[dr461]

The Second Treatment Goal - Reduce Symptoms

Fortunately, most people who have PVCs do not "feel" them at all. However, some perceive their PVCs as palpitations, which they usually describe as "skips" or "pounding" that can vary from mildly annoying to extremely disturbing.
So, in addition to doing an evaluation for heart disease, sometimes it is necessary to consider doing something about the PVCs themselves, in order to reduce symptoms.

The treatment of PVCs would be easy if we had antiarrhythmic drugs that were both safe and effective at getting rid of PVCs. Unfortunately, this is not the case. So deciding whether to treat PVCs, and how to treat them, is often more difficult than one would think.

If your PVCs are not causing symptoms or if the palpitations you experience are not troublesome to you, the best thing to do is leave them alone. However, if your PVCs are causing palpitations sufficient to disrupt your life, then you and your doctor should discuss the options for treating PVCs.

First, ask yourself whether you ever "felt" your PVCs before your doctor discovered them. Sometimes, patients have no symptoms from their PVCs until their doctor expresses (inappropriate) alarm upon discovering them on an electrocardiogram. If this is what happened to you, there is a good chance that your physician-instigated heightened anxiety is worsening your palpitations. If this is the case, you should try to remind yourself that PVCs themselves are benign and that palpitations are not dangerous.

You should also strongly consider eliminating your intake of caffeine, which can increase the frequency of PVCs. The same thing goes for tobacco products and alcohol. There's also evidence that regular exercise can reduce palpitations in some people.

If your attempts to reassure yourself and to make appropriate lifestyle changes do not give you sufficient relief, you and your doctor may want to consider a trial of drug therapy.

If you opt for drug therapy, it is usually a good idea to start with a trial of beta blockers - drugs that blunt the effect of adrenaline. Beta blockers are not as effective as "true" antiarrhythmic drugs at eliminating PVCs, but they are safe and usually well tolerated. They will often reduce the PVCs themselves or the symptoms they cause.

The more powerful antiarrhythmic drugs are often reasonably effective at suppressing PVCs. However, these drugs are prone to cause significant problems. Chief among them is a tendency to cause "proarrhythmia" - that is, actually triggering arrhythmias that are far more dangerous than the PVCs. Proarrhythmia is particularly likely in people who have underlying heart disease, but it can happen to anyone. In addition, antiarrhythmic drugs each has its own unique toxicity profile that renders this class of drugs among the most toxic used in medicine.

If you decide for a trial of antiarrhythmic drugs, your doctor will need to carefully tailor drug selection in an attempt to minimize the odds of proarrhythmia and other possible toxicities. Since most doctors today have relatively little experience using these difficult drugs, it may be worthwhile asking to see a cardiac electrophysiologist (heart rhythm specialist).

[Susie]

Good article, has lots of great info.

[Chaoticdopey]

Good article