What is the drug of choice for treatment of symptomatic premature ventricular contractions (PVCs)?

Lidocaine is the preferred medication for the treatment of symptomatic premature ventricular contractions (PVCs) due to its effective antiarrhythmic properties, particularly in cases where PVCs are associated with ischemia or myocardial irritability. Lidocaine works by stabilizing the cardiac cell membrane, thereby reducing the excitability and conduction velocity of abnormal electrical signals in the heart. This mechanism makes it particularly suitable for managing PVCs in a clinical setting.

Other options, while they are important in different contexts of cardiac rhythm management, are not the primary choice for PVCs. Adenosine is typically used for immediate termination of certain supraventricular tachycardias rather than PVCs. Amiodarone, although effective for a wide range of arrhythmias, is generally reserved for more serious ventricular tachycardia or fibrillation scenarios. Atropine primarily addresses bradycardia rather than tachyarrhythmias like PVCs. Therefore, among the available options, lidocaine is the most appropriate choice for treating symptomatic premature ventricular contractions.