p.55 抽出テキスト

Patient with PVCs / Monomorphic VT and non- a ppa r ent SHD a

ECG , Holte

, r, and echoca

, r diogram

Assessment

Assessment

>20% PVCs R V

R R O T / Fascicular PVC/VT

O O d

Symptoms c

>10% PVCs

Discharge e Go to fl o wcha r t

PVC-induced ca r dio

r r m yopat h y (Figu r e 18)

SHD or PVC-induced ca r dio m y opat h y CMR (Class IIa)

Inconclusi v e or atypical p r esentation b

Catheter ablation

(Class I) Beta-bloc k ers,

k k CCB or Flecainide (Class IIa) B et a -bl oc k er

k k o

r r CC B (Cl ass I ) Flecainide (Class IIa) Catheter ablation

(Class IIa)

Regular f oll f f o w-up L VEF

L L (Class I)

Structural abnormal hea r t

Idiopathic PVC/ VT

Structural normal hea r t

Regular f oll f f o w-up L VEF

L L (Class I)

Catheter ablation

(Class IIb)

Y Y Y Y N

N

N

N

Figure 17 Algorithm for the management of patients with idiopathic premature ventricular complexes/ventricular tachycardia and non-apparent structural heart disease. CCB, calcium channel blocker; CMR, cardiac magnetic resonance; ECG, electrocardiogram; LVEF, left ventricular ejection fraction; N, No; PVC, premature ventricular complex; RVOT, right ventricular outflow tract; SHD, structural heart disease; VT, ventricular tachycardia; Y, Yes. aNon-apparent SHD is defined by lack of significant abnormalities in physical examination, basal ECG, and echocardiogram. bAtypical presentation: e.g. older age, right bundle branch block morphology, sustained monomorphic VT consistent with re-entry. cSymptoms should be relevant and related to PVC/VT. dOrigin suspected by ECG or confirmed during electrophysiological evaluation. eConsider re-evaluation in case of new symptoms or changes in patient clinical condition.

Table 9 Summary of the recommendations for the treatment of patients with frequent idiopathic premature ventricular complexes/ventricular tachycardia or premature ventricular complex-induced cardiomyopathy

Ablation Beta-blocker CCB Flecainide Amiodarone

RVOT/fascicular PVC/VT: Symptomatic, normal LV function Class I Class IIa Class IIa Class IIa Class III PVC/VT other than RVOT/fascicular: Symptomatic, normal LV function Class IIa Class I Class I Class IIa Class III RVOT/fascicular PVC/VT: LV dysfunction Class I Class IIa Class IIIa Class IIab Class IIa PVC/VT other than RVOT/fascicular: LV dysfunction Class I Class IIa Class IIIa Class IIab Class IIa PVC: Burden .20%, asymptomatic, normal LV function Class IIb Class III © ESC 2022

CCB, calcium channel blocker; LV, left ventricular; PVC, premature ventricular complex; RVOT, right ventricular outflow tract; VT, ventricular tachycardia. aIntravenous calcium channel blockers. bIn selected patients (only moderate LV dysfunction). Downloaded from academic.oup.com/eurheartj/article/43/40/3997/6675633 by guest on 07 October 2026