Premature ventricular contraction medical therapy

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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]

Overview

Isolated premature ventricular contractions with benign characteristics require no treatment. In healthy individuals, PVCs can often be resolved by restoring the balance of magnesium, calcium and potassium within the body.

Medical Therapy

Therapies with limited data to support their use:

In the setting of existing cardiac disease, however, PVCs must be watched carefully, as they may cause a form of ventricular tachycardia (rapid heartbeat).

Overview

There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR   The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Medical Therapy

  • Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
  • Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
  • Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
  • Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Disease Name

  • 1 Stage 1 - Name of stage
    • 1.1 Specific Organ system involved 1
      • 1.1.1 Adult
        • Preferred regimen (1): drug name 100 mg PO q12h for 10-21 days (Contraindications/specific instructions)
        • Preferred regimen (2): drug name 500 mg PO q8h for 14-21 days
        • Preferred regimen (3): drug name 500 mg q12h for 14-21 days
        • Alternative regimen (1): drug name 500 mg PO q6h for 7–10 days
        • Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
        • Alternative regimen (3): drug name 500 mg PO q6h for 14–21 days
      • 1.1.2 Pediatric
        • 1.1.2.1 (Specific population e.g. children < 8 years of age)
          • Preferred regimen (1): drug name 50 mg/kg PO per day q8h (maximum, 500 mg per dose)
          • Preferred regimen (2): drug name 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
          • Alternative regimen (1): drug name10 mg/kg PO q6h (maximum, 500 mg per day)
          • Alternative regimen (2): drug name 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
          • Alternative regimen (3): drug name 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
        • 1.1.2.2 (Specific population e.g. 'children < 8 years of age')
          • Preferred regimen (1): drug name 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
          • Alternative regimen (1): drug name 10 mg/kg PO q6h (maximum, 500 mg per day)
          • Alternative regimen (2): drug name 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
          • Alternative regimen (3): drug name 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
    • 1.2 Specific Organ system involved 2
      • 1.2.1 Adult
        • Preferred regimen (1): drug name 500 mg PO q8h
      • 1.2.2 Pediatric
        • Preferred regimen (1): drug name 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
  • 2 Stage 2 - Name of stage
    • 2.1 Specific Organ system involved 1
      Note (1):
      Note (2):
      Note (3):
      • 2.1.1 Adult
        • Parenteral regimen
          • Preferred regimen (1): drug name 2 g IV q24h for 14 (14–21) days
          • Alternative regimen (1): drug name 2 g IV q8h for 14 (14–21) days
          • Alternative regimen (2): drug name 18–24 MU/day IV q4h for 14 (14–21) days
        • Oral regimen
          • Preferred regimen (1): drug name 500 mg PO q8h for 14 (14–21) days
          • Preferred regimen (2): drug name 100 mg PO q12h for 14 (14–21) days
          • Preferred regimen (3): drug name 500 mg PO q12h for 14 (14–21) days
          • Alternative regimen (1): drug name 500 mg PO q6h for 7–10 days
          • Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
          • Alternative regimen (3):drug name 500 mg PO q6h for 14–21 days
      • 2.1.2 Pediatric
        • Parenteral regimen
          • Preferred regimen (1): drug name 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
          • Alternative regimen (1): drug name 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
          • Alternative regimen (2):  drug name 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '(Contraindications/specific instructions)'
        • Oral regimen
          • Preferred regimen (1): drug name 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)
          • Preferred regimen (2): drug name (for children aged ≥ 8 years) 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
          • Preferred regimen (3): drug name 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)
          • Alternative regimen (1): drug name 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)
          • Alternative regimen (2): drug name 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)
          • Alternative regimen (3): drug name 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)
    • 2.2 'Other Organ system involved 2'
      Note (1):
      Note (2):
      Note (3):
      • 2.2.1 Adult
        • Parenteral regimen
          • Preferred regimen (1): drug name 2 g IV q24h for 14 (14–21) days
          • Alternative regimen (1): drug name 2 g IV q8h for 14 (14–21) days
          • Alternative regimen (2): drug name 18–24 MU/day IV q4h for 14 (14–21) days
        • Oral regimen
          • Preferred regimen (1): drug name 500 mg PO q8h for 14 (14–21) days
          • Preferred regimen (2): drug name 100 mg PO q12h for 14 (14–21) days
          • Preferred regimen (3): drug name 500 mg PO q12h for 14 (14–21) days
          • Alternative regimen (1): drug name 500 mg PO q6h for 7–10 days
          • Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
          • Alternative regimen (3):drug name 500 mg PO q6h for 14–21 days
      • 2.2.2 Pediatric
        • Parenteral regimen
          • Preferred regimen (1): drug name 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
          • Alternative regimen (1): drug name 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
          • Alternative regimen (2):  drug name 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
        • Oral regimen
          • Preferred regimen (1): drug name 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)
          • Preferred regimen (2): drug name 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
          • Preferred regimen (3): drug name 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)
          • Alternative regimen (1): drug name 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)
          • Alternative regimen (2): drug name 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)
          • Alternative regimen (3): drug name 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)


2017 AHA/ACC/HRS Guideline for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (DO NOT EDIT)[1]

Recommendation for Pharmacological Prevention of Sudden Cardiac Death (SCD)

Class I
1. In patients with HFrEF (LVEF ≤40%), treatment with a beta blocker, a mineralocorticoid receptor antagonist and either an angiotensin-converting enzyme inhibitor, an angiotensin-receptor blocker, or an angiotensin receptor-neprilysin inhibitor is recommended to reduce SCD and all-cause mortality (Level of Evidence: A).[2][3][4][5][6][7][8][9]

Recommendations for Autonomic Modulation

Class IIa
1. In patients with symptomatic, non–lifethreatening VA, treatment with a beta blocker is reasonable (Level of Evidence: C-LD).[10]

Recommendations for Patients With Coronary Artery Spasm

Class I
1. In patients with VA due to coronary artery spasm, treatment with maximally tolerated doses of a calcium channel blocker and

smoking cessation are indicated to reduce recurrent ischemia and VA (Level of Evidence: B-NR).[11][12]

Class IIa
1. In patients resuscitated from SCA due to coronary artery spasm in whom medical therapy is ineffective or not tolerated, an ICD is reasonable if meaningful survival of greater than 1 year is expected. (Level of Evidence: B-NR).[13][14][15][16]
Class IIb
1. In patients resuscitated from SCA due to coronary artery spasm, an ICD in addition to medical therapy may be reasonable if

meaningful survival of greater than 1 year is expected. (Level of Evidence: B-NR). [13][14][15][16]

References

  1. ↑ 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.
  2. ↑ Yancy, Clyde W.; Jessup, Mariell; Bozkurt, Biykem; Butler, Javed; Casey, Donald E.; Colvin, Monica M.; Drazner, Mark H.; Filippatos, Gerasimos; Fonarow, Gregg C.; Givertz, Michael M.; Hollenberg, Steven M.; Lindenfeld, JoAnn; Masoudi, Frederick A.; McBride, Patrick E.; Peterson, Pamela N.; Stevenson, Lynne Warner; Westlake, Cheryl (2016). "2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America". Circulation. 134 (13). doi:10.1161/CIR.0000000000000435. ISSN 0009-7322.
  3. ↑ "The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial". Lancet (London, England). 353 (9146): 9–13. 1999. PMID 10023943. Unknown parameter |month= ignored (help)
  4. ↑ Cohn, Jay N.; Johnson, Gary; Ziesche, Susan; Cobb, Frederick; Francis, Gary; Tristani, Felix; Smith, Raphael; Dunkman, W. Bruce; Loeb, Henry; Wong, Maylene; Bhat, Geetha; Goldman, Steven; Fletcher, Ross D.; Doherty, James; Hughes, C. Vincent; Carson, Peter; Cintron, Guillermo; Shabetai, Ralph; Haakenson, Clair (1991). "A Comparison of Enalapril with Hydralazine–Isosorbide Dinitrate in the Treatment of Chronic Congestive Heart Failure". New England Journal of Medicine. 325 (5): 303–310. doi:10.1056/NEJM199108013250502. ISSN 0028-4793.
  5. ↑ Packer, Milton; Bristow, Michael R.; Cohn, Jay N.; Colucci, Wilson S.; Fowler, Michael B.; Gilbert, Edward M.; Shusterman, Neil H. (1996). "The Effect of Carvedilol on Morbidity and Mortality in Patients with Chronic Heart Failure". New England Journal of Medicine. 334 (21): 1349–1355. doi:10.1056/NEJM199605233342101. ISSN 0028-4793.
  6. ↑ "Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial". The Lancet. 357 (9266): 1385–1390. 2001. doi:10.1016/S0140-6736(00)04560-8. ISSN 0140-6736.
  7. ↑ Pitt, Bertram; Remme, Willem; Zannad, Faiez; Neaton, James; Martinez, Felipe; Roniker, Barbara; Bittman, Richard; Hurley, Steve; Kleiman, Jay; Gatlin, Marjorie (2003). "Eplerenone, a Selective Aldosterone Blocker, in Patients with Left Ventricular Dysfunction after Myocardial Infarction". New England Journal of Medicine. 348 (14): 1309–1321. doi:10.1056/NEJMoa030207. ISSN 0028-4793.
  8. ↑ Al Chekakie, M. Obadah (2013). "Traditional Heart Failure Medications and Sudden Cardiac Death Prevention". Journal of Cardiovascular Pharmacology and Therapeutics. 18 (5): 412–426. doi:10.1177/1074248413491496. ISSN 1074-2484.
  9. ↑ Pfeffer, Marc A.; McMurray, John J.V.; Velazquez, Eric J.; Rouleau, Jean-Lucien; Køber, Lars; Maggioni, Aldo P.; Solomon, Scott D.; Swedberg, Karl; Van de Werf, Frans; White, Harvey; Leimberger, Jeffrey D.; Henis, Marc; Edwards, Susan; Zelenkofske, Steven; Sellers, Mary Ann; Califf, Robert M. (2003). "Valsartan, Captopril, or Both in Myocardial Infarction Complicated by Heart Failure, Left Ventricular Dysfunction, or Both". New England Journal of Medicine. 349 (20): 1893–1906. doi:10.1056/NEJMoa032292. ISSN 0028-4793.
  10. ↑ Krittayaphong, Rungroj; Bhuripanyo, Kiertijai; Punlee, Kesaree; Kangkagate, Charuwan; Chaithiraphan, Suphachai (2002). "Effect of atenolol on symptomatic ventricular arrhythmia without structural heart disease: A randomized placebo-controlled study". American Heart Journal. 144 (6): 1–5. doi:10.1067/mhj.2002.125516. ISSN 0002-8703.
  11. ↑ Myerburg, Robert J.; Kessler, Kenneth M.; Mallon, Stephen M.; Cox, Marilyn M.; deMarchena, Eduardo; Interian, Alberto; Castellanos, Agustin (1992). "Life-Threatening Ventricular Arrhythmias in Patients with Silent Myocardial Ischemia Due to Coronary Artery Spasm". New England Journal of Medicine. 326 (22): 1451–1455. doi:10.1056/NEJM199205283262202. ISSN 0028-4793.
  12. ↑ Chevalier, Philippe; Dacosta, Antoine; Defaye, Pascal; Chalvidan, Thierry; Bonnefoy, Eric; Kirkorian, Gilbert; Isaaz, Karl; Denis, Bernard; Touboul, Paul (1998). "Arrhythmic Cardiac Arrest Due to Isolated Coronary Artery Spasm: Long-Term Outcome of Seven Resuscitated Patients". Journal of the American College of Cardiology. 31 (1): 57–61. doi:10.1016/S0735-1097(97)00442-7. ISSN 0735-1097.
  13. ↑ 13.0 13.1 Takagi, Yusuke; Yasuda, Satoshi; Tsunoda, Ryusuke; Ogata, Yasuhiro; Seki, Atsushi; Sumiyoshi, Tetsuya; Matsui, Motoyuki; Goto, Toshikazu; Tanabe, Yasuhiko; Sueda, Shozo; Sato, Toshiaki; Ogawa, Satoshi; Kubo, Norifumi; Momomura, Shin-ichi; Ogawa, Hisao; Shimokawa, Hiroaki (2011). "Clinical Characteristics and Long-Term Prognosis of Vasospastic Angina Patients Who Survived Out-of-Hospital Cardiac Arrest". Circulation: Arrhythmia and Electrophysiology. 4 (3): 295–302. doi:10.1161/CIRCEP.110.959809. ISSN 1941-3149.
  14. ↑ 14.0 14.1 Matsue, Yuya; Suzuki, Makoto; Nishizaki, Mitsuhiro; Hojo, Rintaro; Hashimoto, Yuji; Sakurada, Harumizu (2012). "Clinical Implications of an Implantable Cardioverter-Defibrillator in Patients With Vasospastic Angina and Lethal Ventricular Arrhythmia". Journal of the American College of Cardiology. 60 (10): 908–913. doi:10.1016/j.jacc.2012.03.070. ISSN 0735-1097.
  15. ↑ 15.0 15.1 Ahn, Jung-Min; Lee, Ki Hong; Yoo, Sang-Yong; Cho, Young-Rak; Suh, Jon; Shin, Eun-Seok; Lee, Jae-Hwan; Shin, Dong Il; Kim, Sung-Hwan; Baek, Sang Hong; Seung, Ki Bae; Nam, Chang-Wook; Jin, Eun-Sun; Lee, Se-Whan; Oh, Jun-Hyok; Jang, Jae Hyun; Park, Hyung Wook; Yoon, Nam Sik; Cho, Jeong Gwan; Lee, Cheol Hyun; Park, Duk-Woo; Kang, Soo-Jin; Lee, Seung-Whan; Kim, Jun; Kim, Young-Hak; Nam, Ki-Byung; Lee, Cheol Whan; Choi, Kee-Joon; Song, Jae-Kwan; Kim, You-Ho; Park, Seong-Wook; Park, Seung-Jung (2016). "Prognosis of Variant Angina Manifesting as Aborted Sudden Cardiac Death". Journal of the American College of Cardiology. 68 (2): 137–145. doi:10.1016/j.jacc.2016.04.050. ISSN 0735-1097.
  16. ↑ 16.0 16.1 Meisel, Simcha R.; Mazur, Alex; Chetboun, Israel; Epshtein, Menashe; Canetti, Menahem; Gallimidi, Jacob; Katz, Amos; Strasberg, Boris; Peled, Benny (2002). "Usefulness of implantable cardioverter-defibrillators in refractory variant angina pectoris complicated by ventricular fibrillation in patients with angiographically normal coronary arteries". The American Journal of Cardiology. 89 (9): 1114–1116. doi:10.1016/S0002-9149(02)02283-X. ISSN 0002-9149.

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