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Randomized Controlled Trial
. 2021 Mar;7(3):380-390.
doi: 10.1016/j.jacep.2020.08.028. Epub 2020 Nov 25.

Outcomes of Premature Ventricular Contraction-Cardiomyopathy in the Veteran Population: A Secondary Analysis of the CHF-STAT Study

Jose F Huizar  1 , Susan G Fisher  2 , Frederick V Ramsey  2 , Karoly Kaszala  3 , Alex Y Tan  3 , Hans Moore  4 , Jayanthi N Koneru  5 , Jordana Kron  5 , Santosh K Padala  5 , Kenneth A Ellenbogen  5 , Steven N Singh  4
Affiliations
Randomized Controlled Trial

Outcomes of Premature Ventricular Contraction-Cardiomyopathy in the Veteran Population: A Secondary Analysis of the CHF-STAT Study

Jose F Huizar et al. JACC Clin Electrophysiol. 2021 Mar.

Abstract

Objectives: This study sought to assess the rate and outcomes of premature ventricular contractions (PVC)-cardiomyopathy from the CHF-STAT (Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure) trial, a population with cardiomyopathy (left ventricular [LV] ejection fraction of <40%) and frequent PVCs (>10 PVCs per hour).

Background: PVCs are associated with heart failure and PVC-cardiomyopathy. The prevalence of PVC-cardiomyopathy and outcome benefits of PVC suppression are not clear.

Methods: A secondary analysis of the CHF-STAT study was performed to compare the rate of successful PVC suppression (≥80% PVC reduction), LV recovery (defined as improvement in LV ejection fraction of ≥10% points), and PVC-cardiomyopathy between amiodarone and placebo groups at 6 months. PVC-cardiomyopathy was defined if both PVC reduction of ≥80% and LV ejection fraction improvement of ≥10% were present at 6 months. Cardiac events (death or resuscitated cardiac arrest) were compared between PVC-cardiomyopathy versus non-PVC-cardiomyopathy during a 5-year follow-up.

Results: The rates of successful PVC suppression and LV recovery were significantly higher in the amiodarone (72% and 39%, respectively) when compared to the placebo group (12% and 16%, respectively; p < 0.001), regardless of cardiomyopathy etiology. PVC-cardiomyopathy was present in 29% and 1.8% of patients in the amiodarone and placebo groups, respectively (p < 0.001). Similar PVC-cardiomyopathy rates were found in ischemic (24% amiodarone vs. 2% placebo; p < 0.001) and nonischemic populations (41% amiodarone vs. 1.5% placebo; p < 0.001). Death and resuscitated cardiac arrest were significantly lower in patients with PVC-cardiomyopathy and those treated with amiodarone.

Conclusions: The overall prevalence of PVC-cardiomyopathy in the CHF-STAT study was significant regardless of ischemic substrate (29%, overall population; 41%, nonischemic cardiomyopathy). Treatment of PVC-cardiomyopathy with amiodarone is likely to improve survival in this high-risk population.

Keywords: LV systolic dysfunction; amiodarone; antiarrhythmics; cardiomyopathy; premature ventricular contractions.

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Conflict of interest statement

FUNDING SUPPORT AND AUTHOR DISCLOSURES Supported by 1R01HL139874-01 (Principal Investigator: Dr. Huizar), 5R34HL138110-02 (Principal Investigator: Dr. Huizar). Dr. Huizar has received research support from Abbott. Dr. Kaszala has received research support from Boston Scientific and Abbott. Dr. Tan has received research support from Boston Scientific, MDT, and Biotronik. Dr. Ellenbogen has received research support from Boston Scientific, Biosense Webster, MDT, Abbott, and the National Institutes of Health; has served as a consultant for Boston Scientific, Abbott, Atricure, and Medtronic; and has received honoraria from MDT, Boston Scientific, Biotronik, Biosense Webster, and Atricure. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Figure 1.
Figure 1.
Enrollment and distribution of PVC-Cardiomyopathy in CHF-STAT study. (A) Enrollment of CHF-STAT study and rationale for final 421 patients included in secondary analysis. (B) Prevalence of PVC-Cardiomyopathy (PVC-CM) by treatment randomization including PVC suppression and improvement in LVEF.
Figure 2.
Figure 2.
PVC suppression, LV recovery and full LV recovery by treatment randomization. (A). Rate of successful PVC suppression (left panel) and LV-recovery (right panel) based on treatment randomization in overall, ischemic and non-ischemic cardiomyopathy. Successful PVC suppression defined as ≥ 80% reduction of PVC burden at 6-month follow up; LV-recovery defined as ≥ 10% points increase in LVEF at 6-month follow up. (B) Rate of patients with full recovery of LV function (LVEF >50%) in the overall population (upper panel) and those with successful PVC suppression (lower panel) at 6 months. CM, Cardiomyopathy; PVC-CM, PVC-Cardiomyopathy.
Figure 3.
Figure 3.
Kaplan Meier Curves in PVC- vs. non-PVC-Cardiomyopathy on amiodarone group arm only. Comparison of Event free survival between subjects with PVC-Cardiomyopathy (PVC suppression >80% and LV recovery) vs. non-PVC-Cardiomyopathy (PVC suppression <80% with or without LV recovery and PVC suppression >80% without LV recovery) in overall (A), ischemic (B) and non-ischemic (C) population within the amiodarone-treated group only. PVC-CM, PVC-Cardiomyopathy.
Central Figure.
Central Figure.
Rate and Kaplan Meier Curves of PVC-Cardiomyopathy. (A) Rate of PVC-Cardiomyopathy in the overall population based on different treatment groups (amiodarone vs placebo groups) at 6 months. PVC-Cardiomyopathy defined as LV-recovery (LVEF improvement ≥10%) on only those with successful PVC suppression (≥80% PVC reduction). No LV-recovery (LVEF improvement <10%) despite successful PVC suppression represents cardiomyopathy unrelated to PVCs. LV recovery despite lack of PVC suppression represents a reversible CM unrelated to PVCs. Comparison of Event free survival between subjects with PVC-Cardiomyopathy (PVC suppression >80% and LVEF increase >10%) vs. non-PVC-Cardiomyopathy (PVC suppression <80% with or without LV recovery and PVC suppression >80% without LV recovery) in overall (B) and non-ischemic (C) population regardless of treatment randomization. PVC-CM, PVC-Cardiomyopathy.
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