Long-Term Outcome of Non-Sustained Ventricular Tachycardia in Structurally Normal Hearts

Abstract

BackgroundThe impact of non-sustained ventricular tachycardia (NSVT) on the risk of thromboembolic event and clinical outcomes in patients without structural heart disease remains undetermined. This study aimed to evaluate the association between NSVT and clinical outcomes.MethodsThe study population of 5903 patients was culled from the “Registry of 24-hour ECG monitoring at Taipei Veterans General Hospital” (REMOTE database) between January 1, 2002 and December 31, 2004. Of that total, we enrolled 3767 patients without sustained ventricular tachycardia, structural heart disease, and permanent pacemaker. For purposes of this study, NSVT was defined as 3 or more consecutive beats arising below the atrioventricular node with an RR interval of <600 ms (>100 beats/min) and lasting < 30 seconds.ResultThere were 776 deaths, 2042 hospitalizations for any reason, 638 cardiovascular (CV)-related hospitalizations, 350 ischemic strokes, 409 transient ischemic accident (TIA), 368 new-onset heart failure (HF), and 260 new-onset atrial fibrillation (AF) with a mean follow-up duration of 10 ± 1 years. In multivariate analysis, the presence of NSVT was independently associated with death (hazard ratio [HR]: 1.362, 95% confidence interval [CI]: 1.071–1.731), CV hospitalization (HR: 1.527, 95% CI: 1.171–1.992), ischemic stroke (HR: 1.436, 95% CI: 1.014–2.032), TIA (HR 1.483, 95% CI: 1.069–2.057), and new-onset HF (HR: 1.716, 95% CI: 1.243–2.368). There was no significant association between the presence of NSVT and all-cause hospitalization or new-onset AF.ConclusionIn patients without structural heart disease, presence of NSVT on 24-hour monitoring was independently associated with death, CV hospitalization, ischemic stroke, TIA, and new onset heart failure.

Management of asymptomatic arrhythmias: a European Heart Rhythm Association (EHRA) consensus document, endorsed by the Heart Failure Association (HFA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Cardiac Arrhythmia Society of Southern Africa (CASSA), and Latin America Heart Rhythm Society (LAHRS)

“…141,144 The benefit of anticoagulating patients structural alterations that may be associated with the undesired outcome of major ventricular arrhythmias or sudden death ( Table 5). 151,152 There is no absolute threshold of the number of PVCs that can be used as a cut-off for underlying disease and hence should trigger further investigations. A study in apparently healthy athletes has shown that in those with >2000 PVC per day, there was a 30% risk of finding underlying heart disease.…”

“…Very rarely, otherwise 'benign' PVCs may give rise to polymorphic VT or ventricular fibrillation (VF) due to their short coupling interval. 152 Short-coupled PVCs impinging on the T wave may induce polymorphic VT/VF in a setting of ischaemia, electrolyte abnormalities, underlying LQTS, or early repolarization syndrome. This may also rarely occur in a 'normal' heart, sometimes called 'short-coupled form of torsades de pointes'.…”

Prognostic significance of premature ventricular complex burden on hospitalized patients with heart failure

“…In addition, the HF patients with high‐PVC burden also had a higher prevalence of NSVT and multifocal PVCs, LA dilatation, and impaired exercise capacity compared with those with low‐PVC burden. The prevalence of NSVT and multifocal PVCs is associated with the development of cardiac death attributed to HF . LA overload due to LV dysfunction leads to LA enlargement, and LA remodeling is an independent predictor of mortality .…”

Risk of Stroke in Patients With Short-Run Atrial Tachyarrhythmia

“…These clinical end points were investigated in detail based on initial identification through International Classification of Diseases, Ninth Edition, with reference to diagnostic codes or mention of an end point on discharge summary, and the database of the Collaboration Center of Health Information Application and National Health Insurance Research Database which had been previously validated. 9,[11][12][13][14] For detailed information, see the online-only Data Supplement. The overall end of follow-up was February 28, 2013.…”

“…This methodology has been validated in our previous studies. [9][10][11][12] Furthermore, the institutional review board at Taipei Veterans General Hospital, Taipei, Taiwan, approved this study (Veterans General Hospital institutional review board number: 2013-08-002AC#1).…”