Management of Premature Ventricular Complexes in the Outpatient Setting

With an aging population and an explosion in ambulatory electrocardiographic monitoring, primary care clinicians will undoubtedly see an increase in patients presenting with premature ventricular complexes (PVCs), especially given how common they are in the general population. A sizable number of patients with PVCs are asymptomatic, and these PVCs have no significant clinical implications. In contrast, PVCs can predispose patients to or are a clinical marker of an underlying cardiomyopathy, heart failure, or sudden cardiac death. Such a dichotomy can create fear in dealing with PVCs in the outpatient setting, both in immediate situations and for surveillance and follow-up. In this review, we provide a comprehensive overview of the pathophysiologic basis of PVCs, appropriate diagnostic testing, management, and prognostic considerations necessary when faced with PVCs in the outpatient clinic. We also provide a simplistic approach to help guide the initial work-up of PVCs, basic treatment strategies, and indications of when to refer for cardiovascular specialty consultation to improve physician comfort and to enhance patient care. (c) 2023 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Automated summary

With the increase in ambulatory electrocardiographic monitoring and an aging population, primary care clinicians will see more patients with premature ventricular complexes (PVCs), which are common in the general population. While many patients with PVCs are asymptomatic and have no significant clinical implications, PVCs can also be a sign of underlying cardiomyopathy, heart failure, or sudden cardiac death. This review provides a comprehensive overview of the pathophysiology, diagnosis, management, and prognosis of PVCs in the outpatient setting, offering a simplified approach and guidance for initial work-up, treatment strategies, and referral indications for cardiovascular specialty consultation.