Premature ventricular contraction interventions

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2] Radwa AbdElHaras Mohamed AbouZaied, M.B.B.S[3]Mugilan Poongkunran M.B.B.S [4]


There are no recommended therapeutic interventions for the management of [disease name].


[name of intervention] is not the first-line treatment option for patients with [disease name]. [name of intervention] is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].


The mainstay of treatment for [disease name] is medical therapy/surgery. [Name of intervention] is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].


The feasibility of [name of intervention] depends on the stage of [disease or malignancy] at the time of diagnosis.


[Name of intervention] is the mainstay of treatment for [disease or malignancy].


The mainstay of treatment for TT is medical therapy.


Radiofrequency ablation is useful for treating patients with high frequency of premature ventricular contraction episodes.


Recent studies have shown that those subjects who have an extremely high occurrence of PVCs (several thousand a day) can develop dilated cardiomyopathy. In these cases, if the PVCs are reduced or removed by ablation therapy, the cardiomyopathy usually regresses.[1][2]

2017 AHA/ACC/HRS Guideline for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (DO NOT EDIT)[3]

Recommendations for Autonomic Modulation

Class IIb
1. In patients with VT/VF storm in whom a beta blocker, other antiarrhythmic medications, and catheter ablation are ineffective, not tolerated, or not possible, cardiac sympathetic denervation may be reasonable (Level of Evidence: C-LD).[4][5][6]

Recommendations for Management of Cardiac Arrest

Class I
1. CPR should be performed in patients in cardiac arrest according to published basic and advanced cardiovascular life support algorithms (Level of Evidence: A).[7][8][9]

2. In patients with hemodynamically unstable VA that persist or recur after a maximal energy shock, intravenous amiodarone should be administered to attempt to achieve a stable rhythm after further defibrillation (Level of Evidence: A). [7][10][11]

3. Patients presenting with VA with hemodynamic instability should undergo direct current cardioversion (Level of Evidence: A).[7][8][9]

4. In Patients with polymorphic VT or VF with ST-elevation MI, angiography with emergency revascularization is recommended (Level of Evidence: B-NR).[12][13][14][15]

5. Patients with a wide-QRS tachycardia should be presumed to have VT if the diagnosis is unclear (Level of Evidence: C-EO).

Class IIa
1. In patients with hemodynamically stable VT, administration of intravenous procainamide can be useful to attempt to terminate VT (Level of Evidence: A).[16][17][18]

2. In patients with a witnessed cardiac arrest due to VF or polymorphic VT that is unresponsive to CPR, defibrillation, and vasopressor therapy, intravenous lidocaine can be beneficial (Level of Evidence: B-R).[7][10][19][20][21]

3. In patients with polymorphic VT due to myocardial ischemia, intravenous beta blockers can be useful(Level of Evidence: B-R).[22][23]

4. In patients with a recent MI who have VT/VF that repeatedly recurs despite direct current cardioversion and antiarrhythmic medications (VT/VF storm), an intravenous beta blocker can be useful(Level of Evidence: B-NR).[23][24]

Class IIb
1. In patients in cardiac arrest, administration of epinephrine (1 mg every 3 to 5 minutes) during CPR may be reasonable (Level of Evidence: A).[7][25][26][27][28][29][30]

2. In patients with hemodynamically stable VT, administration of intravenous amiodarone or sotalol may be considered to attempt to terminate VT (Level of Evidence: B-R).[19][18][31][32]

Class III: No Benefit
1. In patients with cardiac arrest, administration of high-dose epinephrine (>1 mg boluses) compared with standard doses is not beneficial (Level of Evidence: A).[33][27]

2. In patients with refractory VF not related to torsades de pointes, administration of intravenous magnesium is not beneficial (Level of Evidence: A).[34][35]

Class III: Harm
1. In patients with suspected AMI, prophylactic administration of lidocaine or high-dose amiodarone for the prevention of VT is potentially harmful (Level of Evidence: B-R).


2. In patients with a wide QRS complex tachycardia of unknown origin, calcium channel blockers (eg, verapamil and diltiazem) are potentially harmful(Level of Evidence: C-LD).[38][39]


  1. Belhassen B (2005), "Radiofrequency ablation of "benign" right ventricular outflow tract extrasystoles: a therapy that has found its disease? In patients with no known coronary artery disease (CAD), the presence of frequent premature ventricular contractions (PVCs) is linked to acute myocardial infarction and sudden death. The Framingham Heart Study defines frequent as >30 PVCs per hour. The American College of Cardiology and the American Heart Association recommend evaluation for CAD in patients who have frequent PVCs and cardiac risk factors, such as hypertension and smoking (SOR C). Evaluation for CAD may include stress testing, echocardiography, and ambulatory rhythm monitoring", J. Am. Coll. Cardiol., 45 (8): 1266–8, doi:10.1016/j.jacc.2005.01.028, PMID 15837260 Unknown parameter |month= ignored (help)
  2. Shiraishi, Hirokazu; Ishibashi, Kazuya; Urao, Norifumi; Tsukamoto, Masaki; Hyogo, Masayuki; Keira, Natsuya; Hirasaki, Satoshi; Shirayama, Takeshi; Nakagawa, Masao (2002), "A case of cardiomyopathy induced by premature ventricular complexes", Circulation, 66 (11): 1065–7, doi:10.1253/circj.66.1065
  3. Al-Khatib, Sana M.; Stevenson, William G.; Ackerman, Michael J.; Bryant, William J.; Callans, David J.; Curtis, Anne B.; Deal, Barbara J.; Dickfeld, Timm; Field, Michael E.; Fonarow, Gregg C.; Gillis, Anne M.; Granger, Christopher B.; Hammill, Stephen C.; Hlatky, Mark A.; Joglar, José A.; Kay, G. Neal; Matlock, Daniel D.; Myerburg, Robert J.; Page, Richard L. (2018). "2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death". Circulation. 138 (13). doi:10.1161/CIR.0000000000000549. ISSN 0009-7322.
  4. Vaseghi, Marmar; Barwad, Parag; Malavassi Corrales, Federico J.; Tandri, Harikrishna; Mathuria, Nilesh; Shah, Rushil; Sorg, Julie M.; Gima, Jean; Mandal, Kaushik; Sàenz Morales, Luis C.; Lokhandwala, Yash; Shivkumar, Kalyanam (2017). "Cardiac Sympathetic Denervation for Refractory Ventricular Arrhythmias". Journal of the American College of Cardiology. 69 (25): 3070–3080. doi:10.1016/j.jacc.2017.04.035. ISSN 0735-1097.
  5. Vaseghi, Marmar; Gima, Jean; Kanaan, Christopher; Ajijola, Olujimi A.; Marmureanu, Alexander; Mahajan, Aman; Shivkumar, Kalyanam (2014). "Cardiac sympathetic denervation in patients with refractory ventricular arrhythmias or electrical storm: Intermediate and long-term follow-up". Heart Rhythm. 11 (3): 360–366. doi:10.1016/j.hrthm.2013.11.028. ISSN 1547-5271.
  6. Schwartz, Peter J.; Motolese, Mario; Pollavini, Giorgio; Lotto, Antonio; Ruberti, Ugo; Trazzi, Rinaldo; Bartorelli, Cesare; Zanchetti, Alberto; Group, The Italian Sudden Death Prevention (1992). "Prevention of Sudden Cardiac Death After a First Myocardial Infarction by Pharmacologic or Surgical Antiadrenergic Interventions". Journal of Cardiovascular Electrophysiology. 3 (1): 2–16. doi:10.1111/j.1540-8167.1992.tb01090.x. ISSN 1045-3873.
  7. 7.0 7.1 7.2 7.3 7.4 Link, Mark S.; Berkow, Lauren C.; Kudenchuk, Peter J.; Halperin, Henry R.; Hess, Erik P.; Moitra, Vivek K.; Neumar, Robert W.; O’Neil, Brian J.; Paxton, James H.; Silvers, Scott M.; White, Roger D.; Yannopoulos, Demetris; Donnino, Michael W. (2015). "Part 7: Adult Advanced Cardiovascular Life Support". Circulation. 132 (18 suppl 2): S444–S464. doi:10.1161/CIR.0000000000000261. ISSN 0009-7322.
  8. 8.0 8.1 Stiell, Ian G.; Wells, George A.; Field, Brian; Spaite, Daniel W.; Nesbitt, Lisa P.; De Maio, Valerie J.; Nichol, Graham; Cousineau, Donna; Blackburn, Josée; Munkley, Doug; Luinstra-Toohey, Lorraine; Campeau, Tony; Dagnone, Eugene; Lyver, Marion (2004). "Advanced Cardiac Life Support in Out-of-Hospital Cardiac Arrest". New England Journal of Medicine. 351 (7): 647–656. doi:10.1056/NEJMoa040325. ISSN 0028-4793.
  9. 9.0 9.1 Sasson, Comilla; Rogers, Mary A.M.; Dahl, Jason; Kellermann, Arthur L. (2010). "Predictors of Survival From Out-of-Hospital Cardiac Arrest". Circulation: Cardiovascular Quality and Outcomes. 3 (1): 63–81. doi:10.1161/CIRCOUTCOMES.109.889576. ISSN 1941-7713.
  10. 10.0 10.1 Dorian, Paul; Cass, Dan; Schwartz, Brian; Cooper, Richard; Gelaznikas, Robert; Barr, Aiala (2002). "Amiodarone as Compared with Lidocaine for Shock-Resistant Ventricular Fibrillation". New England Journal of Medicine. 346 (12): 884–890. doi:10.1056/NEJMoa013029. ISSN 0028-4793.
  11. P. J. Kudenchuk, L. A. Cobb, M. K. Copass, R. O. Cummins, A. M. Doherty, C. E. Fahrenbruch, A. P. Hallstrom, W. A. Murray, M. Olsufka & T. Walsh (1999). "Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation". The New England journal of medicine. 341 (12): 871–878. doi:10.1056/NEJM199909163411203. PMID 10486418. Unknown parameter |month= ignored (help)
  12. Spaulding, Christian M.; Joly, Luc-Marie; Rosenberg, Alain; Monchi, Mehran; Weber, Simon N.; Dhainaut, Jean-François A.; Carli, Pierre (1997). "Immediate Coronary Angiography in Survivors of Out-of-Hospital Cardiac Arrest". New England Journal of Medicine. 336 (23): 1629–1633. doi:10.1056/NEJM199706053362302. ISSN 0028-4793.
  13. Cronier, Pierrick; Vignon, Philippe; Bouferrache, Koceila; Aegerter, Philippe; Charron, Cyril; Templier, François; Castro, Samuel; El Mahmoud, Rami; Lory, Cécile; Pichon, Nicolas; Dubourg, Olivier; Vieillard-Baron, Antoine (2011). "Impact of routine percutaneous coronary intervention after out-of-hospital cardiac arrest due to ventricular fibrillation". Critical Care. 15 (3): R122. doi:10.1186/cc10227. ISSN 1364-8535.
  14. Zanuttini, Davide; Armellini, Ilaria; Nucifora, Gaetano; Carchietti, Elio; Trillò, Giulio; Spedicato, Leonardo; Bernardi, Guglielmo; Proclemer, Alessandro (2012). "Impact of Emergency Coronary Angiography on In-Hospital Outcome of Unconscious Survivors After Out-of-Hospital Cardiac Arrest". The American Journal of Cardiology. 110 (12): 1723–1728. doi:10.1016/j.amjcard.2012.08.006. ISSN 0002-9149.
  15. Dumas, Florence; Bougouin, Wulfran; Geri, Guillaume; Lamhaut, Lionel; Rosencher, Julien; Pène, Frédéric; Chiche, Jean-Daniel; Varenne, Olivier; Carli, Pierre; Jouven, Xavier; Mira, Jean-Paul; Spaulding, Christian; Cariou, Alain (2016). "Emergency Percutaneous Coronary Intervention in Post–Cardiac Arrest Patients Without ST-Segment Elevation Pattern". JACC: Cardiovascular Interventions. 9 (10): 1011–1018. doi:10.1016/j.jcin.2016.02.001. ISSN 1936-8798.
  16. Gorgels, Anton P.M.; van den Dool, Adri; Hofs, Anton; Mulleneers, Rob; Smeets, Joep L.R.M.; Vos, Marc A.; Wellens, Hein J.J. (1996). "Comparison of procainamide and lidocaine in terminating sustained monomorphic ventricular tachycardia". The American Journal of Cardiology. 78 (1): 43–46. doi:10.1016/S0002-9149(96)00224-X. ISSN 0002-9149.
  17. Markel, David T.; Gold, Laura S.; Allen, Judith; Fahrenbruch, Carol E.; Rea, Thomas D.; Eisenberg, Mickey S.; Kudenchuk, Peter J. (2010). "Procainamide and Survival in Ventricular Fibrillation Out-of-hospital Cardiac Arrest". Academic Emergency Medicine. 17 (6): 617–623. doi:10.1111/j.1553-2712.2010.00763.x. ISSN 1069-6563.
  18. 18.0 18.1 Ortiz, Mercedes; Martín, Alfonso; Arribas, Fernando; Coll-Vinent, Blanca; del Arco, Carmen; Peinado, Rafael; Almendral, Jesús (2016). "Randomized comparison of intravenous procainamide vs. intravenous amiodarone for the acute treatment of tolerated wide QRS tachycardia: the PROCAMIO study". European Heart Journal: ehw230. doi:10.1093/eurheartj/ehw230. ISSN 0195-668X.
  19. 19.0 19.1 Kudenchuk, Peter J.; Brown, Siobhan P.; Daya, Mohamud; Rea, Thomas; Nichol, Graham; Morrison, Laurie J.; Leroux, Brian; Vaillancourt, Christian; Wittwer, Lynn; Callaway, Clifton W.; Christenson, James; Egan, Debra; Ornato, Joseph P.; Weisfeldt, Myron L.; Stiell, Ian G.; Idris, Ahamed H.; Aufderheide, Tom P.; Dunford, James V.; Colella, M. Riccardo; Vilke, Gary M.; Brienza, Ashley M.; Desvigne-Nickens, Patrice; Gray, Pamela C.; Gray, Randal; Seals, Norman; Straight, Ron; Dorian, Paul (2016). "Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest". New England Journal of Medicine. 374 (18): 1711–1722. doi:10.1056/NEJMoa1514204. ISSN 0028-4793.
  20. Herlitz, Johan; Ekström, Lars; Wennerblom, Bertil; Axelsson, Åsa; Bång, Angela; Lindkvist, Jonny; Persson, Nils Gunnar; Holmberg, Stig (1997). "Lidocaine in out-of-hospital ventricular fibrillation. Does it improve survival?". Resuscitation. 33 (3): 199–205. doi:10.1016/S0300-9572(96)01018-0. ISSN 0300-9572.
  21. Kudenchuk, Peter J.; Newell, Cameron; White, Lindsay; Fahrenbruch, Carol; Rea, Tom; Eisenberg, Mickey (2013). "Prophylactic lidocaine for post resuscitation care of patients with out-of-hospital ventricular fibrillation cardiac arrest". Resuscitation. 84 (11): 1512–1518. doi:10.1016/j.resuscitation.2013.05.022. ISSN 0300-9572.
  22. K. K. Teo, S. Yusuf & C. D. Furberg (1993). "Effects of prophylactic antiarrhythmic drug therapy in acute myocardial infarction. An overview of results from randomized controlled trials". JAMA. 270 (13): 1589–1595. PMID 8371471. Unknown parameter |month= ignored (help)
  23. 23.0 23.1 Nademanee, Koonlawee; Taylor, Richard; Bailey, William E.; Rieders, Daniel E.; Kosar, Erol M. (2000). "Treating Electrical Storm". Circulation. 102 (7): 742–747. doi:10.1161/01.CIR.102.7.742. ISSN 0009-7322.
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  26. Donnino, M. W.; Salciccioli, J. D.; Howell, M. D.; Cocchi, M. N.; Giberson, B.; Berg, K.; Gautam, S.; Callaway, C. (2014). "Time to administration of epinephrine and outcome after in-hospital cardiac arrest with non-shockable rhythms: retrospective analysis of large in-hospital data registry". BMJ. 348 (may20 2): g3028–g3028. doi:10.1136/bmj.g3028. ISSN 1756-1833.
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  33. M. Callaham, C. D. Madsen, C. W. Barton, C. E. Saunders & J. Pointer (1992). "A randomized clinical trial of high-dose epinephrine and norepinephrine vs standard-dose epinephrine in prehospital cardiac arrest". JAMA. 268 (19): 2667–2672. PMID 1433686. Unknown parameter |month= ignored (help)
  34. Hassan, T B (2002). "A randomised trial to investigate the efficacy of magnesium sulphate for refractory ventricular fibrillation". Emergency Medicine Journal. 19 (1): 57–62. doi:10.1136/emj.19.1.57. ISSN 1472-0205.
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  37. Elizari, M (2000). "Morbidity and mortality following early administration of amiodarone in acute myocardial infarction". European Heart Journal. 21 (3): 198–205. doi:10.1053/euhj.1999.1687. ISSN 0195-668X.
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