Premature ventricular contractions (PVCs)

Hi All,

Putting aside my previous problems post pacemaker surgery which now seem to be mostly solved, I've a question concerning Premature Ventricular Contractions (PVCs).

My Electrocardiologist informs me that despite getting PVCs (which at times can be quite severe) they should not be cause for concern unless they become regular. His definition of regular being more than 100 of them per DAY. He stated that most people, even those without a pacemaker or heart problems, will have PVCs and not realise because they are so mild.

At the moment I get maybe two per week, the worst of which has me feeling as though I will faint. My surgeon assures me that this will not happen and gave me a detailed explanation of what's occuring during a PVC event which went some way to reassuring me that everything is aok.

I have Mobitz Type II heart block (hence the pacemaker surgery) and my medication is 2.5mg Bisoprolol which was prescribed when they discovered the PVCs. I was getting regular but very mild PVCs before taking the Bisop but now they are less regular but much more obvious and debilitating when they do occur.

Anyone here had a similar experience?


Bisoprolol and ectopics

by Gemita - 2021-12-15 05:52:32

Paul, yes I can suffer from PVCs as well as PACs and other arrhythmias.  Unfortunately putting some of us on beta blockers like Bisoprolol (which I also take to control my heart rate during atrial fibrillation) for ectopics may just worsen rather than improve our situation.  Some of my PVCs are actually caused by the slowing of my heart rate and a beta blocker will do this of course.  

Do you know what your base rate (minimum rate) is set at?  At 70 bpm my lower rate outpaces and effectively helps to eradicate slow ectopics like PACs and PVCs.  If you haven't any other arrhythmias, you could ask:

1) whether you could reduce Bisoprolol to 1.25 mg lowest dose?

2) whether you could increase your base rate from your present setting?

Both these measures might help + get your electrolytes checked, keep hydrated, reduce caffeine, alcohol and stress.  Get adequate sleep

Prior to my pacemaker I was getting prolonged ectopics daily and they were triggering other more significant arrhythmias.  I was very unstable with them.  They may be benign but they can still cause some of us troublesome symptoms.  I presume they have ruled out all other possible causes?


by paulh - 2021-12-15 07:15:23

Good Morning Gemita, I recall you answering some of my queries last year post implant. It took over 6 months and multiple visits to the pacemaker clinic before someone would actually listen to what I was telling them...

In relation to the PVCs, My base rate is 70, it started off lower but just wasn't doing the job at that level. I was also switched from single to dual chamber pacing. The PVCs were 'found' when the clinic put me on a treadmill and subsequently prescribed Bisop. However they (PVCs) occur at any time not only when I increase my activity levels and as I said previously they have become much less frequent but way more intense. Very strange.

On my last consultants visit I expressed concern over the PVCs but he had no issue with them because they are so infrequent. The flip side of that of course is that I could be having multiple events but just not noticing them, only the 'heavier' events becoming evident. He did state that these would be recorded by the PM. When I do get one of the more intense PVCs it's quite worrying to be honest.

We haven't discussed other causes. not sure why but it's just never come up in conversation. However one thing I will run by the medical team is that I was treated for hyperthyroidism, it was many years ago and is something I've never thought to inform them of until now. I know that it can be the cause of many heart irregularities.




by Gemita - 2021-12-15 08:38:56

Paul, you sound as though you are making progress.

It is possible that you have got other things going on as well as a few PVCs and unless you have had any recent pacemaker checks/downloads or are being frequently monitored, they may not see the extent of this.  Also my EP has got my pacemaker set up to aggressively reject all ectopics because there simply wouldn’t be enough space to record and store all my arrhythmias. 

The only sure way to see the total daily burden of your PVCs is to request external monitoring and the longer the better because arrhythmias can be difficult to pick up sometimes in a 24 hour period, so you need 7 day or longer to get to know what is normal for you.  Not sure in present climate they will want to do this for simple infrequent ectopics, but push if you are really symptomatic because a more significant arrhythmia could be present.

PVCs - the long pause, followed by a thump can really be destabilising especially if they occur frequently.  It feels as though my heart rate is falling to pre pacemaker levels when I get runs of PVCs, so I know exactly what you are feeling.

Yes, even the smallest changes in thyroid hormones can trigger arrhythmias, so a thyroid function blood test is advisable Paul.

Stop the meds?

by Gotrhythm - 2021-12-15 12:06:35

I've never had this PVC issue specifically, but I have certainly had PVCs that would bring me to my knees. It can be frustrating to be told that they are benign when there's nothing benign about them in my experience. 

I don't begin to have the grasp of arrythmias and medications that Gemitra does, but if I'm understanding your post correctly, the medication was given to help with PVCs but in fact, is making them fewer but worse, i.e. you are more symtomatic. 

If there is no reason other than PVCs for the medication, the solution is simple. Ask the doctor to stop the meds.

It's really a quality of life issue. Only you can say which you would rather have, more PVCs or fewer PVCs that make you feel really bad. 

There's a really good Youtube video on PVCs. I don't have the url. You'll have to type in Dr Joshua Cooper PVCs in Plain English. Sometimes seeing a picture when listening to an explanation helps.


by AgentX86 - 2021-12-15 14:20:33

PCVs are almost always benign, though often are a RPITA. 100/day is nothing.  I've been told that unless they get to 30%, they're not taken seriously.  I can't imagine it's that high but it seems that if they aren't interrupting the heart so much that it can't get oxygen to the rest of the body, they're not a big risk.  They are "uncomfortable" in strings or bi/trigeminy (the understatement of the week).

Gemita is right.  PVCs are the ventricals' "escape rhythm" poking through, much like PACs often are for the atria. Since the escape rhythms are usually pretty low (ventricular, usually 15-20bpm), getting one a second is unusual.  It aslo means that the higher the heart rate, the further from "normal" and the fewer PVCs make it through.  My HR was set to 80bpm because of bigeminy PVCs soon after my implant.  It's never been lowered (something I should ask about).


by AgentX86 - 2021-12-15 18:13:22

Benign, in this case, means that they're not dangerous (i.e. they won't kill you). Afib, by itself, is pretty benign, too.  It's the accompanying blood clots and cardiomyopathy that aren't so good. Though not dangerous PVCs can make your life miserable, though (they sure do me).

I sure wouldn't trade frequent but asymptomatic PVCs for rare but syptomatic PVCs.  If I don't feel it, I don't care (much like my permanent flutter, now).

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