From Guidelines to Innovation: The Evolving Paradigm of Premature Ventricular Complex Management

Abstract

Context: Premature ventricular complexes (PVCs) are among the most common arrhythmias encountered in clinical practice, affecting up to 75% of individuals during prolonged monitoring. However, their management remains unstructured and inconsistent across centers. Recent studies demonstrate that a high PVC burden independently predicts adverse cardiovascular outcomes, including atrial fibrillation, heart failure, and increased mortality. Nonetheless, current therapeutic approaches rely largely on expert judgment rather than on standardized, evidence-based algorithms. Evidence Acquisition: This narrative review synthesized current evidence on the management of PVCs, including their diagnosis, risk stratification, and treatment options. PubMed and major cardiology journals were searched for publications from 2015 to 2025 using terms including "premature ventricular complex," "PVC management," "catheter ablation," and "ventricular ectopy." Recent systematic reviews, meta-analyses, randomized controlled trials, and major clinical practice guidelines, including the 2017 AHA/ACC/HRS and 2022 ESC guidelines, were prioritized. ClinicalTrials.gov was also searched for ongoing trials relevant to the diagnosis and treatment of PVCs. Results: Recent advances in diagnostic imaging, ablation technology, machine learning, and novel pharmacological agents are increasingly challenging traditional management paradigms. In addition, ongoing clinical trials are evaluating innovative therapeutic approaches and standardized protocols. Conclusions: This narrative review synthesizes current evidence on PVC management, discusses recent findings that are reshaping clinical practice, and presents a vision for the future paradigm of PVC care. In this vision, management becomes truly personalized and guided by objective data. This approach may enable improved diagnostic strategies, refined patient selection criteria, and technological innovations that optimize outcomes for patients with PVCs.