㉮ For most patients with symptomatic PVCs, we suggest first-line therapy with a beta blocker or, less commonly, a non-dihydropyridine calcium channel blocker, rather than starting with antiarrhythmic medications or catheter ablation.
㉠ Beta blockers — Commonly used beta blockers include metoprolol, carvedilol, bisoprolol, nebivolol, propranolol, nadolol, betaxolol, and atenolol. Atenolol, betaxolol, nadolol, and propranolol should not be used in patients with HF or cardiomyopathy.
ⓐ Bisoprolol: 2.5 mg orally once daily; maximum dose 10 mg once daily
ⓑ Nebivolol: 5 mg orally once daily; maximum dose 40 mg once daily (lower doses of 1.25 to 10 mg to be used in patients with heart failure)
㉡ Non-dihydropyridine calcium channel blockers — Diltiazem and verapamil may be preferred in patients with HTN or in patients with fascicular PVCs, but should not be used in patients with HF or cardiomyopathy.
㉯ For patients with ongoing PVC-related symptoms following initial medical therapy, or for those who do not tolerate medical therapy due to adverse effects, we suggest catheter ablation, rather than antiarrhythmic drug therapy, as the next treatment in patients with a high burden of monomorphic PVCs.
REF. UpToDate 2020.06.26
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