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1.
Heart Rhythm ; 2024 Apr 18.
Artículo en Inglés | MEDLINE | ID: mdl-38641221

RESUMEN

BACKGROUND: Premature ventricular contraction (PVC) burden is a risk factor for heart failure and cardiovascular death in patients with structural heart disease. Long-term electrocardiographic monitoring can have a significant impact on PVC burden evaluation by further defining PVC distribution patterns. OBJECTIVE: This study aimed to ascertain the optimal duration of electrocardiographic monitoring to characterize PVC burden and to understand clinical characteristics associated with frequent PVCs and nonsustained ventricular tachycardia in a large US cohort. METHODS: Commercial data (iRhythm's Zio patch) from June 2011 to April 2022 were analyzed. Inclusion criteria were age >18 years, PVC burden ≥5%, and wear period ≥13 days. PVC burden cutoffs were determined on the basis of AHA/ACC/HRS guidelines for very frequent PVCs (10,000-20,000 during 24 hours). Patients were assigned to categories by PVC densities: low, <10%; moderate, 10% to <20%; and high, ≥20%. Mean measured error was assessed at baseline and daily until the wear period's end for overall PVC burden and different PVC densities. RESULTS: Analysis of 106,705 patch monitors revealed a study population with mean age of 70.6 ± 14.6 years (33.6% female). PVC burden was higher in male patients and those >65 years of age. PVC burden mean error decreased from 2.9% at 24 hours to 1.3% at 7 days and 0.7% at 10 days. Number of ventricular tachycardia episodes per patient increased with increasing PVC burden (P < .0001). CONCLUSION: Extending ambulatory monitoring beyond 24 hours to 7 days or more improves accuracy of assessing PVC burden. Ventricular tachycardia frequency and duration vary by initial PVC density, highlighting the need for prolonged cardiac monitoring.

2.
J Clin Med ; 13(6)2024 Mar 20.
Artículo en Inglés | MEDLINE | ID: mdl-38542020

RESUMEN

Background: Evaluation of left ventricular (LV) function in patients with idiopathic premature ventricular contraction (PVC) with preserved LV ejection fraction (LVEF), especially in the subclinical stage, may be of great importance in terms of directing early treatment. Methods: A total of 122 patients, retrospectively recruited, were divided into three groups according to PVC burden: Group 1; 5% ≤ PVC < 10%, Group 2; 10% ≤ PVC < 15%, and Group 3; 15% ≤ PVC. Transthoracic echocardiography (TTE) was performed to evaluate LV parameters. Results: LV-GLS (Global longitudinal strain) was found to be significantly lower in groups 2 and 3 with high PVC burden (18.9% ± 1.4, 17.5% ± 2.1, 16.3% ± 1.3; p < 0.001, respectively). Correlation analysis revealed a positive and significant correlation between PVC burden and deterioration in LV-GLS (r: 0.536; p < 0.001). In addition, PVC burden was found to be an independent predictor of LV-GLS deterioration in multiple linear regression analysis (ß: 0.525, p < 0.001). The ROC curve analysis demonstrated that a PVC burden cut-off value of 8.4% was associated with a LV-GLS deterioration greater than -18, with a specificity of 75.4% and a sensitivity of 75.4% (AUC: 0.81 [0.73-0.88] 95% CI; p < 0.001). Conclusions: PVC burden was an independent predictor of deterioration in LV-GLS. The presence of LV-GLS deterioration due to PVC burden emphasizes the necessity for closer patient monitoring, observation of the response to pharmacological treatment, and evaluation of early invasive treatment strategies in selected patient groups.

3.
Cureus ; 15(11): e48405, 2023 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-37942125

RESUMEN

Premature ventricular complex (PVC) is one of the most common arrhythmias detected in young patients. We report a case of a young patient with symptomatic high-burden PVC suspected to originate from the posterior right ventricular outflow tract (RVOT) who underwent an electrophysiology study (EPS) and was subsequently successfully ablated with markedly reduced PVC burden. The following day, it was noted that there was a change in PVC morphology. A repeat 3D electroanatomical mapping localized the second PVC morphology to posterolateral RVOT and abolished it with radiofrequency ablation (RFA).

4.
Europace ; 25(5)2023 05 19.
Artículo en Inglés | MEDLINE | ID: mdl-36942834

RESUMEN

AIMS: This study aimed to examine the clinical benefits of targeted ablation of all Premature ventricular complex (PVC) morphologies vs. predominant PVC only. METHODS AND RESULTS: A total of 171 consecutive patients with reduced left ventricular ejection fraction (LVEF) and ≥2 PVC morphology with high burden (>10%/day) undergoing their first ablation procedure were included in the analysis. At the initial procedure, prevalent PVC alone was ablated in the majority. However, at the redo, all PVC morphologies were targeted for ablation. : At the first procedure, 152 (89%) patients received ablation of the dominant PVC only. In the remaining 19 (11%) patients, all PVC morphologies were ablated. At two years, high PVC burden was detected in 89 (52%) patients. Repeat procedure was performed in 78 of 89, where all PVC morphologies were ablated. At 5 years after the repeat procedure, 71 (91%) had PVC burden of <5% [3.8 ± 1.1% vs. 15.4 ± 4.3% in successful vs. failed subjects (P < 0.001)]. In patients with low PVC burden after the initial procedure, LVEF improved from 37.5% to 41.6% [mean difference (MD): 3.39 ± 2.9%, P < 0.001], whereas a reduction in LVEF from 39.8% to 34.5% (MD: 6.45 ± 4.7%, P < 0.001) was recorded in patients with high PVC burden. One year after the repeat procedure, LVEF improved from 36.2% to 41.7% (MD: 5.5 ± 4.3%, P < 0.001) in patients with successful ablation. CONCLUSION: In this observational series, ablation of all PVC morphologies was associated with significantly lower PVC burden and improvement of LVEF at long-term follow-up, compared with ablation of the dominant morphology only.


Asunto(s)
Ablación por Catéter , Disfunción Ventricular Izquierda , Complejos Prematuros Ventriculares , Humanos , Ablación por Catéter/efectos adversos , Ablación por Catéter/métodos , Volumen Sistólico/fisiología , Función Ventricular Izquierda/fisiología , Complejos Prematuros Ventriculares/diagnóstico , Complejos Prematuros Ventriculares/cirugía , Complejos Prematuros Ventriculares/complicaciones
6.
J Cardiovasc Electrophysiol ; 32(6): 1665-1674, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-33783912

RESUMEN

BACKGROUND: Premature ventricular contractions (PVCs) may be found in any stage of arrhythmogenic right ventricular cardiomyopathy (ARVC) and have been associated with the risk of sustained ventricular tachycardia (VT). OBJECTIVE: To investigate the role of PVC ablation in ARVC patients. METHODS: We studied consecutive ARVC patients who underwent PVC ablation due to symptomatic high PVC burden. Mean daily PVC burden and antiarrhythmic drug (AAD) use were assessed before and after the procedure. Complete long-term success was defined as more than 80% reduction in PVC burden off of membrane-active AADs. RESULTS: Eight patients (37 ± 15 years; 4 males) underwent PVC ablation. The mean daily PVC burden before ablation ranged from 5.4% to 24.8%. A total of 7 (87.5%) patients underwent epicardial ablation. Complete acute elimination of PVCs was achieved in 4 (50%) patients (no complications). The mean daily PVC burden variation ranged from an 87% reduction to a 26% increase after the procedure. Over a median follow-up of 345 days (range: 182-3004 days), only one (12.5%) patient presented complete long-term success, and 6 (75%) patients either maintained or increased the need for Class I or Class III AADs. A total of 2 (25%) patients experienced sustained VT for the first time following the ablation procedure, requiring repeat ablation. No death or heart transplantation occurred. CONCLUSION: PVC ablation was not associated with a consistent reduction of the PVC burden in ARVC patients with symptomatic, frequent PVCs. PVC ablation may be reserved for highly symptomatic patients who failed AADs. Additional investigation is required to improve the efficacy of PVC ablation in ARVC patients.


Asunto(s)
Displasia Ventricular Derecha Arritmogénica , Ablación por Catéter , Taquicardia Ventricular , Complejos Prematuros Ventriculares , Displasia Ventricular Derecha Arritmogénica/diagnóstico , Displasia Ventricular Derecha Arritmogénica/cirugía , Ablación por Catéter/efectos adversos , Humanos , Masculino , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/cirugía , Resultado del Tratamiento , Complejos Prematuros Ventriculares/diagnóstico , Complejos Prematuros Ventriculares/cirugía
7.
Ann Noninvasive Electrocardiol ; 26(1): e12800, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32964593

RESUMEN

INTRODUCTION: Premature ventricular contractions (PVC) have been associated with mortality and heart failure (HF) regardless the presence of structural heart disease (SHD). The aim of this study was assessing the impact of burden and complexity of PVCs on prognosis, according to presence of SHD. METHODS: 312 patients were retrospectively evaluated out of 1967 consecutive patients referred for 24-hr Holter at a single hospital, with a PVC count >1% of total beats. Two groups with and without SHD. PVC burden (PVC%), presence of complex forms, incidence of all-cause death, combined outcomes of all-cause death and cardiovascular hospitalizations, HF death and HF hospitalizations and, sudden death (SD) or hospitalizations due to ventricular arrhythmias (VA)were assessed. RESULTS: Premature ventricular contraction burden was 2.7 (IQR: 1.6-6.7). SHD patients had more polymorphic PVCs, 77% versus 65%, p = .022, triplets and episodes of non-sustained ventricular tachycardia (NSVT): 44% versus 27%, p = .002; 30% versus 12%, p < .0001. In idiopathic patients, a PVC% in the third quartile was independently associated with all-cause mortality hazard ratio (HR) 2.288 (1.042-5.026) p = .039, but not in SHD. The complexity of the PVCs was not independently associated with outcomes in both groups. In SHD group, NSVT was associated with lower survival free from SD and VA hospitalizations, p = .028; after multivariable, there was a trend for a higher arrhythmic outcome with NSVT, HR 3.896 (0.903-16.81) p = .068. CONCLUSION: Premature ventricular contractions in SHD showed more complex patterns. In idiopathic patients, a higher PVC count was associated with higher mortality but not is SHD patients. Complexity was not independently associated with worse prognosis.


Asunto(s)
Electrocardiografía Ambulatoria/métodos , Complejos Prematuros Ventriculares/diagnóstico , Complejos Prematuros Ventriculares/fisiopatología , Anciano , Femenino , Cardiopatías/complicaciones , Cardiopatías/diagnóstico , Cardiopatías/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Complejos Prematuros Ventriculares/complicaciones
8.
Pacing Clin Electrophysiol ; 43(5): 462-470, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32181916

RESUMEN

BACKGROUND: Premature ventricular complexes (PVCs) are an important therapeutic target in symptomatic patients and in the setting of PVC-induced cardiomyopathy; however, measuring burden and therapeutic response is challenging. We developed and validated an algorithm for continuous long-term monitoring of PVC burden in an insertable cardiac monitor (ICM). METHODS: A high-specificity PVC detection algorithm was developed using real-world ICM data and validated using simultaneous Holter data and real-world ICM data. The PVC algorithm uses long-short-long RR interval sequence and morphology characteristics for three consecutive beats to detect the occurrence of single PVC beats. Data are expressed as gross incidence, patient average, and generalized estimating equation estimates, which were used to determine sensitivity, specificity, positive and negative predictive value (PPV, NPV). RESULTS: The PVC detection algorithm was developed on eighty-seven 2-min EGM strips recorded by an ICM to obtain a sensitivity and specificity of 75.9% and 98.8%. The ICM validation data cohort consisted of 787 ICM recorded ECG strips 7-16 min in duration from 134 patients, in which the algorithm detected PVC beats with a sensitivity, specificity, PPV, and NPV of 75.2%, 99.6%, 75.9%, and 99.5%, respectively. In the Holter validation dataset with continuous 2-h snippets from 20 patients, the algorithm sensitivity, specificity, PPV, and NPV were 74.4%, 99.6%, 68.8%, and 99.7%, respectively, for detecting PVC beats. CONCLUSIONS: The PVC detection algorithm was able to achieve a high specificity with only 0.4% of the normal events being incorrectly identified as PVCs, while detecting around three of four PVCs on a continuous long-term basis in ICMs.


Asunto(s)
Algoritmos , Electrocardiografía Ambulatoria/instrumentación , Telemetría/instrumentación , Complejos Prematuros Ventriculares/diagnóstico , Humanos , Sensibilidad y Especificidad , Complejos Prematuros Ventriculares/fisiopatología
9.
Heart Rhythm ; 16(10): 1570-1574, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31004780

RESUMEN

BACKGROUND: Frequent premature ventricular contractions (PVCs) can cause disabling symptoms and decrease left ventricular ejection fraction. PVC burden, typically quantified by a 24-hour monitor, is one of the factors that determines the clinical management of PVCs. OBJECTIVE: The purpose of this study was to evaluate the extent of variability in 24-hour PVC burden during 14-day ambulatory cardiac monitoring in patients with significant PVC burden. METHODS: All patients referred for PVC evaluation received a 14-day ambulatory cardiac monitor. Parameters of interest included mean 14-day PVC burden, minimum and maximum 24-hour PVC burden, and absolute change in 24-hour PVC burden (maximum minus minimum). We included only patients with a mean 14-day PVC burden of more than 5%. RESULTS: Fifty-nine patients were included in the study. The median of mean 14-day PVC burden, maximum 24-hour PVC burden, and minimum 24-hour PVC burden were 9.0% (IQR 6.4%-17.9%), 16.2% (IQR 11.7%-26.2%), and 4.5% (IQR 2.6%-11.2%) respectively (P < .001). The median of the absolute 24-hour PVC burden change was 9.9% (IQR 5.4%-14.5%). There was a 2.45-fold (IQR 1.68- to 5.55-fold) median difference between maximum 24-hour PVC burden and minimum 24-hour burden in the same patient. When categorized by low (<10%), intermediate (10%-20%), and high (>20%) 24-hour PVC burden, 72.9% patients fell into at least 2 categories depending on the 24-hour period considered. CONCLUSION: There is a significant variation in 24-hour PVC burden when measured over a 14-day period in patients with of PVC burden of more than 5%. This variation might impact critical clinical decisions in a significant proportion of such patients.


Asunto(s)
Electrocardiografía Ambulatoria/métodos , Volumen Sistólico/fisiología , Disfunción Ventricular Izquierda/diagnóstico por imagen , Complejos Prematuros Ventriculares/diagnóstico por imagen , Complejos Prematuros Ventriculares/fisiopatología , Anciano , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Factores de Tiempo , Disfunción Ventricular Izquierda/fisiopatología
10.
Curr Cardiol Rep ; 19(9): 80, 2017 09.
Artículo en Inglés | MEDLINE | ID: mdl-28752278

RESUMEN

PURPOSE OF REVIEW: The aim of this review is to describe predictors and therapeutic principles for PVC-induced cardiomyopathy. RECENT FINDINGS: PVC-induced cardiomyopathy is a treatable condition resulting in a reversible form of cardiomyopathy. PVC-induced cardiomyopathy has only recently been recognized as an entity that causes a reversible form of cardiomyopathy. The mechanism of development of PVC-induced cardiomyopathy has not yet been elucidated, although dyssynchrony appears to play a major role. Multiple factors have been described that are independently associated with PVC-induced cardiomyopathy. Predictors of PVC-induced cardiomyopathy include PVC prevalence, epicardial origin, male gender, longer symptom duration and asymptomatic status, presence of interpolated PVCs, lack of circadian variability, and a broader PVC-QRS width. In the presence of cardiomyopathy, work-up for structural heart disease and its etiology should be performed, followed by aggressive attempts at PVC reduction. There is evidence that ablation therapy is superior to medical therapy for frequent PVCs, but treatment decisions need to be individualized depending on the patients symptoms, PVC prevalence, PVC origin, patients comorbidities, and patient preference. The potential of sudden cardiac death associated with the presence of structural heart disease needs to be recognized, and appropriate risk stratification is mandatory.


Asunto(s)
Cardiomiopatías/etiología , Cardiomiopatías/terapia , Complejos Prematuros Ventriculares/complicaciones , Ablación por Catéter , Muerte Súbita Cardíaca/etiología , Humanos , Masculino , Factores Sexuales , Complejos Prematuros Ventriculares/fisiopatología
11.
J Cardiovasc Electrophysiol ; 25(7): 756-62, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24612052

RESUMEN

INTRODUCTION: Patients with frequent premature ventricular complexes (PVCs) might be at risk for the developing or exacerbation of left ventricular (LV) dysfunction. However, some patients with a high-PVC burden do not develop cardiomyopathy, while other patients with low-PVC burden can develop cardiomyopathy. The purpose of this study was to evaluate the positive predictors of idiopathic PVCs-induced cardiomyopathy. METHODS AND RESULTS: We investigated 214 patients undergoing successful ablation of PVCs who had no other causes of cardiomyopathy. We divided the study cohort into 2 groups: ejection fraction (EF) ≥ 50% (normal LV) and EF < 50% (LV dysfunction). We analyzed the clinical characteristics, including the electrocardiogram and findings at electrophysiology study. Among these patients, 51 (24%) had reduced LVEF and 163 (76%) had normal LV function. Patients with LV dysfunction had significantly longer coupling interval (CI) dispersion (maximum-CI-minimum-CI) and had significantly higher PVC burden compared to those with normal LV function (CI-dispersion: 115 ± 25 milliseconds vs. 94 ± 19 milliseconds; P < 0.001; PVC burden: 19% vs. 15%; P = 0.04). Furthermore, patients with LV dysfunction had significantly higher body mass index (BMI) compared to those with normal LV function (BMI > 30 kg/m(2) ; 37% vs. 13%; P = 0.001). Logistic regression analysis showed that CI-dispersion, PVC burden, and BMI (>30 kg/m(2) ) are independent predictors of PVC-induced cardiomyopathy. CONCLUSIONS: In addition to the PVC burden, the CI-dispersion and BMI are associated with PVC-induced cardiomyopathy.


Asunto(s)
Índice de Masa Corporal , Cardiomiopatías/etiología , Sistema de Conducción Cardíaco/fisiopatología , Disfunción Ventricular Izquierda/etiología , Complejos Prematuros Ventriculares/complicaciones , Potenciales de Acción , Adulto , Anciano , Cardiomiopatías/diagnóstico , Cardiomiopatías/fisiopatología , Ablación por Catéter , Distribución de Chi-Cuadrado , Electrocardiografía Ambulatoria , Técnicas Electrofisiológicas Cardíacas , Femenino , Sistema de Conducción Cardíaco/cirugía , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo , Volumen Sistólico , Factores de Tiempo , Resultado del Tratamiento , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/fisiopatología , Función Ventricular Izquierda , Complejos Prematuros Ventriculares/diagnóstico , Complejos Prematuros Ventriculares/fisiopatología , Complejos Prematuros Ventriculares/cirugía
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