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. 2021 Jan;26(1):e12800.
doi: 10.1111/anec.12800. Epub 2020 Sep 23.

Frequent premature ventricular contractions. Association of burden and complexity with prognosis according to the presence of structural heart disease

Leonor Parreira  1 , Rita Marinheiro  1 , Pedro Amador  1 , Dinis Mesquita  1 , Jose Farinha  1 , Artur Lopes  1 , Marta Fonseca  1 , Duarte Chambel  1 , Jose Venancio  1 , Claudia Lopes  1 , Rui Caria  1
Affiliations

Frequent premature ventricular contractions. Association of burden and complexity with prognosis according to the presence of structural heart disease

Leonor Parreira et al. Ann Noninvasive Electrocardiol. 2021 Jan.

Abstract

Introduction: Premature ventricular contractions (PVC) have been associated with mortality and heart failure (HF) regardless the presence of structural heart disease (SHD). The aim of this study was assessing the impact of burden and complexity of PVCs on prognosis, according to presence of SHD.

Methods: 312 patients were retrospectively evaluated out of 1967 consecutive patients referred for 24-hr Holter at a single hospital, with a PVC count >1% of total beats. Two groups with and without SHD. PVC burden (PVC%), presence of complex forms, incidence of all-cause death, combined outcomes of all-cause death and cardiovascular hospitalizations, HF death and HF hospitalizations and, sudden death (SD) or hospitalizations due to ventricular arrhythmias (VA)were assessed.

Results: Premature ventricular contraction burden was 2.7 (IQR: 1.6-6.7). SHD patients had more polymorphic PVCs, 77% versus 65%, p = .022, triplets and episodes of non-sustained ventricular tachycardia (NSVT): 44% versus 27%, p = .002; 30% versus 12%, p < .0001. In idiopathic patients, a PVC% in the third quartile was independently associated with all-cause mortality hazard ratio (HR) 2.288 (1.042-5.026) p = .039, but not in SHD. The complexity of the PVCs was not independently associated with outcomes in both groups. In SHD group, NSVT was associated with lower survival free from SD and VA hospitalizations, p = .028; after multivariable, there was a trend for a higher arrhythmic outcome with NSVT, HR 3.896 (0.903-16.81) p = .068.

Conclusion: Premature ventricular contractions in SHD showed more complex patterns. In idiopathic patients, a higher PVC count was associated with higher mortality but not is SHD patients. Complexity was not independently associated with worse prognosis.

Keywords: PVC burden; PVC complexity; idiopathic; premature ventricular contractions; prognosis; structural heart disease.

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Conflict of interest statement

None declared.

Figures

FIGURE 1
FIGURE 1
Kaplan–Meier survival estimate of overall survival and CV hospitalizations‐free survival stratified by the quartile of PVC percentage in both groups with and without structural heart disease. Quartiles 1 through 4 represented PVC burdens of 1%–1.63%, 1.63%–2.74%, 2.74%–6.77%, and more than 6.67%, respectively. CV, cardiovascular; PVC, premature ventricular contractions
FIGURE 2
FIGURE 2
Kaplan–Meier survival estimate of overall survival and CV hospitalizations‐free survival stratified by the presence of triplets in both groups with and without structural heart disease. CV, cardiovascular
FIGURE 3
FIGURE 3
Kaplan–Meier survival estimate of overall survival and CV hospitalizations‐free survival stratified by the presence of NSVT in both groups with and without structural heart disease. CV, cardiovascular; NSVT, non‐sustained ventricular tachycardia
FIGURE 4
FIGURE 4
Kaplan–Meier survival estimate of overall survival and CV hospitalizations‐free survival stratified by the morphology of the PVCs in both groups with and without structural heart disease. CV, cardiovascular; PVC, premature ventricular contractions
See this image and copyright information in PMC

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