VPCs in ECG

ECG Quiz: Ventricular Premature Complexes (VPCs)


VPCs in ECG

VPCs in ECG – Risk Stratification (20 Key Points)

#ParameterHigh-Risk FeaturesLow-Risk Features
1Underlying heart diseaseStructural heart disease (e.g. MI, cardiomyopathy)Normal heart
2Frequency>10,000 VPCs/day or >10% burden<1% burden, rare
3PatternBigeminy, couplets, triplets, runsIsolated VPCs
4MorphologyPolymorphic, multifocalMonomorphic
5VPC timingR-on-T phenomenonOccurs after T wave
6Exercise stress testVPCs in recovery phaseVPCs at peak exercise or absent
7SymptomsSyncope, presyncope, palpitationsAsymptomatic
8Ejection fraction (EF)LVEF <40%LVEF >50%
9Response to exerciseIncrease in VPCsSuppression with exercise
1024-hr Holter monitoring>500 VPCs/hour<30 VPCs/hour
11Couplets/tripletsPresentAbsent
12Sustained VT historyPresentAbsent
13Family history of SCDPresentAbsent
14VPC burden effect on LVLV dysfunction (PVC-induced cardiomyopathy)No effect on LV
15Fusion beatsSeen (suggests re-entry)Absent
16QT intervalProlonged QT with VPCs → torsades riskNormal QT
17Presence of scar (MRI)Scar/fibrosis seenNormal myocardium
18Response to beta blockersPoor/no responseSymptom relief
19Inducibility on EP studyVT inducibleNot inducible
20ICD indicationMeets primary/secondary prevention criteriaNot indicated
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