Can You Have AFib With PVC?

In this article, we will examine the relationship between atrial fibrillation (AFib) and premature ventricular complexes (PVCs). We will explore the risk factors, causes, diagnosis, and treatment options for these medical conditions.
Jakub Gwiazdecki

Jakub Gwiazdecki

Fifth year medical student at the Medical Faculty of Comenius University in Bratislava.

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Can You Have AFib With PVC?

Yes, it is possible to have atrial fibrillation (AFib) with premature ventricular complexes (PVCs). Both conditions are linked, as PVC increases the risk of AFib [1]. The higher the PVC burden, the higher the risk of AFib de novo [2].

However, individuals with PVC are not said to have AFib; there is only a high probability that they will get it.

What are premature ventricular complexes?

Premature ventricular complexes (PVCs) are additional and irregular heartbeats in the ventricle. As the name indicates, they occur prematurely, in between the normal beats. PVC is one of the most common arrhythmias and can be felt as a stronger or skipped heartbeat [3, 4].

During the day, it is normal that many people experience PVCs. Despite the high prevalence, those are usually harmless and not persistent events [5]. However, the additional beat can be a trigger for an arrhythmia, like ventricular tachycardia or fibrillation. When PVCs occur frequently, over time they can also lead to cardiomyopathy (disease of the cardiac muscle) [6].

While mostly asymptomatic, PVCs can sometimes cause symptoms such as heart palpitations, shortness of breath, dizziness, and heart failure. In patients with already-developed cardiac disease, those additional beats indicate an elevated risk for adverse outcomes [7].

What can cause PVC?

Many factors can cause PVCs. In most cases, the causes are unknown. However, there are a few risk factors that have been established to increase the risk of PVC occurrence.

Two of the biggest contributors to PVC development are high levels of stress and anxiety. Reduction in both can limit the occurrence of premature beats [8, 9].

High consumption of caffeine, alcohol, and nicotine can also induce PVCs. Caffeine and nicotine have a known cardiostimulatory effect, which can lead to PVCs. Another property of nicotine, which it shares with alcohol, is its toxicity. Substances like these can significantly disturb the electric pathways in the heart, also contributing to the creation of ectopic (additional) beats [8, 10].

The PVCs are electric impulses, and in the body, they are established by ions. Therefore, an electrolyte imbalance can also increase the risk of abnormal beat formation. Particularly dangerous are lower levels of potassium and magnesium, as well as high concentrations of calcium [8, 9].

The frequency of PVCs can increase due to a lack of sleep and the use of stimulant drugs [8, 9].

Also, some health conditions can increase the risk of PVCs. These include anemia, cardiomyopathy, high blood pressure, hyperthyroidism, and heart attack [9].

How is PVC diagnosed and treated?

Premature ventricular complex (PVC) can vary in symptoms from none to pronounced. During diagnosis, the most important thing is the exclusion of structural heart disease. In patients with more than ten thousand PVCs per 24 hours, a PVC-induced cardiomyopathy is suspected [11, 12].

Therefore, the diagnostic procedure includes echocardiography and Holter monitoring. In cases where the PVCs occur frequently or by chance and are recorded on a full 12-lead ECG, their origin can be estimated [13].

Upon exclusion of the structural heart disease and ECG or Holter confirmation, the diagnosis can be made. When the PVCs are a burden or, like in the case of a heart patient, pose a threat, treatment should be considered. Frequent PVCs may cause impaired left ventricular function, which is usually reversible after treatment [13].

In symptomatic patients, pharmacological therapy is indicated. All of the therapies have a good prognosis. Drugs used in the treatment are beta-blockers, or in healthy patients, nondihydropyridine calcium channel blockers. In cases of treatment failure with the above drugs, other antiarrhythmic medications can be considered, like amiodarone. However, the most effective treatment for PVCs is catheter ablation [11].

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Jakub Gwiazdecki

Jakub Gwiazdecki

Jakub is in his fifth year as a medical student at Comenius University in Bratislava, Slovakia. He has special interested in cardiology and in patient-centered medicine. His love for heart health isn't just book-smarts; he wants to know how it works, what it means for our feelings, and how key it is for health and happiness. Jakub thinks real good health care comes from always putting the patient at the centre, treating each person as a whole.