Work-up
- ECG
- Event monitor
- characterize PVC frequency, morphology and complexity
- Echocardiogramecho
- to assess for structural heart disease, e.g. Cardiomyopathies or valvular disorders
- Cardiac MRI
- even if Echo normal
- particularly useful for patients with PVCs/VT and a non-idiopathic origin
- Exercise ECG
- ↓/resolution of PVCs with exercise →
- monomorphic PVCs that ↓/resolve during exercise are generally considered benign
- may be d/t heightened sympathetic tone (↑ HR) suppressing abnormal automaticity that sometimes causes PVCs
- ↑/persistent PVCs during exercise or recovery →
- high-grade PVCs (frequent, multifocal, R-on-T, or VT) during recovery are associated with an ↑ long-term risk of CV mortality, even in the absence of known heart disease.
- thought to be d/t insufficient vagal reactivation post-exercise
- exercise-induced PVCs (esp. if high-grade) may reflect underlying structural heart disease or subclinical ischemia
- high-grade PVCs (frequent, multifocal, R-on-T, or VT) during recovery are associated with an ↑ long-term risk of CV mortality, even in the absence of known heart disease.
- In a study of asymptomatic individuals, 1 found that “high-grade PVCs occurring during recovery were associated with long-term risk of cardiovascular mortality in asymptomatic individuals, whereas PVCs occurring only during exercise were not associated with increased risk.”
- ↓/resolution of PVCs with exercise →
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Footnotes
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Refaat MM, Gharios C, Moorthy MV, Abdulhai F, Blumenthal RS, Jaffa MA, Mora S. Exercise-Induced Ventricular Ectopy and Cardiovascular Mortality in Asymptomatic Individuals. J Am Coll Cardiol. 2021 Dec 7;78(23):2267-2277. doi: 10.1016/j.jacc.2021.09.1366. PMID: 34857087; PMCID: PMC8720278. ↩