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. 2022 Aug 2;12(8):e059337.
doi: 10.1136/bmjopen-2021-059337.

Prevalence and heart rate variability characteristics of premature ventricular contractions detected by 24-hour Holter among outpatients with palpitations in China: a cross-sectional study

Yan Dong  1 , Xiaorong Li  2 , Wei Zheng  1 , Yilong Man  1 , Jin Liu  3 , Ping Yu  1 , Fengxiang Zhang  1 , Bing Yang  4 , Kejiang Cao  1
Affiliations

Prevalence and heart rate variability characteristics of premature ventricular contractions detected by 24-hour Holter among outpatients with palpitations in China: a cross-sectional study

Yan Dong et al. BMJ Open. .

Abstract

Objective: To analyse the prevalence and heart rate variability (HRV) characteristics of premature ventricular contraction (PVC) detected by 24-hour Holter among Chinese outpatients with palpitations.

Design: A cross-sectional study.

Setting: This study was conducted in a tertiary hospital.

Participants: A total of 4754 outpatients who received 24-hour Holter for palpitations.

Main outcome measures: Prevalence, HRV time-domain and frequency-domain analyses of 24-hour Holter, and echocardiographic parameters were assessed. Propensity score matching (PSM) was applied to balance baseline variables (age, gender) to decrease the bias between comparison groups.

Results: The prevalence of PVC was 67.7% (3220/4754), and was higher in men than women (69.9% vs 66.0%, p=0.004); the prevalence of frequent PVCs (PVC burden≥5%) was 7.7% (368/4754). Older patients had the highest frequency of PVC among all patients. However, among 3220 patients with PVC, younger patients' PVC burden was much higher. Matched 1:1 by age and gender, the HRV time-domain parameters in patients with PVC were all lower than those in patients without PVC (all p<0.05); for the HRV frequency-domain parameters, the patients with frequent PVCs had a higher low frequency/high frequency (LF/HF) ratio (5.4 vs 2.8, p<0.001) than those with PVC burden less than 5%.

Conclusions: The prevalence of PVC and frequent PVCs were 67.7% and 7.7%, respectively, detected by 24-hour Holter among Chinese outpatients with palpitations. Decreased HRV time-domain parameters suggested the occurrence of PVC, and increased LF/HF ratio represented the imbalance of autonomic nervous system in patients with frequent PVCs. Further studies are needed to understand the HRV indexes in PVC patients.

Keywords: Cardiac Epidemiology; EPIDEMIOLOGY; Pacing & electrophysiology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Example of premature ventricular contraction (PVC). The arrows show the morphology of PVC.
Figure 2
Figure 2
The prevalence of PVC detected by 24-hour Holter monitoring in 4754 patients with palpitations. A total of 3220 (67.7%) patients had at least 1 PVC, with 2852 (60.0%) having PVC burden<5% and 368 (7.7%) having PVC burden≥5%. PVC, premature ventricular contraction.
Figure 3
Figure 3
The prevalence of PVC detected by 24-hour Holter monitoring in 4754 patients of different gender and age groups. The PVC prevalence was 67.7% in men than in women (69.9% vs 66.0%, p=0.004). It generally increased with age, ranging from 54.0% (30–39 age group) to 84.6% (≥80 age group). PVC, premature ventricular contraction.
Figure 4
Figure 4
The frequency of frequent PVCs (PVC burden≥5%) based on 24-hour Holter monitoring in 4754 patients of different gender and age groups. The frequency of frequent PVCs (PVC burden≥5%) was 7.7%, with no significant difference between men and women (7.6% vs 7.8%, p=0.779). PVC, premature ventricular contraction.
Figure 5
Figure 5
The mean PVC burden based on 24-hour Holter monitoring in 3220 patients with PVC. The PVC burden decreased as age increased, except for three very elderly patients with higher PVC burden. PVC, premature ventricular contraction.
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