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. 2025 Oct;48(10):1157-1166.
doi: 10.1111/pace.70033. Epub 2025 Aug 25.

The Impact of the Spatial Distribution of Ventricular Extrasystoles on Implantable Cardioverter-Defibrillator Recipients

Carlos Arthur Hansel Diniz da Costa  1 , Gabriela Menichelli Medeiros Coelho  1 , Rhanniel Theodorus Helhyas Oliveira Shilva Gomes Villar  1 , Gabriela Rodrigues de Oliveira  1 , Pedro Henrique Correia Filgueiras  1 , Enia Lucia Coutinho  1 , Claudio Cirenza  1 , Angelo Amato Vincenzo de Paola  1
Affiliations

The Impact of the Spatial Distribution of Ventricular Extrasystoles on Implantable Cardioverter-Defibrillator Recipients

Carlos Arthur Hansel Diniz da Costa et al. Pacing Clin Electrophysiol. 2025 Oct.

Abstract

Introduction: Premature ventricular complexes (PVC) are a common phenomenon observed in both normal and pathological heart conditions. However, they do not always behave in the same way. Different PVCs present with varying QRS morphologies, mechanisms, and origin sites. These differences may imply distinct prognoses. To date, the impact of the three-dimensional distribution of PVCs across the heart on the prognosis of ICD recipients has not been adequately investigated.

Material and methods: We conducted an ambidirectional cohort study. Patients underwent two twelve-lead ambulatory ECG recordings during follow-up. The spatial distribution of PVCs was analyzed using the algorithm proposed by Kuchar et al. The impact of this spatial distribution on clinical variables was assessed using mixed generalized models.

Results: Fifty-five patients were enrolled, with a mean follow-up time of 41.12 ± 13.48 months. All patients underwent two 12-lead ambulatory ECG recordings. The median PVC count was 91.5. PVCs were classified according to the algorithm proposed by Kuchar et al. PVCs arising from exit sites located in the intermediate left ventricle were associated with a higher number of therapies (odds ratio [OR]: 4.78; 95% confidence interval [CI], 1.19-19.26; p = 0.028) and prolonged QRS duration. PVCs with exit sites located in the septal region were associated with higher NYHA functional classes (OR: 2.22 [95% CI: 1.08-4.44]; p = 0.030). No statistically significant interaction was found between PVC topography and gender, number of ATP episodes, ATP success rate, or number of shock episodes.

Conclusion: The spatial distribution of PVCs influenced the prognosis of ICD recipients.

Keywords: cardiomyopathies; cohort study; implantable cardioverter‐defibrillator; premature ventricular complexes; prognosis.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Kuchar's algorithm. The algorithm proposed by Kuchar et al. for classifying ventricular arrhythmias based on QRS polarity of key leads. Red boxes denote topographies that could not be properly classified and were, therefore, excluded from the final analysis. [Colour figure can be viewed at wileyonlinelibrary.com]
FIGURE 2
FIGURE 2
The tridimensional system. The triaxial system. Axes were defined using the right anterior oblique (RAO) and left anterior oblique (LAO) projections. A, apical; An, anterior; B, basal; C, central; Im, intermedium; In, inferior; L, lateral; M, medium; S, septal. [Colour figure can be viewed at wileyonlinelibrary.com]
FIGURE 3
FIGURE 3
Study flowchart. Out of 80 patients evaluated for inclusion, 22 were excluded due to inconsistent follow‐up. A total of 58 patients were included in the study. Three additional patients were excluded from the final analysis because they either lacked two 12‐lead AECG recordings or failed to return for follow‐up.
See this image and copyright information in PMC

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