Characteristics of unselected high-burden premature ventricular contraction patients

Pacing Clin Electrophysiol. 2014 Dec;37(12):1671-80. doi: 10.1111/pace.12476. Epub 2014 Aug 1.

Abstract

Background: High-burden premature ventricular contractions (PVCs) may be an important determinant of heart failure (HF) in patients presenting for PVC ablation. The prevalence and characteristics of high-burden PVC patients outside this setting remain unknown. We, therefore, sought to determine predictors of high-burden PVCs and, among high-burden PVC patients, predictors of HF.

Methods: We identified all patients undergoing a 24-48-hour Holter study showing at least 20% PVCs between 2005 and 2013 at the University of California, San Francisco. Three time-matched controls undergoing Holter monitoring were selected for each high-burden PVC patient. Medical records were reviewed and test characteristics of PVC counts from 12-lead electrocardiograms (ECG) as predictors of high-burden PVC Holters were analyzed.

Results: Among 5,091 participants, 66 (1.3%) exhibited at least 20% PVCs. After multivariate adjustment, high-burden PVC patients had a three-fold greater odds of HF (odds ratio [OR] 3.15; 95% confidence interval [CI] 1.28-6.50; P = 0.005) and 10-fold greater odds of having a first-degree family member with sudden death (OR 9.97; 95% CI 1.78-60.8; P = 0.011). The C-statistic for the number of PVCs on 12-lead electrocardiogram as a predictor of high-burden PVCs was 0.7949. Among high-burden PVC patients, HF was associated with a history of coronary artery bypass grafting (OR 11.76; 95% CI 1.30-106.49; P = 0.028).

Conclusion: Among all undergoing Holter monitoring, 1.3% exhibited high-burden PVCs, a phenomenon associated with HF and a first-degree family history of sudden death. In an analysis restricted to high-burden PVC patients, a history of coronary artery bypass grafting was a predictor of HF.

Keywords: Holter monitor; congestive heart failure; electrocardiogram; premature ventricular contractions; sudden death.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cross-Sectional Studies
  • Electrocardiography, Ambulatory
  • Female
  • Heart Failure / etiology
  • Humans
  • Male
  • Middle Aged
  • Severity of Illness Index
  • Ventricular Premature Complexes / complications
  • Ventricular Premature Complexes / diagnosis*
  • Ventricular Premature Complexes / physiopathology