Premature ventricular contraction electrocardiogram: Difference between revisions

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/* 2017 AHA/ACC/HRS Guideline for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (DO NOT EDIT){{cite journal|last1=Al-Khatib|first1=Sana M.|last2=Stevenson|first2=William G.|last3=Ackerman|first3=Michael...
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| bgcolor="LightGreen"|<nowiki></nowiki>'''1.''' Ambulatory electrocardiographic monitoring is useful to evaluate whether symptoms, including palpitations, presyncope, or
| bgcolor="LightGreen"|<nowiki></nowiki>'''1.''' Ambulatory electrocardiographic monitoring is useful to evaluate whether symptoms, including palpitations, presyncope, or
syncope, are caused by VA ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B-NR]])''.<ref name="BarrettKomatireddy2014">{{cite journal|last1=Barrett|first1=Paddy M.|last2=Komatireddy|first2=Ravi|last3=Haaser|first3=Sharon|last4=Topol|first4=Sarah|last5=Sheard|first5=Judith|last6=Encinas|first6=Jackie|last7=Fought|first7=Angela J.|last8=Topol|first8=Eric J.|title=Comparison of 24-hour Holter Monitoring with 14-day Novel Adhesive Patch Electrocardiographic Monitoring|journal=The American Journal of Medicine|volume=127|issue=1|year=2014|pages=95.e11–95.e17|issn=00029343|doi=10.1016/j.amjmed.2013.10.003}}</ref><ref name="TurakhiaHoang2013">{{cite journal|last1=Turakhia|first1=Mintu P.|last2=Hoang|first2=Donald D.|last3=Zimetbaum|first3=Peter|last4=Miller|first4=Jared D.|last5=Froelicher|first5=Victor F.|last6=Kumar|first6=Uday N.|last7=Xu|first7=Xiangyan|last8=Yang|first8=Felix|last9=Heidenreich|first9=Paul A.|title=Diagnostic Utility of a Novel Leadless Arrhythmia Monitoring Device|journal=The American Journal of Cardiology|volume=112|issue=4|year=2013|pages=520–524|issn=00029149|doi=10.1016/j.amjcard.2013.04.017}}</ref><nowiki/>
syncope, are caused by VA ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B-NR]])''.<ref name="BarrettKomatireddy2014">{{cite journal|last1=Barrett|first1=Paddy M.|last2=Komatireddy|first2=Ravi|last3=Haaser|first3=Sharon|last4=Topol|first4=Sarah|last5=Sheard|first5=Judith|last6=Encinas|first6=Jackie|last7=Fought|first7=Angela J.|last8=Topol|first8=Eric J.|title=Comparison of 24-hour Holter Monitoring with 14-day Novel Adhesive Patch Electrocardiographic Monitoring|journal=The American Journal of Medicine|volume=127|issue=1|year=2014|pages=95.e11–95.e17|issn=00029343|doi=10.1016/j.amjmed.2013.10.003}}</ref><ref name="TurakhiaHoang2013">{{cite journal|last1=Turakhia|first1=Mintu P.|last2=Hoang|first2=Donald D.|last3=Zimetbaum|first3=Peter|last4=Miller|first4=Jared D.|last5=Froelicher|first5=Victor F.|last6=Kumar|first6=Uday N.|last7=Xu|first7=Xiangyan|last8=Yang|first8=Felix|last9=Heidenreich|first9=Paul A.|title=Diagnostic Utility of a Novel Leadless Arrhythmia Monitoring Device|journal=The American Journal of Cardiology|volume=112|issue=4|year=2013|pages=520–524|issn=00029149|doi=10.1016/j.amjcard.2013.04.017}}</ref><ref name="TurakhiaHoang2013">{{cite journal|last1=Turakhia|first1=Mintu P.|last2=Hoang|first2=Donald D.|last3=Zimetbaum|first3=Peter|last4=Miller|first4=Jared D.|last5=Froelicher|first5=Victor F.|last6=Kumar|first6=Uday N.|last7=Xu|first7=Xiangyan|last8=Yang|first8=Felix|last9=Heidenreich|first9=Paul A.|title=Diagnostic Utility of a Novel Leadless Arrhythmia Monitoring Device|journal=The American Journal of Cardiology|volume=112|issue=4|year=2013|pages=520–524|issn=00029149|doi=10.1016/j.amjcard.2013.04.017}}</ref>
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===Recommendation for Implanted Cardiac Monitors===
 
{|class="wikitable"
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ESC guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon" |<nowiki></nowiki>'''1.'''  In patients with sporadic symptoms (including syncope) suspected to be related to VA, implanted cardiac monitors can be
useful ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B-R]].''<ref name="KrahnKlein1999">{{cite journal|last1=Krahn|first1=Andrew D.|last2=Klein|first2=George J.|last3=Yee|first3=Raymond|last4=Takle-Newhouse|first4=Teri|last5=Norris|first5=Caro|title=Use of an Extended Monitoring Strategy in Patients With Problematic Syncope|journal=Circulation|volume=99|issue=3|year=1999|pages=406–410|issn=0009-7322|doi=10.1161/01.CIR.99.3.406}}</ref><ref name="SolbiatiCostantino2016">{{cite journal|last1=Solbiati|first1=Monica|last2=Costantino|first2=Giorgio|last3=Casazza|first3=Giovanni|last4=Dipaola|first4=Franca|last5=Galli|first5=Andrea|last6=Furlan|first6=Raffaello|last7=Montano|first7=Nicola|last8=Sheldon|first8=Robert|title=Implantable loop recorder versus conventional diagnostic workup for unexplained recurrent syncope|journal=Cochrane Database of Systematic Reviews|year=2016|issn=14651858|doi=10.1002/14651858.CD011637.pub2}}</ref><ref name="VolosinStadler2013">{{cite journal|last1=Volosin|first1=K.|last2=Stadler|first2=R. W.|last3=Wyszynski|first3=R.|last4=Kirchhof|first4=P.|title=Tachycardia detection performance of implantable loop recorders: results from a large 'real-life' patient cohort and patients with induced ventricular arrhythmias|journal=Europace|volume=15|issue=8|year=2013|pages=1215–1222|issn=1099-5129|doi=10.1093/europace/eut036}}</ref><ref name="Bloch ThomsenJons2010">{{cite journal|last1=Bloch Thomsen|first1=Poul Erik|last2=Jons|first2=Christian|last3=Raatikainen|first3=M.J. Pekka|last4=Moerch Joergensen|first4=Rikke|last5=Hartikainen|first5=Juha|last6=Virtanen|first6=Vesa|last7=Boland|first7=J.|last8=Anttonen|first8=Olli|last9=Gang|first9=Uffe Jakob|last10=Hoest|first10=Nis|last11=Boersma|first11=Lucas V.A.|last12=Platou|first12=Eivin S.|last13=Becker|first13=Daniel|last14=Messier|first14=Marc D.|last15=Huikuri|first15=Heikki V.|title=Long-Term Recording of Cardiac Arrhythmias With an Implantable Cardiac Monitor in Patients With Reduced Ejection Fraction After Acute Myocardial Infarction|journal=Circulation|volume=122|issue=13|year=2010|pages=1258–1264|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.109.902148}}</ref><nowiki/>
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Revision as of 23:16, 15 April 2020

Premature ventricular contraction Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mugilan Poongkunran M.B.B.S [2]

Overview

When looking at an electrocardiograph, premature ventricular contractions are easily spotted and therefore a definitive diagnosis can be made. The QRS and T waves look very different to normal readings. The spacing between the PVC and the preceding QRS wave is a lot shorter than usual and the time between the PVC and the proceeding QRS is a lot longer. However, the time between the preceding and proceeding QRS waves stays the same as normal due to the compensatory pause.

Electrocardiogram

  1. The beats are premature in relation to the expected beat of the basic rhythm.
  2. Ectopic beats from the same focus tend to have a constant coupling interval (the interval between the ectopic beat and the preceding beat of the basic sinus rhythm).
    • They do not vary from each other by more than 0.08 seconds if the focus is the same.
    • PVCs with the same morphology but with a varying coupling interval should make one suspect a parasystolic mechanism.
    • A longer RR interval is followed by a relatively longer coupling interval.
  3. The QRS complex is abnormal in duration and configuration. There are secondary ST segment and T wave changes. The morphology of the QRS may vary in the same patient.
    • If the PVC originates from the RV then the QRS has a LBBB morphology.
    • The duration of the QRS is >0.12 seconds, but a narrower QRS may occur if the focus is higher in the septum.
    • The T wave is inverted and the ST segment is depressed.
  4. There is usually a full compensatory pause following the PVC.
    • The sum of the RR intervals that precede and follow the ectopic beat (or the RR interval that contains the PVC) equals two RR intervals of the sinus beats.
    • Because of sinus arrhythmia, the RR interval that contains the PVC may not be exactly twice the duration of the RR interval of the adjacent sinus beat, even though a full compensatory pause does exist).
  5. Retrograde capture may or may not occur.
  6. They may occur in various frequency and distribution patterns such as bigeminy, trigeminy (occurrence of a PVC every third beat), quadrigeminy (occurrence of a PVC every fourth beat), and couplets (two ventricular premature complexes in a row). These are called complex PVCs.
    • The Rule of Bigeminy:
      1. PVCs frequently occur after a long RR interval
      2. The compensatory pause of the precipitated PVC constitutes another long RR interval, which in turn favors the appearance of another PVC
      3. Therefore bigeminy tends to perpetuate itself
  7. Occasionally PVCs may be interpolated:
    • Between 2 beats without disturbing NSR
    • Occurs mostly when the NSR is slow and the PVC is early
    • The PR following the PVC is nearly always prolonged because of concealed retrograde conduction of the ectopic ventricular impulse, which renders the AV junction partially refractory.[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 12-lead ECG and Exercise Testing

Class I
1. In patients with VA symptoms associated with exertion, suspected ischemic heart disease, or catecholaminergic polymorphic ventricular tachycardia, exercise treadmill testing is useful to assess for exercise-induced VA (Level of Evidence: B-NR).[4][5]

2. In patients with suspected or documented VA, a 12-lead ECG should be obtained in sinus rhythm to look for evidence of heart disease (Level of Evidence: B-NR).[6]

Recommendation for Ambulatory Electrocardiography

Class I
1. Ambulatory electrocardiographic monitoring is useful to evaluate whether symptoms, including palpitations, presyncope, or

syncope, are caused by VA (Level of Evidence: B-NR).[7][8][8]


Recommendation for Implanted Cardiac Monitors

Class IIa
1. In patients with sporadic symptoms (including syncope) suspected to be related to VA, implanted cardiac monitors can be

useful (Level of Evidence: B-R.[9][10][11][12]

References

  1. ↑ Chou's Electrocardiography in Clinical Practice Third Edition, pp. 398-409.
  2. ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:194 ISBN 1591032016
  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. ↑ Elhendy, Abdou; Chandrasekaran, Krishnaswamy; Gersh, Bernard J; Mahoney, Douglas; Burger, Kelli N; Pellikka, Patricia A (2002). "Functional and prognostic significance of exercise-induced ventricular arrhythmias in patients with suspected coronary artery disease". The American Journal of Cardiology. 90 (2): 95–100. doi:10.1016/S0002-9149(02)02428-1. ISSN 0002-9149.
  5. ↑ Grady, Thomas A. (1998). "Prognostic Significance of Exercise-Induced Left Bundle-Branch Block". JAMA. 279 (2): 153. doi:10.1001/jama.279.2.153. ISSN 0098-7484.
  6. ↑ Pérez-Rodon, Jordi; Martínez-Alday, Jesus; Barón-Esquivias, Gonzalo; Martín, Alfonso; García-Civera, Roberto; del Arco, Carmen; Cano-Gonzalez, Alicia; Moya-Mitjans, Àngel (2014). "Prognostic value of the electrocardiogram in patients with syncope: Data from the Group for Syncope Study in the Emergency Room (GESINUR)". Heart Rhythm. 11 (11): 2035–2044. doi:10.1016/j.hrthm.2014.06.037. ISSN 1547-5271.
  7. ↑ Barrett, Paddy M.; Komatireddy, Ravi; Haaser, Sharon; Topol, Sarah; Sheard, Judith; Encinas, Jackie; Fought, Angela J.; Topol, Eric J. (2014). "Comparison of 24-hour Holter Monitoring with 14-day Novel Adhesive Patch Electrocardiographic Monitoring". The American Journal of Medicine. 127 (1): 95.e11–95.e17. doi:10.1016/j.amjmed.2013.10.003. ISSN 0002-9343.
  8. ↑ 8.0 8.1 Turakhia, Mintu P.; Hoang, Donald D.; Zimetbaum, Peter; Miller, Jared D.; Froelicher, Victor F.; Kumar, Uday N.; Xu, Xiangyan; Yang, Felix; Heidenreich, Paul A. (2013). "Diagnostic Utility of a Novel Leadless Arrhythmia Monitoring Device". The American Journal of Cardiology. 112 (4): 520–524. doi:10.1016/j.amjcard.2013.04.017. ISSN 0002-9149.
  9. ↑ Krahn, Andrew D.; Klein, George J.; Yee, Raymond; Takle-Newhouse, Teri; Norris, Caro (1999). "Use of an Extended Monitoring Strategy in Patients With Problematic Syncope". Circulation. 99 (3): 406–410. doi:10.1161/01.CIR.99.3.406. ISSN 0009-7322.
  10. ↑ Solbiati, Monica; Costantino, Giorgio; Casazza, Giovanni; Dipaola, Franca; Galli, Andrea; Furlan, Raffaello; Montano, Nicola; Sheldon, Robert (2016). "Implantable loop recorder versus conventional diagnostic workup for unexplained recurrent syncope". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD011637.pub2. ISSN 1465-1858.
  11. ↑ Volosin, K.; Stadler, R. W.; Wyszynski, R.; Kirchhof, P. (2013). "Tachycardia detection performance of implantable loop recorders: results from a large 'real-life' patient cohort and patients with induced ventricular arrhythmias". Europace. 15 (8): 1215–1222. doi:10.1093/europace/eut036. ISSN 1099-5129.
  12. ↑ Bloch Thomsen, Poul Erik; Jons, Christian; Raatikainen, M.J. Pekka; Moerch Joergensen, Rikke; Hartikainen, Juha; Virtanen, Vesa; Boland, J.; Anttonen, Olli; Gang, Uffe Jakob; Hoest, Nis; Boersma, Lucas V.A.; Platou, Eivin S.; Becker, Daniel; Messier, Marc D.; Huikuri, Heikki V. (2010). "Long-Term Recording of Cardiac Arrhythmias With an Implantable Cardiac Monitor in Patients With Reduced Ejection Fraction After Acute Myocardial Infarction". Circulation. 122 (13): 1258–1264. doi:10.1161/CIRCULATIONAHA.109.902148. ISSN 0009-7322.

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