Premature ventricular complexes and non-sustained ventricular tachycardia in older women

While ventricular ectopy is common across broad populations and becomes even more prevalent with age, this topic has been largely understudied, particularly among women. Recent data have revealed that the prevalence of frequent ventricular ectopy among older women is higher than expected. Furthermore, older women are more likely to experience symptomatic arrhythmias and palpitations resulting in cardiac monitoring and the detection of ectopy. Incidental ventricular ectopy, namely premature ventricular complexes (PVCs) and non-sustained ventricular tachycardia (NSVT), is being identified more frequently across both sexes due to recent expansion of cardiac monitoring, often for atrial fibrillation screening. Definitions and clinically relevant thresholds of frequent ventricular ectopy vary widely across clinical studies and society guidelines. As a result, the diagnosis and management of frequent ventricular ectopy is challenging. Given the consequences of frequent PVCs and NSVT, namely incident cardiomyopathy and associated morbidity and mortality, further characterization of these entities and consensus on diagnostics and therapeutics is needed to guide providers in caring for an aging population. This review seeks to synthesize the literature on the prevalence and clinical significance of ventricular ectopy, while also proposing novel, evidence-based diagnostic and treatment algorithms. A special focus will be placed on postmenopausal women in an effort to tackle existing sex disparities and highlight unique insights relevant to the clinical care of this understudied population.