The effect of idiopathic premature ventricular complexes on left ventricular ejection fraction

Abstract

Aim Current literature lacks a definitive threshold of idiopathic premature ventricular complex (PVC) burden for predicting cardiomyopathy (CMP). The main objective of the present study was to evaluate relationship between the PVC burden and left ventricular ejection fraction (LVEF). Method This multicenter, cross‐sectional study included 341 consecutive patients with more than 1,000 idiopathic PVC in 24 hr of Holter monitoring admitted to the cardiology clinics between January 2019 and May 2019 in the nineteen different centers. The primary outcome was the LVEF measured during the echocardiographic examination. Result Overall, the median age was 50 (38–60) and 139 (49.4%) were female. Percentage of median PVC burden was 9% (IQR: 4%–17.4%). Median LVEF was found 60% (55–65). We used proportional odds logistic regression method to examine the relationship between continuous LVEF and candidate predictors. Increase in PVC burden (%) (regression coefficient (RE) −0.644 and 95% CI −1.063, –0.225, p < .001), PVC QRS duration (RE‐0.191 and 95% CI −0.529, 0.148, p = .049), and age (RE‐0.249 and 95% CI −0.442, −0.056, p = .018) were associated with decrease in LVEF. This inverse relationship between the PVC burden and LVEF become more prominent when PVC burden was above 5%. A nomogram developed to estimate the individual risk for decrease in LVEF. Conclusion Our study showed that increase in PVC burden %, age, and PVC QRS duration were independently associated with decrease in LVEF in patients with idiopathic PVC. Also, inverse relationship between PVC burden and LVEF was observed in lower PVC burden than previously known.

Very-high-power short-duration ablation for treatment of premature ventricular contractions – The FAST-AND-FURIOUS PVC study

“…Approximately 70% of them originate from the RVOT [3] , [8] and the remaining from the LVOT and adjacent structures such as pulmonary artery, the ASV and LV summit [12] , [6] , [7] , [8] . It has been shown that a high burden of PVCs is associated with a decline in LV ejection fraction (LVEF) [13] , [14] . According to the latest guidelines, CA is recommended for the treatment of Vas originating from the cardiac OT in symptomatic patients or in those exhibiting arrhythmia-induced cardiomyopathy [3] , [4] .…”

Diagnostic and prognostic significance of premature ventricular complexes in community and hospital-based participants: A scoping review

“… b Represents the follow-up period range using mean/median years (or months [mo] when indicated). References not reporting the follow-up timeframe [ 36 , 44 , 48 , 55 , 62 , 63 , 65 , 82 , 91 , 93 ]. Details on follow-up period for all studies are available in S3 Table .…”

“…PVC morphology has also been associated with a lower LVEF. For example, patients with a lower LVEF have PVCs that are either notched or have a wide shelved QRS [ 93 ], or have a greater coupling interval and longer PVC QRS duration [ 64 , 82 ]. Studies show that there is a higher prevalence of LV dysfunction in patients with frequent PVCs (≥ 10 PVCs/hour or > 1,000 PVCs/day) [ 49 , 103 ] or a high burden of PVCs (i.e., PVCs >30% of all beats/day) [ 60 ], indicating PVCs are a marker of LV dysfunction.…”

“…Similarly, to date, there is a lack of clinical trials to show whether PVCs cause HF, and almost all of the available evidence on these topics comes from cross-sectional and longitudinal studies. Cross-sectional studies suggested that the PVCs might be a manifestation for the extent of HF [ 68 , 82 ]. Longitudinal studies might provide a better insight into the association between PVCs and LV dysfunction since PVCs are present before incident HF or LV dysfunction [ 56 , 70 , 73 , 74 ].…”

Empiric ablation of asymptomatic PVCs when there is greater than 20% burden but normal left ventricular function—An argument in support of catheter ablation

“… 4 However, this study did identify a patient with PVC burden of 10% with a PVC cardiomyopathy 4 ; this correlates with findings from other studies with a PVC burden as low as 5%–6% causing a PVC cardiomyopathy. 5 , 6 , 7 This is a sobering finding, since the PVC burden has been identified as our most reliable criterion for identifying patients at risk, so proper vigilance requires monitoring patients carefully for PVC burdens of ≥5%. Part of this variability in PVC burden and its association with PVC cardiomyopathy may be other contributing factors that include male sex, asymptomatic PVCs, repetitive monomorphic ventricular tachycardia, variability of the PVC coupling interval, PVC duration >150 ms, and epicardial PVC origin.…”