Premature Ventricular Contractions (PVCs): A Narrative Review


      Premature ventricular complexes/contractions (PVCs) are relatively common, occurring in 3%-20% of the general population, and are often found during work-up of palpitations or incidentally on routine electrocardiographic testing. They are usually considered benign but can be a sign of underlying cardiac disease and cause significantly impairing symptoms. While often thought of as a problem for the cardiologist, it is not uncommon for PVCs to be identified initially in a primary care or inpatient general medicine setting. This paper will review etiologies, epidemiology, evaluation, and management of PVCs for the internist.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Zipes DP
        • Jalife J
        Cardiac Electrophysiology: From Cell to Bedside.
        W.B. Saunders, Philadelphia1990
      1. Longo D Fauci AS Kasper DL Hauser SL Jameson JL Loscalzo J Harrison's Principals of Internal Medicine. 18th ed. McGraw-Hill, New York2012
        • Tada H
        • Ito S
        • Naito S
        • et al.
        Idiopathic ventricular arrhythmia arising from the mitral annulus: a distinct subgroup of idiopathic ventricular arrhythmias.
        J Am Coll Cardiol. 2005; 45: 877-886
        • Burashnikov A
        • Antzelevitch C
        Late-phase 3 EAD. A unique mechanism contributing to initiation of atrial fibrillation.
        Pacing Clinical Electrophysiol. 2006; 29: 290-295
        • Simpson Jr, RJ
        • Cascio WE
        • Schreiner PJ
        • Crow RS
        • Rautaharju PM
        • Heiss G
        Prevalence of premature ventricular contractions in a population of African American and white men and women: the Atherosclerosis Risk in Communities (ARIC) study.
        Am Heart J. 2002; 143: 535-540
        • Sajadieh A
        • Nielsen OW
        • Rasmussen V
        • et al.
        Ventricular arrhythmias and risk of death and acute myocardial infarction in apparently healthy subjects of age >or= 55 years.
        Am J Cardiol. 2006; 97: 1351-1357
        • Bikkina M
        • Larson MG
        • Levy D
        Prognostic implications of asymptomatic ventricular arrhythmias: the Framingham Heart Study.
        Ann Intern Med. 1992; 117: 990-996
        • Hedblad B
        • Janzon L
        • Johansson BW
        • Juul-Möller S
        Survival and incidence of myocardial infarction in men with ambulatory ECG-detected frequent and complex ventricular arrhythmias. 10 year follow-up of the “Men born 1914” study in Malmö, Sweden.
        Eur Heart J. 1997; 18: 1787-1795
        • Almendral J
        • Villacastin JP
        • Arenal A
        • Tercedor L
        • Merino JL
        • Delcan JL
        Evidence favoring the hypothesis that ventricular arrhythmias have prognostic significance in left ventricular hypertrophy secondary to systemic hypertension.
        Am J Cardiol. 1995; 76: 60D-63D
        • Bayés-Genís A
        • Guindo J
        • Viñolas X
        • et al.
        Cardiac arrhythmias and left ventricular hypertrophy in systemic hypertension and their influences on prognosis.
        Am J Cardiol. 1995; 76: 54D-59D
        • Kafka H
        • Langevin L
        • Armstrong PW
        Serum magnesium and potassium in acute myocardial infarction: influence on ventricular arrhythmias.
        Arch Intern Med. 1987; 147: 465-469
        • Nordrehaug J.E.
        • Johannessen K.A.
        • von der Lippe G.
        Serum potassium concentration as a risk factor of ventricular arrhythmias early in acute myocardial infarction.
        Circulation. 1985; 71: 645-649
        • Shih HT
        • Webb CR
        • Conway WA
        • Peterson E
        • Tilley B
        • Goldstein S
        Frequency and significance of cardiac arrhythmias in chronic obstructive lung disease.
        Chest. 1988; 94: 44-48
        • Namtvedt SK
        • Randby A
        • Einvik G
        • et al.
        Cardiac arrhythmias in obstructive sleep apnea (from the Akershus Sleep Apnea Project).
        Am J Cardiol. 2011; 108: 1141-1146
        • Kennedy HL
        • Whitlock JA
        • Sprague MK
        • Kennedy LJ
        • Buckingham TA
        • Goldberg RJ
        Long-term follow-up of asymptomatic healthy subjects with frequent and complex ventricular ectopy.
        N Engl J Med. 1985; 312: 193-197
        • Osman F
        • Gammage MD
        • Sheppard MC
        • Franklyn JA
        Clinical review 142; cardiac dysrhythmias and thyroid dysfunction: the hidden menace?.
        J Clin Endocrinol Metab. 2002; 87: 963-967
        • Olshausen KV
        • Bischoff S
        • Kahaly G
        • et al.
        Cardiac arrhythmias and heart rate in hyperthyroidism.
        Am J Cardiol. 1989; 63: 930-933
        • Cha Y-M
        • Lee GK
        • Klarich KW
        • Grogan M
        Premature ventricular contraction-induced cardiomyopathy: a treatable condition.
        Circ Arrhythm Electrophysiol. 2012; 5: 229-236
        • Huizar JF
        • Kaszala K
        • Potfay J
        • et al.
        Left ventricular systolic dysfunction induced by ventricular ectopy: a novel model for premature ventricular contraction-induced cardiomyopathy.
        Circ Arrhythm Electrophysiol. 2011; 4: 543-549
        • Al-Khatib SM
        • Stevenson WG
        • Ackerman MJ
        • et al.
        2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
        J Am Coll Cardiol. 2018; 72: e91-e220
        • Baman TS
        • Lange DC
        • Ilg KG
        • et al.
        Relationship between burden of premature ventricular contractions and left ventricular function.
        Heart Rhythm. 2010; 7: 865-869
        • Yokokawa M
        • Kim HM
        • Good E
        • et al.
        Impact of QRS duration of frequent premature ventricular complexes on the development of cardiomyopathy.
        Heart Rhythm. 2012; 9: 1460-1464
        • Zipes DP
        • Camm AJ
        • Borggrefe M
        • et al.
        ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.
        Circulation. 2006; 114: e385-e484
        • Frolkis JP
        • Pothier CE
        • Blackstone EH
        • Lauer MS
        Frequent ventricular ectopy after exercise as a predictor of death.
        N Engl J Med. 2003; 348: 781-790
        • Papademetriou V
        • Narayan P
        • Kokkinos P
        Effects of diltiazem, metoprolol, enalapril and hydrochlorothiazide on frequency of ventricular premature complexes.
        Am J Cardiol. 1994; 73: 242-246
        • Singh SN
        • Fletcher RD
        • Fisher SG
        • et al.
        Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia. Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure.
        N Engl J Med. 1995; 333: 77-82
        • Deyell MW
        • Park KM
        • Han Y
        • et al.
        Predictors of recovery of left ventricular dysfunction after ablation of frequent ventricular premature depolarizations.
        Heart Rhythm. 2012; 9: 1465-1472
        • Lakkireddy D
        • Di Biase L
        • Ryschon K
        • et al.
        Radiofrequency ablation of premature ventricular ectopy improves the efficacy of cardiac resynchronization therapy in nonresponders.
        J Am Coll Cardiol. 2012; 60: 1531-1539
        • Lü F
        • Benditt DG
        • Yu J
        • Graf B
        Effects of catheter ablation of “asymptomatic” frequent ventricular premature complexes in patients with reduced (<48%) left ventricular ejection fraction.
        Am J Cardiol. 2012; 110: 852-856
        • Wijnmaalen AP
        • Delgado V
        • Schalij MJ
        • et al.
        Beneficial effects of catheter ablation on left ventricular and right ventricular function in patients with frequent premature ventricular contractions and preserved ejection fraction.
        Heart. 2010; 96: 1275-1280