Determining the optimal duration for premature ventricular contraction monitoring

Hsia, Brian; Greige, Nicolas; Patel, Shreyans K.; Clark, Rachel M.; Ferrick, Kevin J.; Fisher, John D.; Gross, Jay N.; Biase, Luigi Di; Krumerman, Andrew

doi:10.1016/j.hrthm.2020.07.013

Cited by 13 publications

(11 citation statements)

References 22 publications

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“…Holter PVC circadian variability predicts intra‐procedural PVC frequency and response to pharmacologic induction 15 . Accordingly, the global PVC burden determined based on one 24h Holter recording may only partly reflect the overall PVC burden, 16 and thus may only vaguely predict the intra‐procedural PVC frequency. Second, in patients with infrequent PVCs at the beginning of the procedure, infusion of isoproterenol or low‐dose adrenalin can often induce a sufficient number of PVCs for reliable activation mapping and ablation 17 .…”

Section: Discussionmentioning

confidence: 99%

Pre‐procedural arrhythmia burden and the outcome of catheter ablation of idiopathic premature ventricular complexes

Asatryan

Seiler

Bourquin

et al. 2021

Pacing Clinical Electrophis

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Background Radiofrequency catheter ablation of idiopathic premature ventricular complexes (PVCs) is an effective method for eliminating symptoms and preventing/reversing arrhythmia‐induced cardiomyopathy. One reason for procedural failure is low PVC frequency during the procedure. We aimed to investigate the relation between pre‐procedural PVC burden and outcome of idiopathic PVC catheter ablation. Methods Patients who underwent idiopathic PVC ablation between 2013 and 2019 at two tertiary referral centers were retrospectively included. All procedures were performed using irrigated‐tip ablation catheters and a 3D electro‐anatomical mapping system. Sustained ablation success was defined as a ≥80% reduction of pre‐procedural PVC burden determined by 24h‐Holter at follow‐up. Results Overall, 254 patients (median age 54 years [IQR 42–64]; 47% male) were enrolled. The median pre‐ablation PVC‐burden was 22% (IQR 11–31%), which was reduced to a post‐ablation PVC burden of 0.3% (IQR 0–4%) after a median of 90 days. Sustained ablation success was achieved in 182 patients (72%). Pre‐procedural PVC burden did not differ between patients with sustained ablation success and recurrence during follow‐up (median 21% vs. 22%, p = .76). When assessed in pre‐ablation PVC‐burden groups of ≤5%, 6–15%, 16–30%, and ≥31%, sustained ablation success was achieved in 67%, 75%, 71%, and 72%, respectively, with no significant difference (p = .89). Sustained ablation outcome for PVC‐burden ≤5% versus >5% showed no difference either (67% vs. 72%, p = .52). Conclusions Pre‐procedural Holter‐determined PVC burden does not predict the outcome of idiopathic PVC ablation. Thus, catheter ablation may be a reasonable first choice also for patients with symptomatic yet rare PVCs.

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Section: Discussionmentioning

confidence: 99%

Pre‐procedural arrhythmia burden and the outcome of catheter ablation of idiopathic premature ventricular complexes

Asatryan

Seiler

Bourquin

et al. 2021

Pacing Clinical Electrophis

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“…Taking into account that PVC burden may be variable one day from another, mobile telemetry for a period of 7 days may reflect the overall PVC burden more accurately. Further than that, monitoring for 2 weeks or longer would provide little additional information (20).…”

Section: Clinical Presentationmentioning

confidence: 99%

Premature ventricular complexes : Systematic review, evaluation and management

Alonso-Ventura¹,

Sánchez²,

Ruberte³

et al. 2021

Cardiologia Hungarica

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Premature ventricular complexes (PVCs) are a common finding in general population and can be even considered physiologic in most cases. Nevertheless, very frequent isolated PVCs may lead to the development of a usually reversible left ventricular dysfunction or be a manifestation of an underlying cardiac condition that could be associated with more severe ventricular arrhythmias, heart failure or cardiac death. Three causative mechanisms of the PVCs have been proposed: abnormal automaticity, triggered activity and reentry supposing different diagnostic and therapeutic implications. Although many patients with PVCs remain completely asymptomatic, others may suffer from a wide range of symptoms like palpitations, fatigue, dyspnoea or dizziness of a variable degree. Proper characterisation of the PVCs, their burden and features, as well as the identification of their sites of origin and mechanisms should be pursued to establish the convenience of a conservative or therapeutic approach. Specific treatment with medical therapy or catheter ablation must be contemplated in symptomatic patients or in those who develop related systolic dysfunction or other kind of complications.

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“…Analysis of ECG data may be immediate or postponed. Uncertainty remains regarding necessary monitoring durations in specific clinical situations, such as for detection of infrequently occurring atrial fibrillation, cardiogenic syncope, or suspicion of ventricular arrhythmias, although it has been suggested that longer monitoring durations are necessary [1,2]. Short recording durations imply a risk of missing infrequent arrhythmic episodes [3].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic yield is dependent on monitoring duration. Insights from a full-disclosure mobile cardiac telemetry system

et al. 2022

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Background: Despite the advancement of electrocardiogram (ECG) monitoring methods, the most important factor influencing diagnostic yield (DY) may still be monitoring duration. Ambulatory ECG monitoring, typically with 24-48 hours duration, is widely used but may result in underdiagnosis of rare arrhythmias.Aims: This study aimed to examine the relationship between the DY and monitoring duration in a large patient cohort and investigate sex and age differences in the presentation of arrhythmias. Methods:The study population consisted of 25 151 patients (57.8% women; median [interquartile range, IQR], 71 [64-78] years), who were examined with mobile cardiac telemetry during 2017 in the United States, using the PocketECG TM that continuously transmits a signal on a beat-to-beat basis. We investigated the occurrence of atrial fibrillation at a burden of both ≤1% (atrial fibrillation [AF], ≤1%) and ≤10% (AF ≤10%), premature ventricular contractions (PVC; >10 000 per 24 hours), non-sustained ventricular tachycardias (nsVT), sustained ventricular tachycardias (VT ≥30 seconds), atrioventricular blocks (AVB), pauses of >3 seconds duration, and bradycardia (heart rate <40 beats per minute for ≥60 seconds). Results:The median (IQR) recording duration was 15.4, 8.2-28.2) days. The DY increased gradually with monitoring duration for all types of investigated arrhythmias. Compared to DY after up to 30 days of monitoring, a standard 24 hours monitoring resulted in DY for males/females of 20%/18% for AF ≤1%, 29%/28% for AF ≤10%, 45%/40% for PVCs, 17%/11% for nsVT, 17%/11% for VT ≥30 seconds, 49%/42 for AVB, 27%/20% for pauses, 36%/29% for bradycardia. Conclusion:A substantial number of patients suffering from arrhythmias may remain undiagnosed due to insufficient ECG monitoring time.

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Determining the optimal duration for premature ventricular contraction monitoring

Cited by 13 publications

References 22 publications

Pre‐procedural arrhythmia burden and the outcome of catheter ablation of idiopathic premature ventricular complexes

Pre‐procedural arrhythmia burden and the outcome of catheter ablation of idiopathic premature ventricular complexes

Premature ventricular complexes : Systematic review, evaluation and management

Diagnostic yield is dependent on monitoring duration. Insights from a full-disclosure mobile cardiac telemetry system

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