🧵 Great Review in @Heart_BMJ & accompanying podcast by @jhfrudd #DrBhargava on managing PVC’s
heart.bmj.com/content/early/…
Sharing a few personal learning takeaways:
heart.bmj.com/content/early/…
Sharing a few personal learning takeaways:
☠️ Is the PVC Benign?
✅ Likely Benign:
PVC burden <5% in a normal🫀from typical sites: RVOT, fascicular or papillary muscles more likely to be benign
❌ Likely Non-Benign:
PVC burden >5% in structural abnormal 🫀 from atypical sites (eg: epicardial) or multiple morphologies
✅ Likely Benign:
PVC burden <5% in a normal🫀from typical sites: RVOT, fascicular or papillary muscles more likely to be benign
❌ Likely Non-Benign:
PVC burden >5% in structural abnormal 🫀 from atypical sites (eg: epicardial) or multiple morphologies
⚡️Approaching PVCs
1. If PVC induced sustained VT/VF -> aggressively ⬇️ PVC with CA or AAD
2. Is LVEF normal?
2a. EF >50% - Mx is driven by PVC burden & symptoms: lifestyle, BB, CCB, CA/AAD
2b. EF <50% - is it PVC induced CM or PVC aggravated CM? CA or AAD if burden >5%
1. If PVC induced sustained VT/VF -> aggressively ⬇️ PVC with CA or AAD
2. Is LVEF normal?
2a. EF >50% - Mx is driven by PVC burden & symptoms: lifestyle, BB, CCB, CA/AAD
2b. EF <50% - is it PVC induced CM or PVC aggravated CM? CA or AAD if burden >5%
🔌 Localising PVCs
💊 Medical Mx
BB/CCB: useful in ⬇️ sympathetic tone, ⬇️ inotropy & chronotropy
Class 1C AAD: avoid in ⬇️EF or structural 🫀disease due to ⬆️ mortality risk from CAST Trial (1991, NEJM)
Class 3 AAD: Amiodarone reduced burden & risk of arrhythmic death in EMIAT & CAMIAT trials
BB/CCB: useful in ⬇️ sympathetic tone, ⬇️ inotropy & chronotropy
Class 1C AAD: avoid in ⬇️EF or structural 🫀disease due to ⬆️ mortality risk from CAST Trial (1991, NEJM)
Class 3 AAD: Amiodarone reduced burden & risk of arrhythmic death in EMIAT & CAMIAT trials
• • •
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