Premature ventricular contraction medical therapy
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Premature ventricular contraction Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2] Mugilan Poongkunran M.B.B.S [3]
Overview
Isolated premature ventricular contractions with benign characteristics require no treatment. In healthy individuals, PVCs can often be resolved by restoring the balance of magnesium, calcium and potassium within the body.
Medical Therapy
- Pharmacological agents
- Antiarrhythmics: these agents alter the electrophysiologic mechanisms responsible for PVCs.
- Beta blocker : Propranolol, atenolol, metoprolol
- Calcium channel blockers
- Electrolytes replacement
- Magnesium supplements (e.g. magnesium citrate, orotate, Maalox, etc.)
- Potassium supplements
Therapies with limited data to support their use:
In the setting of existing cardiac disease, however, PVCs must be watched carefully, as they may cause a form of ventricular tachycardia (rapid heartbeat).
2017 AHA/ACC/HRS Guideline for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (DO NOT EDIT)[1]
Recommendation for Pharmacological Prevention of Sudden Cardiac Death (SCD)
| Class I |
| 1. In patients with HFrEF (LVEF ≤40%), treatment with a beta blocker, a mineralocorticoid receptor antagonist and either an angiotensin-converting enzyme inhibitor, an angiotensin-receptor blocker, or an angiotensin receptor-neprilysin inhibitor is recommended to reduce SCD and all-cause mortality (Level of Evidence: A).[2][3][4][5][6][7][8][9] |
Recommendations for Autonomic Modulation
| Class IIa |
| 1. In patients with symptomatic, non–lifethreatening VA, treatment with a beta blocker is reasonable (Level of Evidence: C-LD).[10] |
Recommendations for Patients With Coronary Artery Spasm
| Class I |
| 1. In patients with VA due to coronary artery spasm, treatment with maximally tolerated doses of a calcium channel blocker and
smoking cessation are indicated to reduce recurrent ischemia and VA (Level of Evidence: B-NR).[11][12] |
| Class IIa |
| 1. In patients resuscitated from SCA due to coronary artery spasm in whom medical therapy is ineffective or not tolerated, an ICD is reasonable if meaningful survival of greater than 1 year is expected. (Level of Evidence: B-NR).'[13]
' |
| Class IIb |
| 1. In patients resuscitated from SCA due to coronary artery spasm, an ICD in addition to medical therapy may be reasonable if
meaningful survival of greater than 1 year is expected. (Level of Evidence: B-NR).[13] |
References
- ↑ Al-Khatib, Sana M.; Stevenson, William G.; Ackerman, Michael J.; Bryant, William J.; Callans, David J.; Curtis, Anne B.; Deal, Barbara J.; Dickfeld, Timm; Field, Michael E.; Fonarow, Gregg C.; Gillis, Anne M.; Granger, Christopher B.; Hammill, Stephen C.; Hlatky, Mark A.; Joglar, José A.; Kay, G. Neal; Matlock, Daniel D.; Myerburg, Robert J.; Page, Richard L. (2018). "2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death". Circulation. 138 (13). doi:10.1161/CIR.0000000000000549. ISSN 0009-7322.
- ↑ Yancy, Clyde W.; Jessup, Mariell; Bozkurt, Biykem; Butler, Javed; Casey, Donald E.; Colvin, Monica M.; Drazner, Mark H.; Filippatos, Gerasimos; Fonarow, Gregg C.; Givertz, Michael M.; Hollenberg, Steven M.; Lindenfeld, JoAnn; Masoudi, Frederick A.; McBride, Patrick E.; Peterson, Pamela N.; Stevenson, Lynne Warner; Westlake, Cheryl (2016). "2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America". Circulation. 134 (13). doi:10.1161/CIR.0000000000000435. ISSN 0009-7322.
- ↑ "The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial". Lancet (London, England). 353 (9146): 9–13. 1999. PMID 10023943. Unknown parameter
|month=ignored (help) - ↑ Cohn, Jay N.; Johnson, Gary; Ziesche, Susan; Cobb, Frederick; Francis, Gary; Tristani, Felix; Smith, Raphael; Dunkman, W. Bruce; Loeb, Henry; Wong, Maylene; Bhat, Geetha; Goldman, Steven; Fletcher, Ross D.; Doherty, James; Hughes, C. Vincent; Carson, Peter; Cintron, Guillermo; Shabetai, Ralph; Haakenson, Clair (1991). "A Comparison of Enalapril with Hydralazine–Isosorbide Dinitrate in the Treatment of Chronic Congestive Heart Failure". New England Journal of Medicine. 325 (5): 303–310. doi:10.1056/NEJM199108013250502. ISSN 0028-4793.
- ↑ Packer, Milton; Bristow, Michael R.; Cohn, Jay N.; Colucci, Wilson S.; Fowler, Michael B.; Gilbert, Edward M.; Shusterman, Neil H. (1996). "The Effect of Carvedilol on Morbidity and Mortality in Patients with Chronic Heart Failure". New England Journal of Medicine. 334 (21): 1349–1355. doi:10.1056/NEJM199605233342101. ISSN 0028-4793.
- ↑ "Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial". The Lancet. 357 (9266): 1385–1390. 2001. doi:10.1016/S0140-6736(00)04560-8. ISSN 0140-6736.
- ↑ Pitt, Bertram; Remme, Willem; Zannad, Faiez; Neaton, James; Martinez, Felipe; Roniker, Barbara; Bittman, Richard; Hurley, Steve; Kleiman, Jay; Gatlin, Marjorie (2003). "Eplerenone, a Selective Aldosterone Blocker, in Patients with Left Ventricular Dysfunction after Myocardial Infarction". New England Journal of Medicine. 348 (14): 1309–1321. doi:10.1056/NEJMoa030207. ISSN 0028-4793.
- ↑ Al Chekakie, M. Obadah (2013). "Traditional Heart Failure Medications and Sudden Cardiac Death Prevention". Journal of Cardiovascular Pharmacology and Therapeutics. 18 (5): 412–426. doi:10.1177/1074248413491496. ISSN 1074-2484.
- ↑ Pfeffer, Marc A.; McMurray, John J.V.; Velazquez, Eric J.; Rouleau, Jean-Lucien; Køber, Lars; Maggioni, Aldo P.; Solomon, Scott D.; Swedberg, Karl; Van de Werf, Frans; White, Harvey; Leimberger, Jeffrey D.; Henis, Marc; Edwards, Susan; Zelenkofske, Steven; Sellers, Mary Ann; Califf, Robert M. (2003). "Valsartan, Captopril, or Both in Myocardial Infarction Complicated by Heart Failure, Left Ventricular Dysfunction, or Both". New England Journal of Medicine. 349 (20): 1893–1906. doi:10.1056/NEJMoa032292. ISSN 0028-4793.
- ↑ Krittayaphong, Rungroj; Bhuripanyo, Kiertijai; Punlee, Kesaree; Kangkagate, Charuwan; Chaithiraphan, Suphachai (2002). "Effect of atenolol on symptomatic ventricular arrhythmia without structural heart disease: A randomized placebo-controlled study". American Heart Journal. 144 (6): 1–5. doi:10.1067/mhj.2002.125516. ISSN 0002-8703.
- ↑ Myerburg, Robert J.; Kessler, Kenneth M.; Mallon, Stephen M.; Cox, Marilyn M.; deMarchena, Eduardo; Interian, Alberto; Castellanos, Agustin (1992). "Life-Threatening Ventricular Arrhythmias in Patients with Silent Myocardial Ischemia Due to Coronary Artery Spasm". New England Journal of Medicine. 326 (22): 1451–1455. doi:10.1056/NEJM199205283262202. ISSN 0028-4793.
- ↑ Chevalier, Philippe; Dacosta, Antoine; Defaye, Pascal; Chalvidan, Thierry; Bonnefoy, Eric; Kirkorian, Gilbert; Isaaz, Karl; Denis, Bernard; Touboul, Paul (1998). "Arrhythmic Cardiac Arrest Due to Isolated Coronary Artery Spasm: Long-Term Outcome of Seven Resuscitated Patients". Journal of the American College of Cardiology. 31 (1): 57–61. doi:10.1016/S0735-1097(97)00442-7. ISSN 0735-1097.
- ↑ 13.0 13.1 Takagi, Yusuke; Yasuda, Satoshi; Tsunoda, Ryusuke; Ogata, Yasuhiro; Seki, Atsushi; Sumiyoshi, Tetsuya; Matsui, Motoyuki; Goto, Toshikazu; Tanabe, Yasuhiko; Sueda, Shozo; Sato, Toshiaki; Ogawa, Satoshi; Kubo, Norifumi; Momomura, Shin-ichi; Ogawa, Hisao; Shimokawa, Hiroaki (2011). "Clinical Characteristics and Long-Term Prognosis of Vasospastic Angina Patients Who Survived Out-of-Hospital Cardiac Arrest". Circulation: Arrhythmia and Electrophysiology. 4 (3): 295–302. doi:10.1161/CIRCEP.110.959809. ISSN 1941-3149.