Premature ventricular contraction-induced cardiomyopathy: an emerging entity

Modifiable Predictors of Ventricular Ectopy in the Community

Background

Premature ventricular contractions (PVCs) predict heart failure and death. Data regarding modifiable risk factors for PVCs are scarce.

Methods and Results

We studied 1424 Cardiovascular Health Study participants randomly assigned to 24‐hour Holter monitoring. Demographics, comorbidities, habits, and echocardiographic measurements were examined as predictors of PVC frequency and, among 845 participants, change in PVC frequency 5 years later. Participants exhibited a median of 0.6 (interquartile range, 0.1–7.1) PVCs per hour. Of the more directly modifiable characteristics and after multivariable adjustment, every SD increase in systolic blood pressure was associated with 9% more PVCs (95% confidence interval [CI], 2%–17%; P=0.01), regularly performing no or low‐intensity exercise compared with more physical activity was associated with ≈15% more PVCs (95% CI, 3–25%; P=0.02), and those with a history of smoking exhibited an average of 18% more PVCs (95% CI, 3–36%; P=0.02) than did never smokers. After 5 years, PVC frequency increased from a median of 0.5 (IQR, 0.1–4.7) to 1.2 (IQR, 0.1–13.8) per hour (P<0.0001). Directly modifiable predictors of 5‐year increase in PVCs, described as the odds per each quintile increase in PVCs, included increased diastolic blood pressure (odds ratio per SD increase, 1.16; 95% CI, 1.02–1.31; P=0.02) and a history of smoking (OR, 1.31; 95% CI, 1.02–1.68; P=0.04).

Conclusions

Enhancing physical activity, smoking cessation, and aggressive control of blood pressure may represent fruitful strategies to mitigate PVC frequency and PVC‐associated adverse outcomes.

Frequent Premature Ventricular Contractions and Cardiomyopathy, Chicken and Egg situation

Premature ventricular contractions (PVCs) are usually regarded as benign in the absence of structural heart disease. However, frequent PVCs can lead to depressed LV function, called PVC-induced cardiomyopathy and can be reversible after suppression of PVCs. On the other hand, PVCs can be a part of underlying structural heart disease and may be linked to increased risk of sudden death. In this work, we reviewed the current literature on PVC-induced cardiomyopathy based on a case presentation.