Ventricular Premature Contractions: Expert Opinions and Treatment Options

Ventricular premature contraction (VPC)

Hello Dr.
He: I have experienced palpitations and chest tightness for a while, and this year they have become more frequent.
Additionally, I have asthma and a compromised immune system (frequent allergies and urticaria).
I have consulted three doctors and would like to know which of their opinions is more suitable for me.
Thank you very much.
Below is the 24-hour ECG report.
Doctor A: Diagnosed me with severe ventricular premature contractions (VPCs) that could lead to sudden cardiac death.
The doctor mentioned that long-term use of antiarrhythmic medication would ultimately lead to heart failure, and my asthma exacerbates my arrhythmia, so I should undergo catheter ablation surgery quickly in September.
Doctor B: Stated that my ventricular premature contractions are not due to an extra nerve but rather an unclear point within the ventricle.
Due to the current immaturity of surgical techniques for the ventricles, which are quite large and difficult to navigate, even if ablation is performed, it would only destroy cells and may not target the area causing the episodes.
Ablation is not necessary; I should just take antiarrhythmic medication (Rhythmol), ISOPTIN, and 2 mg of Valium.
If managed well in the future, I might not need to continue medication.
Doctor C: Suggested that ventricular premature contractions do not require ablation or medication, and I should return for a follow-up if I feel uncomfortable.
1.
Basically sinus rhythm with an average heart rate of 89 BPM, a maximal rate of 213 BPM at 21:38:37 hours (during non-sustained ventricular tachycardia), and a minimal rate of 51 BPM at 05:15:58 hours.
2.
Frequent VPCs (total 26,709 beats over 19 hours and 59 minutes, during daytime and nighttime, including one episode of non-sustained ventricular tachycardia, 353 bigeminy runs, and 791 trigeminy runs): no atrial premature contractions (APCs).
3.
There was one episode of non-sustained ventricular tachycardia, with a duration of 1.5 seconds (6 ventricular beats) and a ventricular rate of 213 BPM, occurring at 21:38:35 hours.
4.
No significant ST-T changes.
5.
Seven patient events were recorded between 15:23:38 and 10:06:34 hours.
The ECGs revealed sinus rhythm with VPCs with heart rates between 88 and 131 BPM.

Xiao Hua, 30~39 year old female. Ask Date: 2016/09/05

Dr. He Dongjin reply Cardiology

Hello, your episodes seem to be more frequent.
We should determine the treatment based on your symptoms.
Since you have experienced palpitations and chest tightness more frequently this year, it may not be appropriate to completely disregard treatment with medication.
If your symptoms improve, we can consider starting with medication B and adjusting the dosage based on your symptoms.
If we manage to control your condition well, you might not need to continue medication in the future.
However, if your symptoms show limited improvement and you still feel very uncomfortable, we may need to proceed with option A.
Both options A and B may sound exaggerated; option A should not lead to sudden cardiac death or heart failure, and option B should not result in significantly enlarged ventricles that are difficult to locate.
Even with catheter ablation, it only destroys cells and can create multiple lesions.
It is advisable to consult several major medical centers in Taiwan, such as Taipei Veterans General Hospital, which have extensive experience.
Ultimately, the treatment should be guided by your symptoms, and typically, medication is the first line of treatment.
Changhua Hospital is concerned about your well-being.

Reply Date: 2016/09/05

More Info

Ventricular premature contractions (VPCs) are a common type of arrhythmia characterized by early heartbeats originating from the ventricles. They can be benign or indicative of underlying heart disease, depending on their frequency, associated symptoms, and the overall health of the heart. Given your history of palpitations and chest discomfort, along with asthma and a compromised immune system, it is essential to evaluate the opinions of the three physicians you consulted.

Analysis of Physician Opinions
1. Physician A: This doctor has diagnosed you with severe VPCs and expressed concern about the risk of sudden cardiac death. They recommend catheter ablation (electrophysiological study and radiofrequency ablation) as a treatment option. While it is true that frequent VPCs can lead to cardiomyopathy and heart failure over time, the risk of sudden death is typically associated with underlying heart disease rather than isolated VPCs. If your heart is structurally normal, the risk may be lower. However, if VPCs are symptomatic and frequent, ablation could be a reasonable option, especially if you have not responded well to medication.

2. Physician B: This physician offers a more conservative approach, suggesting that your VPCs are due to ectopic foci within the ventricles rather than a structural issue. They argue that the current surgical techniques are not mature enough to guarantee success and recommend a medication regimen instead. This perspective is valid, particularly if your VPCs are infrequent and not causing significant symptoms. Medications like beta-blockers (e.g., Isoptin) can help manage symptoms and reduce the frequency of VPCs.

3. Physician C: This doctor takes a very conservative stance, suggesting that VPCs do not require any treatment unless they cause discomfort. This approach may be appropriate for patients with infrequent VPCs and no underlying heart disease. However, given your symptoms of palpitations and chest discomfort, this might not be the best approach for you.

Recommendations
Given the varying opinions, it is crucial to consider the following:
- Symptom Severity: If your VPCs are causing significant discomfort or anxiety, a more proactive approach may be warranted. Physician A's recommendation for ablation could be beneficial if other treatments fail.

- Underlying Heart Health: If you have not undergone a comprehensive cardiac evaluation (including echocardiography), it may be wise to do so. Understanding the structural integrity of your heart can help guide treatment decisions.

- Medication Management: If you opt for a conservative approach, medications prescribed by Physician B may help manage your symptoms effectively. Regular follow-up is essential to monitor the effectiveness of the treatment and adjust as necessary.

- Lifestyle Modifications: Regardless of the chosen treatment, lifestyle changes such as reducing caffeine intake, managing stress, and avoiding stimulants can help reduce the frequency of VPCs.

- Regular Monitoring: Continuous monitoring of your heart rhythm through Holter monitoring or event recorders can provide valuable insights into the frequency and patterns of your VPCs, aiding in treatment decisions.

Conclusion
In conclusion, the management of VPCs should be individualized based on symptom severity, underlying heart health, and patient preferences. If your symptoms are significantly impacting your quality of life, discussing the possibility of ablation with a cardiologist specializing in electrophysiology may be beneficial. On the other hand, if your symptoms are manageable, a conservative approach with medication and lifestyle changes may suffice. Regular follow-ups and open communication with your healthcare providers are crucial in managing your condition effectively.

Similar Q&A

Managing Premature Ventricular Contractions: Treatment Options and Advice

I have been experiencing premature ventricular contractions (PVCs) for a long time, occasionally leading to irregular heartbeats. I am unsure if there are medications available to maintain a normal heart rhythm or if there are other treatment options that could resolve this issue...

Dr. Lin Jixiong reply Cardiology
Hello: Ventricular premature contractions are a common arrhythmia. It is recommended to discuss the pharmacological treatment of arrhythmias with a cardiologist. Dr. Lin Chi-Hsiung.

Managing Frequent Ventricular Premature Contractions: Options Beyond Medication

Hello Doctor, many years ago during my military service, I was diagnosed with premature ventricular contractions (PVCs). At that time, I consulted a doctor who said it was fine as long as I didn't feel any discomfort. However, due to work requirements, I have to undergo both...

Dr. He Dongjin reply Cardiology
Hello, there are three solutions for premature ventricular contractions (PVCs): 1. Observation and coexistence; 2. Medication; 3. Catheter ablation. Since I haven't seen the electrocardiogram (ECG), it's difficult to provide specific recommendations. I suggest obtaining...

Understanding Ventricular Premature Contractions: Treatment Options and Risks

Hello Doctor, the results of the 24-hour Holter monitor and echocardiogram indicate that there are premature ventricular contractions (PVCs) occurring at a frequency of 18% to 19%. I would like to ask you the following questions: 1. Given the frequency, does this level warrant ca...

Dr. He Dongjin reply Cardiology
Hello, the symptoms are unlikely to resolve on their own. In my opinion, there is currently no need for electrocautery surgery. Whether medication is necessary should be determined based on the symptoms. If surgery and medication are not pursued for several decades, there is a po...

Understanding Premature Ventricular Contractions: Causes and Treatment Options

Hello, Doctor. At the end of last year, I felt uncomfortable due to palpitations, and a cardiologist performed an echocardiogram and a 24-hour Holter monitor test. The doctor said the echocardiogram showed no issues, but the 24-hour Holter monitor indicated early contractions, an...

Dr. He Dongjin reply Cardiology
Hello, the echocardiogram showed no issues. The occasional VPCs over 24 hours are still within a reasonable and acceptable range. At your age, approaching menopause, you may experience more palpitations. The medication is intended to help stabilize your autonomic nervous system a...