therapy
Patients with ventricular arrhythmia storm that is consistently provoked by VPBs of a similar morphology
Recommendations depend on the underlying cardiac disease; avoidance of caffeine, nicotine, and alcohol may reduce the frequency of VPCs.
Patients deemed to be at high risk of sudden cardiac death may benefit from implantable cardioverter defibrillator (ICD) implantation.
Consultation with a cardiac electrophysiologist may be beneficial. As described above, select patients with symptomatic idiopathic VPCs may benefit from catheter ablation. EPS may help define risk for sudden death in some patients with structural heart disease. ICD implantation is beneficial in patients at high risk of sudden cardiac death, which is typically assessed by the presence of any associated cardiovascular disease, rather than the presence of VPCs per se.
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