Premature ventricular contraction electrocardiogram
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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
- The beats are premature in relation to the expected beat of the basic rhythm.
- 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.
- 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.
- 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).
- Retrograde capture may or may not occur.
- 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.
- Occasionally PVCs may be interpolated:
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] |
References
- ↑ Chou's Electrocardiography in Clinical Practice Third Edition, pp. 398-409.
- ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:194 ISBN 1591032016
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.