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. 2024 Aug;21(8):1280-1288.
doi: 10.1016/j.hrthm.2024.02.040. Epub 2024 Feb 23.

Prevalence of frequent premature ventricular contractions and nonsustained ventricular tachycardia in older women screened for atrial fibrillation in the Women's Health Initiative

Sofia E Gomez  1 , Joseph Larson  2 , Mark A Hlatky  3 , Fatima Rodriguez  3 , Matthew Wheeler  3 , Philip Greenland  4 , Michael LaMonte  5 , Victor Froelicher  3 , Marcia L Stefanick  3 , Robert Wallace  6 , Charles Kooperberg  2 , Lesley F Tinker  2 , Jenny Schoenberg  2 , Elsayed Z Soliman  7 , Mara Z Vitolins  7 , Nazmus Saquib  8 , Tomas Nuño  9 , Bernhard Haring  10 , Marco V Perez  3
Affiliations

Prevalence of frequent premature ventricular contractions and nonsustained ventricular tachycardia in older women screened for atrial fibrillation in the Women's Health Initiative

Sofia E Gomez et al. Heart Rhythm. 2024 Aug.

Abstract

Background: Frequent premature ventricular contractions (PVCs) and nonsustained ventricular tachycardia (NSVT) have been associated with cardiovascular disease and mortality. Their prevalence, especially in ambulatory populations, is understudied and limited by few female participants and the use of short-duration (24- to 48-hour) monitoring.

Objective: The objective of this study was to report the prevalence of frequent PVCs and NSVT in a community-based population of women likely to undergo electrocardiogram (ECG) screening by sequential patch monitoring.

Methods: Participants from the Women's Health Initiative Strong and Healthy (WHISH) trial with no history of atrial fibrillation (AF) but 5-year predicted risk of incident AF ≥5% by CHARGE-AF score were randomly selected to undergo screening with 7-day ECG patch monitors at baseline, 6 months, and 12 months. Recordings were reviewed for PVCs and NSVT (>5 beats); data were analyzed with multivariate regression models.

Results: There were 1067 participants who underwent ECG screening at baseline, 866 at 6 months, and 777 at 12 months. Frequent PVCs were found on at least 1 patch from 4.3% of participants, and 1 or more episodes of NSVT were found in 12 (1.1%) women. PVC frequency directly correlated with CHARGE-AF score and NSVT on any patch. Detection of frequent PVCs increased with sequential monitoring.

Conclusion: In postmenopausal women at high risk for AF, frequent PVCs were relatively common (4.3%) and correlated with higher CHARGE-AF score. As strategies for AF screening continue to evolve, particularly in those individuals at high risk of AF, the prevalence of incidental ventricular arrhythmias is an important benchmark to guide clinical decision-making.

Keywords: Atrial fibrillation; Cardiac monitoring; Frequent premature ventricular contractions; Nonsustained ventricular tachycardia; Remote monitoring; Ventricular arrhythmia.

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Conflict of interest statement

Disclosures Dr Perez is a consultant for Apple Inc, Boston Scientific, Janssen, Bristol Myers Squibb, and Thryv Inc and has ownership interest in QALY, Inc. Dr Wheeler had prior consulting income from BioTelemetry. Dr Froelicher has stock interest in Cardiac Insight (electrocardiographic patch company employed in this study) and is contracted by Cardiac Insight to develop patch interpretation software. The remaining authors have no disclosures.

Figures

Figure 1.
Figure 1.
Box plot of PVC frequencies of each participant across all ECG patches, shown using the full PVC range (left) and focused on PVC range of 0% to 5% (right). The thick black line depicts the median PVC burden while the blue box demonstrates the interquartile range. Please note the vast majority of PVC frequencies was below 5%, with notable outliers who had PVC frequencies > 5% and even fewer outliers with very frequent PVCs > 15%.
Figure 2.
Figure 2.
Cumulative rate of frequent PVCs (> 5%) on sequential monitoring by CHARGE-AF score
Figure 3.
Figure 3.
Dot plot of PVC frequencies on each patch for participants who had a PVC frequency > 5% on any patch. Please note women with PVC frequency > 5% on any patch often had subsequent or prior patches with PVC frequency < 5%, demonstrating the benefit of sequential monitoring to identify changes in PVC burden over time.
Figure 4.
Figure 4.
Average Frequency (95% confidence interval) of premature ventricular complexes by quintiles of CHARGE-AF score
See this image and copyright information in PMC

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