VPCs in ECG
Contents
ECG Quiz: Ventricular Premature Complexes (VPCs)
VPCs in ECG
VPCs in ECG – Risk Stratification (20 Key Points)
# | Parameter | High-Risk Features | Low-Risk Features |
---|---|---|---|
1 | Underlying heart disease | Structural heart disease (e.g. MI, cardiomyopathy) | Normal heart |
2 | Frequency | >10,000 VPCs/day or >10% burden | <1% burden, rare |
3 | Pattern | Bigeminy, couplets, triplets, runs | Isolated VPCs |
4 | Morphology | Polymorphic, multifocal | Monomorphic |
5 | VPC timing | R-on-T phenomenon | Occurs after T wave |
6 | Exercise stress test | VPCs in recovery phase | VPCs at peak exercise or absent |
7 | Symptoms | Syncope, presyncope, palpitations | Asymptomatic |
8 | Ejection fraction (EF) | LVEF <40% | LVEF >50% |
9 | Response to exercise | Increase in VPCs | Suppression with exercise |
10 | 24-hr Holter monitoring | >500 VPCs/hour | <30 VPCs/hour |
11 | Couplets/triplets | Present | Absent |
12 | Sustained VT history | Present | Absent |
13 | Family history of SCD | Present | Absent |
14 | VPC burden effect on LV | LV dysfunction (PVC-induced cardiomyopathy) | No effect on LV |
15 | Fusion beats | Seen (suggests re-entry) | Absent |
16 | QT interval | Prolonged QT with VPCs → torsades risk | Normal QT |
17 | Presence of scar (MRI) | Scar/fibrosis seen | Normal myocardium |
18 | Response to beta blockers | Poor/no response | Symptom relief |
19 | Inducibility on EP study | VT inducible | Not inducible |
20 | ICD indication | Meets primary/secondary prevention criteria | Not indicated |