Premature ventricular complexes: therapeutic dilemmas and decisions.
Adult subjects with high-grade VEA have an increased risk of sudden death. In all likelihood, the risk reflects a predisposition to VF with concomitant but possibly independently caused VEA. Among patients sustaining acute myocardial infarction, the severity of VEA late after infarction appears to depend primarily on the extent of underlying coronary artery disease and the extent of tissue damage sustained, as does the likelihood of sudden death. It is not yet clear whether suppression of one manifestation of severe coronary artery disease, namely VEA, confers protection against more serious manifestations - particularly sudden death. Although increased mortality among patients with and without overt coronary artery disease is associated with high-grade VEA and although the absolute frequency of PVCs is strongly correlated with severity defined with conventional classification schemes, frequent, unifocal PVCs in the absence of high-grade VEA appear to carry only a small associated risk of sudden death [56]. Furthermore, even though early PVCs may be particularly hazardous soon after the onset of acute myocardial infarction, they do not appear to be malignant during the hospital phase or among ambulatory patients with or without coronary artery disease. The temptation to suppress even low-grade VEA is strong because even a single PVC can initiate VF in the ischemic heart, and it is of course possible that suppression could prevent a single PVC from occurring after the onset of ischemia and initiating VF. However, suppression of PVCs, even if successful in an ambulatory patient, will not necessarily suppress VEA initiated by a new bout of ischemia. Accordingly, based on currently available information, low-grade VEA does not require treatment in our view in ambulatory patients without specific indications.
D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D005117:Cardiac Complexes, Premature / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D003327:Coronary Disease / Q000150:complications; D003645:Death, Sudden / Q000209:etiology; D004562:Electrocardiography; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications; D011379:Prognosis; D014693:Ventricular Fibrillation / Q000175:diagnosis
D000889:Anti-Arrhythmia Agents