How Should PVCs Be Treated?

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If you have heart palpitations (also known as PVC's or premature ventricle contractions) you are now aware of your heartbeat. This is a common problem. Even though your heart beat may feel irregular, because you are not usually supposed to be aware of it, it just does its thing, like breathing. Most often PVC's are harmless.
The answer to this question would be easy if we had antiarrhythmic drugs that a) successfully suppressed PVCs, and b) were safe.
Unfortunately, we don’t have antiarrhythmic drugs that fill these criteria. Most antiarrhythmic drugs are relatively poor at treating PVCs (though they often reduce their frequency.) And, all antiarrhythmic drugs can make dangerous arrhythmias more likely. In addition, each of these drugs has its own unique toxicity profile – some more ominous than others – that render these drugs, as a group, among the most toxic used in medicine.
Thus, both doctors and patients should always be very reluctant to treat PVCs with antiarrhythmic drugs.
On occasion, eliminating caffeine intake, as well as tobacco and alcohol usage, may reduce the frequency of PVCs, and these measures should be tried. For some patients, using beta blockers (drugs that block the effect of adrenaline) might reduce arrhythmias.
Since beta blockers are generally well tolerated and do not make the irregular heart beat worse, they are also often worth a try. Also, patients with palpitations should be checked thoroughly. If the patient was without symptoms until the physician’s expression of alarm at seeing PVCs, there is a good chance that a heightened state of anxiety is exacerbating the patient’s palpitations.
In these cases, carefully explaining the benign nature of the arrhythmia may be enough to reduce symptoms to a tolerable level. At the end of the day, however, most patients who have PVCs will continue to have them, and some (fortunately, a small minority) will experience intolerable palpitations.
If PVC-induced palpitations truly are disruptive to a person’s life, then trying to suppress the PVCs with antiarrhythmic drugs becomes a reasonable consideration. Before undertaking this endeavor, however, both parties (the doctors and the patient) should agree on several points:
Both parties should explicitly acknowledge their understanding that the PVCs themselves are not dangerous, whereas the antiarrhythmic drugs potentially are. Thus, both parties must explicitly accept that a certain amount of risk is inherent in using these drugs, no matter what precautions are taken. Then, having agreed on this point, both parties should agree to take every possible precaution to avoid significant problems with the drugs.

Summary:
While PVCs are not dangerous themselves, sometimes they are a marker for underlying cardiac diseases that are dangerous. Thus, if your doctors find a PVC, he or she doctor should evaluate you for possible undiagnosed heart disease. If such disease is found, then instituting optimal therapy often reduces any risk of sudden death.
Patients who have benign but strongly symptomatic PVCs often have a difficult choice to make – living with the PVCs and the palpitations they cause, or trying frequently ineffective and often toxic antiarrhythmic drugs. If drug therapy is chosen, then appropriate precautions can reduce (but not eliminate) the risk of irreversibly bad outcomes.
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