Elsevier

Heart Rhythm

Volume 7, Issue 7, July 2010, Pages 865-869
Heart Rhythm

Clinical
Ventricular tachycardia
Relationship between burden of premature ventricular complexes and left ventricular function

https://doi.org/10.1016/j.hrthm.2010.03.036Get rights and content

Background

Frequent idiopathic premature ventricular complexes (PVCs) can result in a reversible form of left ventricular dysfunction. The factors resulting in impaired left ventricular function are unclear. Whether a critical burden of PVCs can result in cardiomyopathy has not been determined.

Objective

The objective of this study was to determine a cutoff PVC burden that can result in PVC-induced cardiomyopathy.

Methods

In a consecutive group of 174 patients referred for ablation of frequent idiopathic PVCs, the PVC burden was determined by 24-hour Holter monitoring, and transthoracic echocardiograms were used to assess left ventricular function. Receiver-operator characteristic curves were constructed based on the PVC burden and on the presence or absence of reversible left ventricular dysfunction to determine a cutoff PVC burden that is associated with left ventricular dysfunction.

Results

A reduced left ventricular ejection fraction (mean 0.37 ± 0.10) was present in 57 of 174 patients (33%). Patients with a decreased ejection fraction had a mean PVC burden of 33% ± 13% as compared with those with normal left ventricular function 13% ± 12% (P <.0001). A PVC burden of >24% best separated the patient population with impaired as compared with preserved left ventricular function (sensitivity 79%, specificity 78%, area under curve 0.89) The lowest PVC burden resulting in a reversible cardiomyopathy was 10%. In multivariate analysis, PVC burden (hazard ratio 1.12, 95% confidence interval 1.08 to 1.16; P <.01) was independently associated with PVC-induced cardiomyopathy.

Conclusion

A PVC burden of >24% was independently associated with PVC-induced cardiomyopathy.

Section snippets

Patient characteristics

The subjects of this retrospective study were 174 consecutive patients (87 women, age 48 ± 13 years, ejection fraction [EF] 51% ± 13%) with frequent PVCs referred for catheter ablation (Table 1). One hundred forty-seven patients experienced palpitations for a mean duration of 59 ± 92 months. Seventeen patients were asymptomatic, and 10 patients had heart failure symptoms at presentation. LV dysfunction was present in 57 patients who had a mean EF of 35% ± 9%. Additionally, 42 of the 174

Baseline characteristics

Baseline characteristics are shown in Table 1, Table 2. Of the 174 patients, 57 had cardiomyopathy. By univariate analysis, male gender was associated with cardiomyopathy (hazard ratio [HR] 2.18, 95% confidence interval [CI] 1.11 to 4.28; P = 0.02). However, male gender was not independently associated with cardiomyopathy by multivariate analysis. A total of 134 patients were treated with either a beta-blocker or a calcium channel blocker at the time of the procedure, with no difference between

Main findings

The main finding of this study is that a PVC burden of >24% is associated with PVC-induced cardiomyopathy, with a sensitivity and specificity of approximately 80%.

Cardiomyopathy and PVC burden

Frequent PVCs are known to be associated with a reversible form of cardiomyopathy, but an optimal cutoff value has not yet been described. In prior case reports, a burden as low as 4% was associated with cardiomyopathy.7

We demonstrated in this study that a cutoff value of >24% was strongly associated with the presence of

References (8)

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Drs. Bogun and Oral received a grant from the Leducq Foundation.

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