Abstract
While there are published studies that have examined premature ventricular complexes (PVCs) among patients with and without cardiac disease, there has not been a comprehensive review of the literature examining the diagnostic and prognostic significance of PVCs. This could help guide both community and hospital-based research and clinical practice. Scoping review frameworks by Arksey and O'Malley and the Joanna Briggs Institute (JBI) were used. A systematic search of the literature using four databases (CINAHL, Embase, PubMed, and Web of Science) was conducted. The review was prepared adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Review (PRISMA-ScR). A total of 71 relevant articles were identified, 66 (93%) were observational, and five (7%) were secondary analyses from randomized clinical trials. Three studies (4%) examined the diagnostic importance of PVC origin (left/right ventricle) and QRS morphology in the diagnosis of acute myocardial ischemia (MI). The majority of the studies examined prognostic outcomes including left ventricular dysfunction, heart failure, arrhythmias, ischemic heart diseases, and mortality by PVCs frequency, burden, and QRS morphology. Very few studies have evaluated the diagnostic significance of PVCs and all are decades old. No hospital setting only studies were identified. Community-based longitudinal studies, which make up most of the literature, show that PVCs are associated with structural and coronary heart disease, lethal arrhythmias, atrial fibrillation, stroke, all-cause and cardiac mortality. However, a causal association between PVCs and these outcomes cannot be established due to the purely observational study designs employed.
Highlights
Premature ventricular complexes (PVCs) are early depolarizations of myocardial cells that originate in the ventricle and are caused primarily by impulse formation disorder [1,2,3] or reentry mechanisms of myocardial tissues [1, 4,5,6]
Very few studies have evaluated the diagnostic significance of premature ventricular complexes (PVCs) and all are decades old
PVCs are more prevalent in individuals with structural heart disease (SHD), suggesting they may be a marker of cardiac pathology in some subjects [13]
Summary
Premature ventricular complexes (PVCs) are early depolarizations of myocardial cells that originate in the ventricle (right or left) and are caused primarily by impulse formation disorder (enhanced automaticity or triggered activity) [1,2,3] or reentry mechanisms of myocardial tissues [1, 4,5,6]. Preliminary data from the CAST study showed that pharmacologic suppression of PVCs using encainide or flecainide (class IC antiarrhythmics) was associated with increased mortality when compared with placebo [15]. This finding from the interim analysis led to early termination of the study and a shift away from routine aggressive treatment of PVCs in clinical practice. The Practice Standards for ECG monitoring in hospital settings state that the benefit of continuous PVC monitoring is less well-established (class: IIb), and there is a paucity of literature regarding the potential relevance of PVCs among hospitalized patients (level of evidence: C) [17].
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