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The interplay between frequent premature ventricular complexes (PVCs) and the development of left ventricular systolic dysfunction (LVSD) and heart failure (HF) is not a simple one. The first described relationship between frequent PVCs and LV dysfunction was in 1998,1 but importantly this was a description of patients with frequent PVCs and established LVSD, that improved with suppression of PVCs using amiodarone. On the surface, the concept was simple: a high burden of PVCs leads to (or at least contributes to) LVSD and HF. However, the more we learn about PVCs and HF, the more complex the relationship becomes, further highlighted in the current study from Limpitikul and colleagues.2
The study is an analysis of patients with available raw Holter data nested within the prospective Cardiovascular Health Study (CHS). From the original randomly selected 5201 adults ≥65 years recruited in 1989–1990, 1429 were randomly selected to undergo 24 Holter monitor. After exclusions, 871 participants were available, of whom 316 had ≥10 PVCs on monitoring and form the basis of analysis. A further subgroup of 209 patients underwent both a baseline and 5-year echocardiographic evaluation. The association between PVC characteristics and cardiovascular outcomes was examined over a median follow-up of 11 years.
An uncertain epidemiology and pathophysiology
The current study, in combination with the group’s previous work,3 raises fundamental questions about the association between PVCs and HF. The first key observation is that even a relatively low PVC burden is associated with a higher incidence of LVSD, HF and death. The gradient of risk with PVC burden occurred at levels far below (<1% PVC burden) our notion of how PVCs might cause LV dysfunction …
Contributors MWD was responsible for the initial draft of the editorial. MWD and NMH each provided critical revisions of the manuscript and each approved the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Commissioned; externally peer reviewed.