Are ventricular pairs dangerous? - heart rate (2023)

Autobahn 1991

I just got my Holter monitor results
Cup from 59 to 185 l/min
EVs were frequent (1090) and included 3 triplets and 12 couplets.
25 ventricular tachycardia bursts were recorded
Longest run at 158 ​​beats, fastest 120 bpm
1 "ventricular run" at 14:44 appears to be a 66 bpm ventricular pace
AEs were rare (45) _ 4 pairs of auricles
1 atrial race consisting of 4 beats with a maximum rate of 188 bpm
2.5 hours of atrial fibrillation was recorded, which corresponds to 18% of the recording
The maximum frequency was 185 bpm.

As I have a pacemaker because my heart rate was 28, with Warfarin, Aspro and Minax (2 per day). I still don't know what that means, I can't go to the doctor until May.

Should I be worried???




This is probably similar to my holter and just as confusing. On the one hand, I don't quite understand how supraventricular ectopia (SLV) and ventricular ectopia (LV) tend to exist in the same heart. Both are EVS but only one looks like an EV because the holter makes it look like an EV, or does the freak make it look like an EV? What is the probability that both conditions coexist independently of each other?

Next thing I find out here is that I don't know how to count PVCs. Are we saying that a PVC can be a VE event or an EVS event? And how many is too many for one day?

I suspect this is a daily log output, which would make 4009 a good PVC number. Hence the comment that the number is "very common". In this case, you should consider ablation to eliminate the source of the problem, or at least continue talking to your doctor. Too frequent PVCs can be bad for you in the long run.




I'm not sure if that really matters. It really takes a doctor's opinion to appreciate the importance of something I like. You said you had a "consultant" look at it? hmm In fact, I'm very picky about who I let read and interpret my EKG and/or Holter results. Is a consultant a regular doctor or someone with equal qualifications?

I would not stop until I had a satisfactory explanation of the cardiac/thoracic symptoms you were told did not register electrical activity on the Holter monitor. If you have used a manually triggered loop recorder, you can request a full printout of all recorded data. To validate the data, you would at least expect to see a trace and timestamp every time you activate the recorder. Convince yourself of these traces. A PVC is easy to spot, so you should be able to understand at least some of the recordings. If not, you should also consider getting checked out by a doctor.




You really should talk to your cardiologist about your results. I'm a bit confused but the different numbers where one says I isolated 28333 and the other says 4009. I had 2 different monitors, are these 2 different times? They basically have a variety of different types of PVC. Isolation and coupling are nothing to worry about. VT runs are a little more concerning than other crashes, but they don't last long enough to be a cause for concern. That said, you should really check with your doctor if there are any additional steps you need to take. If you haven't already, you should probably get a full cardiac exam, an EKG, an echo, and maybe some tests. If your heart is structurally sound, tubal formation isn't usually a cause for concern, but do discuss it with your doctor. Do you find that exercise improves or worsens tubal pain? Be careful.



(Video) PVCs: Symptoms and Treatment - in Plain English!

Shannon Leroux

Supraventricular Ectopia - 1781 Isolated
106 Couplets

Ventricular ectopy

2833 isolated
52 Couplets
10 races
43 falls while racing
31 longest beats out of 116
11 fastest crossbows with 220 beats per minute.

46 min heart - 71 average
183 max

Very common 4009 isolated PVC and 7 pairs of ventricles
8 Nonsustained broad complex stroke compatible with ventricular tachycardia.
The longest barrel consisted of 25 strokes at 199 bpm and the fastest was 11 crossbows at 204 bpm
121 Occasionally isolated CAP and atrium pair.
Faster than normal rate correlation with VT of 15 beats at 200 bpm

I'm not sure how to read this holter I just received... I'm a 40 year old elite athlete with a very healthy albiet and a dimly lit heart... Perhaps you can tell me what you are about think those numbers . it would be so appreciated...I'm say the least.

Thanks very much,





Hi Steve, I am a 44 year old male with Ebstein anomaly (CHD). In the last year I've had arrhythmias totaling about 1,500 ventricular premature beats in a 24 hour period with about 10 ventricular pairs measured with a Holter I believe. My advisor told me the amount was fine and gave me the option of taking a low dose beta blocker to control the rhythm. He advises that if the couplets were triplets or worse, he would definitely prescribe beta blockers to smooth things out. So I see that the couplets aren't necessarily dangerous and I'm very happy to live with the arrhythmias without having to take medication to control them. If they get worse, maybe I'll think differently. I find it strange that I notice them more when I'm "at rest" which is in the afternoon and at night. During an exercise test on a treadmill, they found that arrhythmias were almost non-existent! Did you think that when the heart is stressed, this is the time when it would not be efficient? He suggested lots of fruits to increase potassium levels in the heart. I hope it helps.




(Video) The man with 20000 PVCs


I had captured 4 and 5 PVC in a row (NSVT) on the monitors. My heart was a bit worried at first and he sent me to an EP Dr at Duke. But after I had the heart MRI, they said that with a structurally normal heart, it should be fine as long as I don't pass out or last more than 30 seconds. Only then would they consider a PE study/ablation.




Hello Rilesnik

Yes, I've heard that before.

The strange thing is that I didn't even feel this "disk" but I feel strange things in my heart all the time.

I've heard that a large population of sane people will also have couplets, but that was a long time ago and I didn't pay much attention to it because I thought I didn't have them!

I wonder if couplets are okay in a structurally normal heart. There doesn't seem to be much information on this topic and I've been checking for the past few days.

I think if there was any danger the cardiologist would have said that in the report but I'm more worried what can you do?





My doctors told me that if they put a monitor on 100 "medically healthy" people, all 100 will have PVCs or PACs, but not all of them feel or know they have them. That makes a lot of sense to me because it doesn't make sense that every heart should be lub, dub 24/7. I think some people never feel them and others, like us, feel many or all of them. Why? Who really knows, but I definitely think a lot of us are wired that way... maybe Type A personalities, Anxiety, Worry, Stress? I don't think it puts me in any greater risk or danger than anyone else walking around, although I don't think rationally about being passed. I wish I hadn't felt them and I remember the days when I didn't feel them. Life was a lot different back then and a lot funnier.




(Video) Ectopics on exercise - Are they dangerous?

Thanks for all replies

So no one really seems to know :(

There was a study where people with PVC were subjected to a 24-hour holter and it found that over 60% of them had couplets, which I think puts things into perspective.

I think I should consider myself lucky that I isolated only one in a 7 day period.

Ah, I found the link to this study on a forum:





I'm with you all... Couplets, triplets, greetings, bigotines, triplets, etc. =)

I have often wondered what is dangerous and what is not. I have mixed feelings about what doctors are telling me and have been to many doctors since July 2009. I finally found a doctor who admitted that there is NO way to know everything that happens in the heart and even doctors are still learning because of the 220,000 things that can go wrong with just 1 cell. My head is still spinning from all the information he spilled when other doctors said my case was too complicated.

I'm a classic case of weird and weird events :P




I also sometimes feel the couplets when I take my pulse. I think I've had palpi all my life and I didn't notice them until the anxiety started. I either want a steady beat or I don't want to feel those damn things!




(Video) Is my abnormal heart rhythm dangerous?

Delta I'm with you, I like it better when the rhythm is too constant hahaha




I have the couplets, usually when my blood pressure and heart rate are slower due to my beta blocker. I like it much better when the rhythm is constant!




I would like to know if other people with "normal" hearts sometimes feel couplets when taking their pulse. I wonder if I have A LOT as I can only take my heart rate and feel the two rapid beats together by randomly checking every other day. I think I have to have a lot of them to get them like this. Any idea?




I can take my pulse and often feel couplets. i hate that



(Video) Ventricular tachycardia (VT) - causes, symptoms, diagnosis, treatment & pathology


Are ventricular couplets dangerous? ›

VPBs are typically considered harmless when they occur in healthy people without a history of cardiovascular disease, but primary care providers should be aware of when this arrhythmia may become life-threatening.

Is ventricular rhythm dangerous? ›

Ventricular tachycardia episodes may be brief and last only a couple of seconds without causing harm. But episodes lasting more than a few seconds (sustained V-tach ) can be life-threatening. Sometimes ventricular tachycardia can cause the heart to stop (sudden cardiac arrest).

Are ventricular arrhythmias more dangerous? ›

Your heartbeat quickens, and you feel as if your heart is “skipping beats.” This rhythm may cause severe shortness of breath, dizziness, or fainting (syncope). The most serious arrhythmia is ventricular fibrillation, which is an uncontrolled, irregular beat.

How many beats of Vtach is significant? ›

V-tach occurs when your pulse rate is more than 100 beats per minute, and you have at least three irregular heartbeats, or arrhythmias, in a row. Besides palpitations, V-tach can cause symptoms like chest pain, lightheadedness, and fainting. Untreated V-tach can be dangerous: It's a major cause of sudden cardiac death.

How many ventricular couplets are normal? ›

Number of ventricular couplets was higher in patients with a normal heart (33±50/day: mean ±1 SD) than in those with an abnormal heart (17±15/day; p<0.05).

Are ventricular couplets normal? ›

Atrial couplets/atrial tachycardia and ventricular couplets/nonsustained ventricular tachycardia are relatively rare, but nevertheless do occur on occassion in normal healthy adults.

Can flecainide cause sudden death? ›

Flecainide-induced arrhythmias include sinus bradycardia or arrest in 2%, bundle branch blocks in 1%, increased premature ventricular depolarizations in 1%, ventricular tachycardia or fibrillation in 0.5%, and sudden death in 0.2% of patients.

Which rhythm of the heart is dangerous? ›

Ventricular fibrillation.

This serious problem can lead to death if a normal heart rhythm isn't restored within minutes.

Can ventricular Ectopics be dangerous? ›

When you have an ectopic beat, the heart beat starts on one side of the muscle of the ventricles so one side contracts and pumps blood before the other. This is very unlikely to cause any harm if this is happening occasionally. However, if this becomes more frequent it can affect how your heart works.

Which is worse AFib or ventricular tachycardia? ›

They also have a higher risk of heart failure, heart attack, cardiac arrest, and dementia. While not as common as AFib, ventricular fibrillation is more deadly.

What is the prognosis for ventricular arrhythmia? ›

The prognosis of VT depends on the cause and cardiac status. Patients who develop VT can suffer from hemodynamic failure and the mortality can exceed 30% if no treatment is provided. In the setting of percutaneous coronary intervention, VT occurring prior to revascularization is associated with very high mortality.

What is the difference between AFib and ventricular arrhythmia? ›

Atrial fibrillation occurs in the heart's upper two chambers, also known as the atria. Ventricular fibrillation occurs in the heart's lower two chambers, known as the ventricles. If an irregular heartbeat (arrhythmia) occurs in the atria, the word “atrial” will precede the type of arrhythmia.

Is V-tach just a run of PVCs? ›

Whenever three or more consecutive PVS's are seen, at a rate of 100 bpm or more, the term used is Ventricular Tachycardia (V. Tach). In the strictest definition, V. Tach is the same as PVC's, except that there are many of them in a row.

How many PVCs are needed for a V-tach? ›

It is important to note that three or more consecutive PVCs are classified as ventricular tachycardia. If the PVCs continuously alternate with a regular sinus beat, the patient is in bigeminy.

Is V-tach always regular? ›

Abstract. Sustained monomorphic ventricular tachycardia is usually regular; that is, it is associated with constant R-R intervals. In several cases, however, the cycles of ventricular tachycardia are more or less variable.

How do you treat ventricular couplets? ›

Beta blockers — The first-line therapy to reduce PVC burden is beta blockers. An exception may be those with heart failure who may proceed directly to catheter ablation. Commonly used beta blockers to treat PVCs include metoprolol and carvedilol.

What is a good ventricular rate? ›

A normal resting heart beats at a rate of 60-100 times per minute. If you have ventricular tachycardia, your ventricles generate a much faster heart rate than normal – many patients experiencing heart rates in the range of 170 or more beats per minute.

How much ventricular Ectopy is too much? ›

Excessive ventricular ectopic activity was defined as >10% of all ventricular depolarisations during a 30-second ECG recording or a run of ≥2 consecutive PVC.

What causes ventricular couplets? ›

Alcohol or drug misuse. Stimulants such as caffeine or tobacco. Increased levels of adrenaline in the body due to exercise or anxiety. Injury to the heart muscle due to disease.

What causes PVC couplets? ›

PVCs can be caused or triggered by: Heart disease or scarring, which can interfere with the normal electrical impulses. Low blood oxygen, which could happen if you have chronic obstructive pulmonary disease (COPD) or pneumonia. Some medications, including decongestants.

What is couplet in heart rhythm? ›

Definition. Two consecutive premature ventricular contractions (PVCs) with no intervening normal beats. [ from HPO]

Is flecainide a high risk drug? ›

There is a chance that flecainide may cause new or make worse existing heart rhythm problems when it is used. Since it has been shown to cause severe problems in some patients, it is only used to treat serious heart rhythm problems. Discuss this possible effect with your doctor.

Can flecainide stop your heart? ›

According to results from the National Heart Lung and Blood Institute's Cardiac Arrhythmia Suppression Trial (CAST), the use of flecainide may cause an increased risk of death or cardiac arrest in certain patients. An increased risk of death was observed in patients who experienced a recent heart attack.

How common is flecainide toxicity? ›

Flecainide toxicity is rare, but the mortality is high. This case demonstrates the use of intravenous fat emulsion therapy in conjunction with intravenous sodium bicarbonate treatment for flecainide toxicity.

What are the 3 lethal heart rhythms? ›

You will need to be able to recognize the four lethal rhythms. Asystole, Ventricle Tachycardia (VT), Ventricle Fibrillation (VF), and Polymorphic Ventricle Tachycardia (Torsade de pointes).

What are the two lethal heart rhythms? ›

Ventricular tachycardia (VT) and ventricular fibrillation (VF) are lethal cardiac arrhythmias, claiming a quarter million lives per year from sudden cardiac death (SCD).

What are the 6 lethal heart rhythms? ›

You will learn about Premature Ventricular Contractions, Ventricular Tachycardia, Ventricular Fibrillation, Pulseless Electrical Activity, Agonal Rhythms, and Asystole. You will learn how to detect the warning signs of these rhythms, how to quickly interpret the rhythm, and to prioritize your nursing interventions.

What percentage of PVCs are dangerous? ›

Although the range differs from person to person, patients with PVCs that comprise 20 percent or more of total heartbeats typically are most at risk for some of the more serious complications associated with the condition.

Can you exercise with ventricular ectopic beats? ›

In many people, cardiac ectopic beats do not require a specific medical treatment. For many patients, we may recommend lifestyle modification – specifically reducing caffeine and alcohol. Increased exercise may also suppress extra beats. Some patients may require medication to control symptoms of extra beats.

Can anxiety cause ventricular ectopic beats? ›

Emotional stressors can lead to ventricular ectopic beats and ventricular tachycardia. Though disturbances of cardiac rhythm due to emotional stress are often transient, sometimes the consequences can be seriously damaging and even fatal [11].

What is the most common cause of ventricular tachycardia? ›

Ventricular tachycardia most often occurs when the heart muscle has been damaged and scar tissue creates abnormal electrical pathways in the ventricles. Causes include: Heart attack. Cardiomyopathy or heart failure.

What is the first line treatment for ventricular tachycardia? ›

Anti-arrhythmic medications are the first-line therapy in emergency departments and CCUs, as discussed earlier. Amiodarone is most commonly used, along with lidocaine, and in some cases procainamide.

Can you exercise with ventricular tachycardia? ›

DO stay active. Exercising is always good for your heart, and a irregular heartbeat doesn't need to stop you.

Can you live with ventricular arrhythmia? ›

This arrhythmia is not dangerous in healthy people because it usually has little impact on the heart. But in people with heart problems, such as a heart valve disease, or those who have had a heart attack, it can trigger more dangerous arrhythmias. These can include ventricular tachycardia or ventricular fibrillation.

How do you fix ventricular arrhythmia? ›

Medications. If you have ventricular tachycardia, you may be given medications called anti-arrhythmics by mouth or IV to slow the fast heart rate. Other heart medications, such as calcium channel blockers and beta blockers, may be prescribed with anti-arrhythmic drugs.

Can ventricular arrhythmia be cured? ›

Some arrhythmias cause few, if any, problems. Other arrhythmias can cause serious complications such as heart failure, stroke, or even cardiac arrest. Many treatment options are available to treat arrhythmia, including medicines, devices, cardiac ablation, and surgery. Many arrhythmias can be cured with procedures.

How long is the life expectancy of ventricular fibrillation? ›

Outlook (Prognosis)

VF will lead to death within a few minutes unless it is treated quickly and properly.

What does ventricular arrhythmia feel like? ›

Abnormal electrical impulses in the lower chambers of the heart cause ventricular arrhythmia, which interrupts blood flow from the heart to other parts of the body. People with ventricular arrhythmias can feel palpitations, along with chest pain, and may experience difficulty breathing and excessive sweating.

What electrolytes can cause ventricular tachycardia? ›

It is well known that changes in serum potassium cause ventricular arrhythmias as a result of clearly documented changes in the electrophysiological characteristics of single fibers.

When are PVCs an emergency? ›

Call 911 and go to your nearest emergency center if you experience other symptoms along with PVCs, including: Dizziness or passing out (syncope). Lightheadedness. Pain in your chest, neck, jaw or arms.

Can PVCs cause sudden cardiac death? ›

PVCs are generally benign in patients without SHD. 4 5 However, PVCs can be a trigger for life-threating arrhythmias such as ventricular tachycardia (VT) and ventricular fibrillation (VF) causing sudden cardiac death (SCD), especially in patients post-myocardial infarction (MI).

What is 4 PVCs in a row called? ›

Multiformed PVCs are common in digitalis intoxication. PVCs may occur as isolated single events or as couplets, triplets, and salvos (4-6 PVCs in a row), also called brief ventricular tachycardias.

What is considered excessive PVCs? ›

“If more than 10% to 15% of a person's heartbeats in 24 hours are PVCs, that's excessive,” Bentz said. The more PVCs occur, the more they can potentially cause a condition called cardiomyopathy (a weakened heart muscle).

Can PVCs turn into AFib? ›

PVCs have an association with a 1.90-fold increased incidence of AFib. A 2021 study also found that having PVC increases a person's risk of new-onset AFib and ischemic stroke. And, in a 2020 case study, researchers reported that PVCs may trigger AFib episodes.

What is the most common treatment for PVCs? ›

Those used for PVCs may include beta blockers and calcium channel blockers. Drugs to control the heart rhythm also may be prescribed if you have a type of irregular heartbeat called ventricular tachycardia or frequent PVCs that interfere with heart function.

What can mimic V-tach? ›

Wide-complex conduction during SVT can mimic VT. The two most common forms are atrioventricular (AV) reentrant tachycardia (AVRT) and AV nodal reentrant tachycardia (AVNRT) with aberrant conduction. AVRT can be either orthodromic or antidromic, depending on the direction of conduction through the AV node.

What do PVC couplets feel like? ›

The most common sensation associated with PVCs is that of a skipped heartbeat followed by a fluttering sensation. Patients commonly present complaining of heart palpitations.

Can PVC cause sudden death? ›

Can a PVC cause sudden death? PVCs can increase your risk of sudden cardiac death, especially if they occur frequently. According to one study, experiencing more than 12 PVCs daily increases your risk of sudden cardiac death. However, they don't lead to sudden cardiac death in most people.

Can you live a long life with PVCs? ›

Can I live a long life with frequent PVCs? Many people who have PVCs never experience significant complications from having them. PVCs are most concerning in people who already have heart disease or have thousands of PVCs daily.

What is the drug of choice for VPC? ›

Verapamil is recommended for treatment of idopathic LVOT VPCs.

Can anxiety cause ventricular ectopics? ›

Emotional stressors can lead to ventricular ectopic beats and ventricular tachycardia. Though disturbances of cardiac rhythm due to emotional stress are often transient, sometimes the consequences can be seriously damaging and even fatal [11].

How many ventricular ectopics are too many? ›

Previous studies suggest that up to 100 ventricular ectopic beats in a 24-hour period (24-hour Holter monitor) are within normal limits.

What is the best exercise for PVCs? ›

Much of the research on PVCs and exercise uses aerobic exercise as the parameter. With that in mind, low intensity forms of cardiovascular exercise, such as hiking, walking, and biking, are most likely the best because they will strengthen your heart — provided they aren't worsening your symptoms.

Is it normal to have PVCs every day? ›

PVCs become more of a concern if they happen frequently. “If more than 10% to 15% of a person's heartbeats in 24 hours are PVCs, that's excessive,” Bentz said. The more PVCs occur, the more they can potentially cause a condition called cardiomyopathy (a weakened heart muscle).

Can beta blockers make PVCs worse? ›

While they may reduce the PVCs themselves, beta blockers work better at reducing the symptoms PVCs cause. The more powerful antiarrhythmic drugs are often reasonably effective at suppressing PVCs.

Can anxiety cause PVCs? ›

As Chaudhari mentioned, stress and anxiety can be a big factor in causing PVCs. “With anxiety and PVCs, it's a vicious cycle,” he said. “Anxious people get more PVCs and PVCs make them more anxious.”


1. EKG l Premature Ventricular contractions (PAC, PJC, PVC)
(Simple Nursing)
2. Premature Atrial Contractions (PACs), Animation.
(Alila Medical Media)
3. Living with Arrhythmias: What to Know When Your Heart is Out of Rhythm
(Alliance for Aging Research)
4. What is a normal heart rate?
(Mount Sinai Health System)
5. Premature Ventricular Contraction - causes, symptoms, diagnosis, treatment, pathology
(Osmosis from Elsevier)
6. Skips, flutters and thuds
(York Cardiology)
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