Premature Ventricular Complexes in Young Adults

Prevalence and Etiology

Premature ventricular complexes (PVCs) occur in approximately 50% of all people on long-term monitoring and are generally benign in young, healthy individuals with high functional capacity, according to the American College of Cardiology 1, 2
PVCs increase in frequency with age, with studies showing prevalence of 0.6% in those <20 years of age and 2.7% in those >50 years of age on 12-lead ECGs, as reported by the American College of Cardiology 1, 2
Longer-term monitoring reveals PVCs in about 50% of all people with or without heart disease, as stated by the American College of Cardiology 1
In athletes, PVCs are uncommon and present in <1% of 12-lead ECGs, according to the American College of Cardiology 3

Most PVCs in young adults with high functional capacity are benign, but risk factors that suggest potential pathology include multiple (≥2) PVCs on a standard 12-lead ECG, PVC burden >10-15% of total heartbeats, multifocal PVCs, wide QRS duration (>160 ms), and family history of sudden cardiac death, as indicated by the American College of Cardiology 3, 4
The American College of Cardiology recommends assessing PVC burden with 24-hour Holter monitoring, and if PVC burden <10% and asymptomatic, it is likely benign 3, 4
Echocardiography is recommended to assess for structural heart disease, and a normal echocardiogram suggests benign etiology in young adults, as stated by the American College of Cardiology 3, 5
Exercise stress test is recommended, and PVCs that suppress with exercise are generally benign, while PVCs that worsen with exercise may indicate underlying pathology, according to the American College of Cardiology 3

Isolated PVCs in a young adult with high functional capacity rarely require treatment if asymptomatic, but monitoring is recommended if PVC burden is significant (>10%) to detect potential development of cardiomyopathy, as recommended by the American College of Cardiology 4, 6
Treatment is indicated for symptomatic PVCs, high PVC burden (>10-15%) with risk of developing cardiomyopathy, and PVCs associated with structural heart disease, according to the American College of Cardiology 7
The American College of Cardiology advises against using class I antiarrhythmic drugs as first-line therapy, which can increase mortality in patients with structural heart disease 1, 2
Multifocal PVCs may indicate higher cardiovascular risk even in young adults, as reported by the American College of Cardiology 1