By Richard N. Fogoros, MD 

 Medically reviewed by Anthony Pearson, MD

Premature ventricular complexes, or PVCs, are among the most common cardiac arrhythmia. In most people, they are benign and do not require specific treatment.

Sometimes, however, they can be a marker for serious underlying cardiac conditions. When they are very frequent, they can cause serious cardiac conditions.

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If you have PVCs, your treatment should depend on the answer to two questions:

First, do you have underlying heart disease?

And second, how severe are the symptoms produced by the PVCs?

PVCs themselves are rarely dangerous.¹ While statistically PVCs are associated with an increased risk of dying, that increased risk is mainly due to the presence of underlying heart disease and to risk factors for cardiac disease. The PVCs themselves, in general, are thought to be largely benign.

The First Treatment Goal: Reduce Cardiac Risk

Because PVCs are often associated with underlying heart disease, your healthcare provider should perform a cardiac evaluation when he or she first discovers them.¹

If it turns out that you have heart disease, adequate treatment of your cardiac condition will often eliminate or reduce the frequency of PVCs. This is especially true if you have coronary artery disease (CAD) or heart failure.

In some rare individuals, extremely frequent PVCs are now thought to be responsible for producing cardiomyopathy (weak heart muscle).

As a result, if unexplained cardiomyopathy is found in the presence of very frequent PVCs, it may be helpful to treat the PVCs to see if the cardiomyopathy improves.

If your healthcare provider finds your heart to be healthy, that's a very good thing. However, PVCs are also associated with several risk factors for CAD, especially hypertension. Non-CAD risk factors for PVCs also include hypomagnesemia (low magnesium) and hypokalemia (low potassium).

You and your healthcare provider should do a thorough assessment of all your cardiac risk factors and embark on an aggressive program to get them under control. In addition to reducing your risk for CAD, this effort may very well also reduce your PVCs.

The Second Treatment Goal: Reduce Symptoms

Fortunately, most people who have PVCs do not "feel" them at all. However, some perceive their PVCs as palpitations, which they usually describe as "skips" or "pounding" that can vary from mildly annoying to extremely disturbing.¹

If your PVCs are not causing symptoms, or if the palpitations you experience are not troublesome, the best thing to do is to leave them alone. However, if your PVCs are causing palpitations sufficient to disrupt your life, then you and your healthcare provider should discuss the options for treating PVCs.

Lifestyle Modifications

Some people note that high caffeine consumption levels increase the frequency or severity of palpitations related to their PVCs.² Therefore, it makes sense to try reducing your coffee and tea consumption to see if this improves symptoms. The same thing goes for tobacco products. Stopping smoking may also help reduce the frequency of PVCs.³

There's also evidence that regular exercise can reduce palpitations.² So if you have been relatively sedentary, talk to your healthcare provider about beginning an exercise program.

Stress and poor sleep are often factors contributing to symptoms of PVCs.⁴ Stress reduction techniques, including yoga and meditation, can help some patients.⁵ These may also improve sleep.

Medications

If you have made these kinds of lifestyle changes and are still troubled by the symptoms of PVCs, you and your healthcare provider may want to consider a trial of drug therapy.

If you opt for drug therapy, it is usually a good idea to start with a trial of beta blockers—drugs that blunt the effect of adrenaline.¹ Beta blockers are not as effective as "true" antiarrhythmic drugs at eliminating PVCs, but they are generally safe and usually well tolerated. While they may reduce the PVCs themselves, beta blockers work better at reducing the symptoms PVCs cause.

The more powerful antiarrhythmic drugs are often reasonably effective at suppressing PVCs. However, these drugs are prone to cause significant problems.⁶ Chief among them is a tendency to cause "proarrhythmia"—that is, actually triggering arrhythmias that may be far more dangerous than the PVCs. Proarrhythmia is particularly likely in people who have underlying heart disease, but it can happen to anyone. In addition, each antiarrhythmic drug has its own unique toxicity profile that renders this class of drugs among the most toxic used in medicine.

Finally, in patients whose PVCs are extremely disturbing and cannot be safely treated with lifestyle changes or drugs, it may be possible for an electrophysiologist to treat them with ablation therapy⁷ —electrically mapping the location that is producing the PVCs and cauterizing it with a special cardiac catheter.