Objective The natural history of frequent premature ventricular complexes (PVCs) in association with preserved left ventricular ejection fraction (LVEF) is uncertain. The optimal management of this population is thus undefined. We studied the outcomes of untreated patients with frequent PVCs and preserved LVEF.
Methods This cohort study prospectively evaluated consecutive patients from 2012 to 2017, with asymptomatic or minimally symptomatic frequent idiopathic PVCs (≥5% PVCs in 24 hours; normal LVEF; no cause identified on comprehensive evaluation). No suppressive therapy (ablation or antiarrhythmic drugs) were used and patients were followed with serial ambulatory ECG monitoring and echocardiography. The primary arrhythmic outcome was reduction in PVC burden to <1% on serial ambulatory monitoring. The primary echocardiographic outcome was a reduction of LVEF to <50%.
Results One hundred patients met inclusion criteria (mean age 51.8 years, 57% female) with a median PVC burden of 18.4%. Reduction to <1% PVCs occurred in 44 of 100 patients (44.0%) at a median of 15.4 months (range 2.6 to 64.3). Recurrence was uncommon (4/44, 9.1%). Four patients (4.3%) with a persistently elevated PVC burden developed left ventricular dysfunction (LVEF <50%) during the follow-up period at a range of 53–71 months. The initial PVC burden did not predict subsequent resolution (HR 1.00(0.97, 1.03); p=0.86).
Conclusions A strategy of active surveillance is appropriate for the majority of patients with frequent idiopathic PVCs in association with preserved LVEF, owing to the low risk of developing left ventricular systolic dysfunction and the high rate of spontaneous resolution.
- premature ventricular beats
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Contributors AKYL and MWD were responsible for the design of the project. AKYL, GA, MWD, SC, JA, MTB were responsible for data gathering. AKYL and MWD were responsible for data analysis. All authors critically revised the manuscript and all authors approved the final manuscript.
Funding This research was supported by funding from the Division of Cardiology of the University of British Columbia, in partnership with the Heart and Stroke Foundation of Canada. AKYL, MWD and ZWL are recipients of Career Scholar awards from the Michael Smith Foundation for Health Research. AK receives support from the Heart and Stroke Foundation of Canada, the Sauder Family and Heart and Stroke Foundation Chair in Cardiology and the Paul Brunes Chair in Heart Rhythm Disorders.
Competing interests None declared.
Ethics approval Providence Health Care/University of British Columbia ethics committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent for publication Not required.