Management of Premature Ventricular Contractions in Patients with Coronary Artery Disease
Initial Management
- Beta-blocker therapy should be initiated immediately for patients with CAD, ischemic cardiomyopathy, and frequent multifocal PVCs that are non-perfusing, as recommended by the American College of Cardiology and the European Society of Cardiology 1, 2
- Beta-blocker therapy is the first-line treatment for PVCs in patients with reduced LVEF and CAD, according to the American Heart Association 1, 2
Alternative Therapies
- Amiodarone can be effective for patients with frequent symptomatic PVCs and LV dysfunction, as suggested by the European Society of Cardiology 2
- Class Ic agents (flecainide, propafenone) are potentially harmful in patients with structural heart disease and should be avoided, as recommended by the American College of Cardiology and the European Society of Cardiology 2, 3
Device Therapy
- Evaluation for ICD implantation is warranted in patients with ischemic cardiomyopathy with reduced LVEF, as recommended by the American College of Cardiology and the European Society of Cardiology 1, 4
- If LVEF ≤35% despite optimal medical therapy for at least 3 months, ICD implantation is indicated, according to the American College of Cardiology and the European Society of Cardiology 1, 4
Long-term Management
- Optimize guideline-directed medical therapy for ischemic cardiomyopathy, including continuation of ACE inhibitor/ARB therapy, as recommended by the American College of Cardiology and the European Society of Cardiology 5, 6
- Maintain high-intensity statin therapy, as suggested by the European Society of Cardiology 6