Identifying and Managing Premature Ventricular Contractions

Diagnostic Criteria

A premature ventricular contraction (PVC) is characterized by a premature abnormal QRS complex with a different morphology compared to the patient's normal sinus QRS, and an absence of a preceding premature P wave, according to the European Heart Journal 1, 2, 3
The QRS duration may be normal or prolonged in PVCs, but the key diagnostic feature is the difference in morphology from the normal sinus QRS, as stated by the European Heart Journal 1, 2, 3

The American College of Cardiology recommends that single or infrequent PVCs in structurally normal hearts are generally benign, but multiple PVCs (≥2 on a single 12-lead ECG) should prompt further evaluation, including ambulatory Holter monitoring, echocardiogram, and exercise stress testing 4, 5, 6
Frequent PVCs (>30 per hour or >1% of beats on 12-lead ECG) are associated with increased cardiovascular risk and mortality in the general population, according to the Journal of the American College of Cardiology 4
A very high burden of PVCs (≥2,000 PVCs per 24 hours) carries up to 30% risk of underlying structural heart disease and warrants comprehensive evaluation, including cardiac MRI, as recommended by the American College of Cardiology 5, 6

The European Heart Journal warns against confusing PVCs with premature atrial beats conducted with aberrancy, and recommends identifying whether a premature P wave precedes the abnormal QRS complex to differentiate between the two 1, 2