Atrial and Ventricular Response to Treatment of Premature Ventricular Complexes

Abstract

Background: Premature ventricular complexes (PVC) may cause ventricular dyssynchrony and lead to left atrium and ventricle mechanical abnormalities. Although ventricular cardiomyopathy due to PVCs has been well studied, little is known about atrial adaptation to PVCs.

Objectives: To assess atrial and ventricular responses to PVC therapy.

Methods: All patients with PVC burden > 5000 beats/day on Holter monitoring were enrolled. Baseline demographics, comorbidities, social habits, Holter parameters, and echocardiography profiles were recorded. Follow-up Holter electrocardiography (ECG) and echocardiography data were compared between PVC-treated and non-treated patients.

Results: Two hundred and eighty-six patients were enrolled, of whom 139 received PVC treatment. Among the treated patients, 125 who underwent follow up Holter ECG or echocardiography were included in the final analysis. The mean follow-up times of Holter ECG and echocardiography were 9.40 ± 6.70 and 9.40 ± 5.52 months, respectively. Ventricular arrhythmic burden was significantly reduced in the treatment group (16.46% vs. 13.41%, p = 0.041) but was significantly increased in the observation group (7.58% vs. 14.95%, p = 0.032). A significant increase in left atrial (LA) diameter (36.94 mm vs. 39.46 mm, p = 0.025) and reduction in left ventricular ejection fraction (LVEF) (57.26% vs. 53.8%, p = 0.040) were noted in the observation group. There were no significant differences in supraventricular arrhythmic burden in the observation group and LA diameter and LVEF in the treatment group.

Conclusions: PVC therapy effectively reduced ventricular arrhythmic burden in the treatment group on follow-up. Our data suggest that PVC treatment may prevent LA dilation and LVEF decline.

Keywords: Antiarrhythmic agent; Cardiomyopathy; Left atrium; Left ventricle; Premature ventricular complex; Radiofrequency catheter ablation.

Figure 1

Study design and patient flow. ECG, electrocardiography; PVCs, premature ventricular complexes.

Figure 2

Response to PVC therapy in Holter ECG monitoring and echocardiography. A, premature atrial contraction; ECG, electrocardiogram; LA, left atrium; LVEF, left ventricular ejection fraction; LVIDd, left ventricular diastolic inner dimension; OBS, observation; PVC, premature ventricular contraction; SVT, supraventricular tachycardia; Tx, treatment; V, premature ventricular contraction.