The prognostic significance of frequency and morphology of premature ventricular complexes during ambulatory holter monitoring

Number of Premature Ventricular Complexes Predicts Long-Term Outcomes in Patients with Persistent Atrial Fibrillation

BACKGROUND

Premature ventricular complexes (PVCs) are common electrocardiographic abnormalities and may be a prognosticator in predicting mortality in patients with structurally normal hearts or chronic heart diseases. Whether PVC burden was associated with mortality in patients with chronic atrial fibrillation (AF) remained unknown. We investigated the prognostic value of PVC burden in patients with persistent AF.

METHODS

A retrospective analysis of 24 h Holter recordings of 1767 patients with persistent AF was conducted. Clinical characteristics, 24 h average heart rate (HR), and PVC measures, including 24 h PVC burden and the presence of consecutive PVCs (including any PVC couplet, triplet, or non-sustained ventricular tachycardia) were examined for the prediction of all-cause and cardiovascular mortality using the Cox proportional hazards model.

RESULTS

After a median follow-up time of 30 months, 286 (16%) patients died and 1481 (84%) patients survived. Multivariate analysis revealed that age, heart failure, stroke, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta-blocker, digoxin, oral anticoagulant use, and estimated glomerular filtration rate were significant baseline predictors of all-cause mortality and cardiovascular mortality. Twenty-four-hour PVC burden and the presence of consecutive PVCs were significantly associated with all-cause and cardiovascular mortality after adjusting for significant clinical factors. When compared to the first quartile of PVC burden (<0.003%/day), the highest quartile (>0.3%/day) was significantly associated with an increased risk of all-cause mortality (hazard ratio, 2.46; 95% CI, 1.77-3.42) and cardiovascular mortality (hazard ratio: 2.67; 95% CI, 1.76-4.06).

CONCLUSIONS

Twenty-four-hour PVC burden is independently associated with all-cause and cardiovascular mortality in patients with persistent AF.

Pathogenetic justification of digestive tract dysfunction correction to reduce the risk of ventricular extrasystoles after coronary bypass grafting

Introduction

In heart pathology, abdominal pathology is often detected, but due attention has not been paid to this issue, and algorithms for predicting, preventing, and correcting the coefficient of endothelial dysfunction (CED) after coronary artery bypass grafting (CABG) with the use of artificial circulation (AC) have not been developed.

Aim

To substantiate the pathogenetic expediency of correction of postoperative intestinal paresis after coronary artery bypass grafting for the prevention of functional cardiac complications.

Material and methods

147 men were divided into 2 groups. Statistical processing of the obtained data was performed using Windows Microsoft Excel software and parametric methods of variational statistics, and the reliability of differences was determined using Student's formula and table.

Results

It was found that in group II, after coronary artery bypass grafting, the clinical symptoms of intestinal dysfunction were significantly less (p = 0.019), and the recovery of defecation was significantly faster (p = 0.033) than in group I. After coronary artery bypass grafting, the frequency of high-grade extrasystoles in group II was significantly lower than in group I (p = 0.033).

Conclusions

The application of the digestive tract dysfunction correction program is pathogenetically justified because it provides a reduction in the frequency of intestinal paresis and hence a reduction in the frequency of development of ventricular extrasystoles of high gradations after coronary artery bypass grafting.

Left Atrial Mechanical Function And Stiffness In Patients With Premature Ventricular Contraction: A Speckle Tracking Study

AIM

Ventricular extrasystole (PVC) is characterized by premature ventricular depolarization and is associated with increased risk of arrhythmias and structural heart disease. This study aimed to investigate the association between the PVC burden and left atrial (LA) function in individuals without known cardiac disease.

MATERIAL AND METHODS

A cross-sectional study was conducted on 102 patients with PVCs who were admitted to a cardiology clinic. Transthoracic echocardiography was used to assess left ventricle (LV) parameters, including LV mass, LV ejection fraction (LVEF), LV global longitudinal strain (LVGLS), and LA function was evaluated using strain imaging. The PVC burden was categorized into three groups: <10 %, 10-20 %, and >20 %.

RESULTS

Changes in LV dimensions and LV mass index were associated with the groups with the PVC burden with 10-20 %, and >20 %. but differences in LVEF and LVGSL were not significant. Mean E / e' increased as the PVC burden increased (p<0.001). The mean global LA peak strain decreased as the PVC burden increased (p<0.001), while other mean LA measurements increased as the PVC burden increased (p<0.001) A higher PVC burden was associated with impaired LA function, as indicated by decreased global LA peak strain (PVC burden <10 %=38.1±3.2 vs. PVC burden 10-20 %=32.4±3.2 vs. PVC burden >20 %=27.7±2.6, in all groups p<0.001) and with increased LA stiffness (PVC burden <10 %=18.6±3.2 vs. PVC burden 10-20 %=27.5±5.5 vs. PVC burden >20 %=39.0±7.9, in all groups p<0.001). A strong negative correlation was found between global LA peak strain and LA stiffness (r=-0.779, p<0.001).

CONCLUSION

In individuals without known cardiac disease, a higher PVC burden was associated with impaired LA function, indicated by increased E / e', decreased LA strain, and increased LA stiffness. These findings suggest that PVC burden may contribute to LA dysfunction, potentially increasing the risk of cardiovascular events.

Subclinical Left Ventricular Dysfunction and Ventricular Arrhythmias in Older Adults With Normal Ejection Fraction

Background Premature ventricular contractions (PVCs) and nonsustained ventricular tachycardia (NSVT) are known to be associated with reduced left ventricular (LV) ejection fraction and adverse outcomes in patients with structural heart disease. The relationship between subclinical LV dysfunction and ventricular arrhythmias in the general population is not established. Methods and Results Participants in the SAFARIS (Subclinical Atrial Fibrillation and Risk of Ischemic Stroke) study with normal left ventricular ejection fraction (n=503; mean age 77 years, 63% women) underwent 14-day electrocardiographic monitoring and 2-dimensional echocardiography. Frequent PVCs were defined as PVCs >500 per 24 hours and NSVT as ≥4 consecutive ventricular ectopic beats. Reduced LV global longitudinal strain (GLS) was used as an indicator of subclinical LV dysfunction. Seventy-six participants (15.1%) had PVCs >500/d, 117 (23.3%) had NSVT episodes. LV GLS was significantly reduced in both frequent PVCs and NSVT groups (P<0.01). In multivariable analyses, lower LV GLS was associated with frequent PVCs (adjusted odds ratio [aOR], 1.19 [95% CI, 1.09-1.30 per unit reduction]; P<0.001) and NSVT (aOR, 1.09 [95% CI, 1.01-1.17]; P=0.036) independently of established risk factors and other echocardiographic parameters. Abnormal LV GLS (>-15.8%) carried a 2-fold increase in risk of ventricular arrhythmias (aOR, 2.18, P=0.029 for PVCs; aOR, 2.09, P=0.026 for NSVT). Conclusions PVCs and NSVT episodes were frequent in this community-based elderly cohort with normal left ventricular ejection fraction and were independently associated with lower LV GLS. The association between LV dysfunction and ventricular arrhythmias is present at an early, subclinical stage, an observation that carries possible preventative implications.

Prognostic impact of morphology and duration of premature ventricular contractions in a population without structural heart disease

BACKGROUND

Premature ventricular contractions (PVCs) are a common form of arrhythmia associated with an unfavorable prognosis in patients with structural heart disease. It is unclear whether PVCs site of origin and QRS-width has a prognostic significance in patients without structural heart disease. The aim of this study was to assess the prognostic importance of PVCs morphology and duration in this patient group.

METHODS

We included 511 consecutive patients without a history of previous heart disease. They were examined with echocardiography and exercise test with normal findings. We categorized the PVCs from a 12 lead ECG according to morphology and width of the QRS-complex and analyzed the outcome in terms of a composite endpoint of total mortality and cardiovascular morbidity.

RESULTS

During a median follow-up time of 5.3 years, 19 patients (3.5%) died and 61 (11.3%) met the composite outcome. Patients with PVCs originating from the outflow tracts had a significantly lower risk for the composite outcome compared to patients with non-OT-PVCs. Similarly, patients with PVC originating from the right ventricle had a better outcome than patients with left ventricular PCVs. No difference in outcome depending on QRS-width during PVCs was noticed.

CONCLUSION

In our cohort of consecutively included PVC patients without structural heart disease PVCs from the outflow tracts were associated with a better prognostic outcome than non-OT PVCs; the same was true for right ventricular PVCs when compared to left ventricular ones. The classification of the origin of the PVCs was based on 12-lead ECG morphology. QRS-width during PVC did not seem to have prognostic significance.

Best ablation strategy in patients with premature ventricular contractions with multiple morphology: a single-centre experience

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.

Arrhythmia Burden and Heart Rate Response During Exercise in Anderson-Fabry Disease

Patients with Anderson-Fabry disease (AFD) have an elevated incidence of resting arrhythmias and ischemic heart disease, but their exercise arrhythmia burden and ischemic changes are not well understood. In addition, little research has been done on heart rate recovery in these patients. We retrospectively reviewed charts of patients with AFD who underwent maximal effort cardiopulmonary exercise testing (CPET) (n=44; 38.2 ± 13.8 yr; 23 men) from 2012 through 2018. Electrocardiographic, Holter monitoring, echocardiographic, cardiac magnetic resonance imaging, and patient demographic data were collected. No patient had adverse events that necessitated CPET termination, whereas 25 (57%) had ectopy during CPET, including 3 (7%) with frequent premature atrial contractions and 5 (11%) with frequent premature ventricular contractions. The ectopic burden was higher during resting electrocardiographic monitoring before exercise. In addition, 7 patients (16%) had pathologic ST-segment or T-wave changes on CPET, defined as ST-segment changes ≥2 mm. Among the patients who had concurrent cardiac magnetic resonance findings with their CPET (n=27), ST-segment or T-wave changes were associated with left ventricular myocardial mass (r=0.43, P=0.02). Chronotropic incompetence was seen during CPET in 28 patients (64%); however, only 2 patients (4%) had abnormal heart rate recovery at 1 minute. This study shows that patients with AFD can safely undergo exercise testing but have a high incidence of exercise-induced arrhythmias and ischemic changes. Ischemic electrocardiographic changes during exercise testing are associated with myocardial mass. Despite the chronotropic incompetence associated with AFD, heart rate recovery appears to be generally preserved in these patients.

Ventricular Arrhythmias in Seniors with Heart Failure: Present Dilemmas and Therapeutic Considerations: A Systematic Review

BACKGROUND

Heart Failure (HF) is a global public health problem, which affects over 23 million people worldwide. The prevalence of HF is higher among seniors in the USA and other developed countries. Ventricular Arrhythmias (VAs) account for 50% of deaths among patients with HF. We aim to elucidate the factors associated with VAs among seniors with HF, as well as therapies that may improve the outcomes.

METHODS

PubMed, Web of Science, Scopus, Cochrane Library databases, Science Direct, and Google Scholar were searched using specific keywords. The reference lists of relevant articles were searched for additional studies related to HF and VAs among seniors as well as associated outcomes.

RESULTS

The prevalence of VAs increases with worsening HF. A 24-hour Holter electrocardiogram may be useful in risk stratifying patients for device therapy if they do not meet the criterion of low ventricular ejection fraction. Implantable Cardiac Defibrillators (ICDs) are superior to anti-arrhythmic drugs in reducing mortality in patients with HF. Guideline-Directed Medical Therapy (GDMT) together with device therapy may be required to reduce symptoms. In general, the proportion of seniors on GDMT is low. A combination of ICDs and cardiac resynchronization therapy may improve outcomes in selected patients.

CONCLUSION

Seniors with HF and VAs have high mortality even with the use of device therapy and GDMT. The holistic effect of device therapy on outcomes among seniors with HF is equivocal. More studies focused on seniors with advanced HF as well as therapeutic options are, therefore, required.

Premature ventricular complexes and development of heart failure in a community-based population

OBJECTIVE

A higher premature ventricular complex (PVC) frequency is associated with incident congestive heart failure (CHF) and death. While certain PVC characteristics may contribute to that risk, the current literature stems from patients in medical settings and is therefore prone to referral bias. This study aims to identify PVC characteristics associated with incident CHF in a community-based setting.

METHODS

The Cardiovascular Health Study is a cohort of community-dwelling individuals who underwent prospective evaluation and follow-up. We analysed 24-hour Holter data to assess PVC characteristics and used multivariable logistic and Cox proportional hazards models to identify predictors of a left ventricular ejection fraction (LVEF) decline and incident CHF, respectively.

RESULTS

Of 871 analysed participants, 316 participants exhibited at least 10 PVCs during the 24-hour recording. For participants with PVCs, the average age was 72±5 years, 41% were women and 93% were white. Over a median follow-up of 11 years, 34% developed CHF. After adjusting for demographics, cardiovascular comorbidities, antiarrhythmic drug use and PVC frequency, a greater heterogeneity of the PVC coupling interval was associated with an increased risk of LVEF decline and incident CHF. Of note, neither PVC duration nor coupling interval duration exhibited a statistically significant relationship with either outcome.

CONCLUSIONS

In this first community-based study to identify Holter-based features of PVCs that are associated with LVEF reduction and incident CHF, the fact that coupling interval heterogeneity was an independent risk factor suggests that the mechanism of PVC generation may influence the risk of heart failure.

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

Background

While there are published studies that have examined premature ventricular complexes (PVCs) among patients with and without cardiac disease, there has not been a comprehensive review of the literature examining the diagnostic and prognostic significance of PVCs. This could help guide both community and hospital-based research and clinical practice.

Methods

Scoping review frameworks by Arksey and O’Malley and the Joanna Briggs Institute (JBI) were used. A systematic search of the literature using four databases (CINAHL, Embase, PubMed, and Web of Science) was conducted. The review was prepared adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Review (PRISMA-ScR).

Results

A total of 71 relevant articles were identified, 66 (93%) were observational, and five (7%) were secondary analyses from randomized clinical trials. Three studies (4%) examined the diagnostic importance of PVC origin (left/right ventricle) and QRS morphology in the diagnosis of acute myocardial ischemia (MI). The majority of the studies examined prognostic outcomes including left ventricular dysfunction, heart failure, arrhythmias, ischemic heart diseases, and mortality by PVCs frequency, burden, and QRS morphology.

Conclusions

Very few studies have evaluated the diagnostic significance of PVCs and all are decades old. No hospital setting only studies were identified. Community-based longitudinal studies, which make up most of the literature, show that PVCs are associated with structural and coronary heart disease, lethal arrhythmias, atrial fibrillation, stroke, all-cause and cardiac mortality. However, a causal association between PVCs and these outcomes cannot be established due to the purely observational study designs employed.

Electrocardiographic features of arrhythmogenic right ventricular cardiomyopathy in school-aged children

It can be difficult to distinguish children with early-stage arrhythmogenic right ventricular cardiomyopathy (ARVC) from those with benign premature ventricular contraction (PVC). We retrospectively evaluated six school-aged children with ARVC and compared with those of 20 with benign PVC. The median age at initial presentation was 11.4 and 10.2 years in ARVC and benign PVC, respectively. None of the ARVC patients fulfilled the diagnostic criteria of ARVC at initial presentation. At ARVC diagnosis, the treadmill exercise test and Holter monitoring showed provoked PVC during exercise and pleomorphic PVC in all ARVC cases, respectively. During the observation period, terminal activation duration (TAD) was prolonged in all ARVC patients. In addition, ΔTAD (5.5 [3-10] ms) were significantly longer than those with benign PVC (p < 0.001). A new notched S-wave in V1 appeared in four (67%) ARVC patients, who had myocardial abnormalities in the right ventricle, and in zero benign PVC. Our electrocardiographic findings, such as provoked PVC during exercise, pleomorphic PVC, prolonged TAD, and a new notched S-wave in V1 could contribute to the early detection of ARVC in school-aged children.

Evaluation and treatment of premature ventricular contractions in heart failure with reduced ejection fraction

Premature ventricular complexes (PVCs) are often observed in patients presenting with heart failure with a reduced ejection fraction (HFrEF). PVCs may in some patients be considered to be the cause of heart failure, while in others it may be the consequence of heart failure. PVCs are important prognostic markers in HFrEF. The uncertainty whether PVCs are the cause or effect in HFrEF impacts clinical decision making. In this review, we discuss the complexity of the cause-effect relationship between PVCs and HFrEF. We demonstrate a workflow with the use of a trial period of amiodarone that may discover whether the reduced LVEF is reversible, the symptoms are due to PVCs and whether biventricular pacing can be increased by the reduction of PVCs. The use of non-invasive and invasive (high-density) mapping techniques may help to improve accuracy and efficacy in the treatment of PVC, which will be demonstrated. With these results in mind, we conclude this review highlighting the future directions for PVC research and treatment.

[The method for prediction of high-grade premature ventricular contractions in patients with heart failure and preserved ejection fraction]

Aim To develop a method for prediction of high-grade ventricular extrasystole (VE) in patients with chronic heart failure with preserved ejection fraction (CHF-PEF) based on results of an echocardiography (EchoCG) study.Material and methods At the first step, the study included 121 patients of the Cardiology Department, Municipal Clinical Hospital #31, St. Petersburg (calculation group) with symptoms and clinical signs of CHF-PEF (median age, 62 years). For testing accuracy of the developed formula, a control group was formed, which consisted of 42 patients with CHF-PEF (median age, 59 years). EchoCG at rest and ECG Holter monitoring were performed for all patient. The VE classification according to B. Lown and M. Wolf (1971) in the M. Ryan (1975) modification was used. Results of the evaluation were determined by the most significant recorded grade. Grade III or higher VE were considered as high-grade VE.Results Using logistic regression analysis of data for patients of the calculation group, a statistical model was constructed and a respective formula was developed to predict a probability of high-grade VE in CHF-PEF patients depending on the presence of risk factors (EchoCG criteria). According to the obtained data the following factors primarily contributed to the model: interventricular septal (IVS) thickness (p=0.007; Wald=7.44), end-diastolic volume index (EDVI) (p=0.044; Wald=4.13), and the degree of diastolic dysfunction (DD) (p&lt;0.0001; Wald=19.90). For testing the formula accuracy, the analysis was performed in the control group. Based on data of both stages, the following values were obtained: for the calculation group, the method sensitivity was 77.8 %, the specificity was 82.4 %, the accuracy was 81.0 %; for the control group, 81.8 %, 70 %, and 76.2 %, respectively; for both groups together, 79.3 %, 80.0 %, and 79.8 %, respectively. In ROC-analysis of this prognostic model, the area under the ROC-curve (AUC) was 0.852 (95 % CI: 0.776-0.910; p&lt;0.0001) for the calculation group; 0.818 (95 % CI: 0.669-0.920; p&lt;0.0001) for the control group; and 0.855 (95 % CI: 0.792-0.905; p&lt;0.0001) for both groups together, which indicated a good quality of the prognostic model.Conclusion The EchoCG predictors of high-grade VE in patients with CHF-PEF included degree of DD, EDVI, and IVS thickness. The developed method with the constructed formula for prediction of high-grade VE in CHF-PEF patients showed high sensitivity, specificity and accuracy.

Ventricular arrhythmia and sudden cardiac death in young Leonbergers

INTRODUCTION

To describe unexpected sudden cardiac death (SCD) in young Leonbergers (<3 years) and to review the circumstances before death and necropsy findings; to prospectively evaluate the presence of possible arrhythmias in young Leonbergers; and to examine pedigrees for determining potential modes of inheritance.

ANIMALS

Postmortem evaluations included 21 Leonbergers. Clinical evaluation consisted of 46 apparently healthy Leonbergers with and without a close family history of SCD.

MATERIALS AND METHODS

Necropsy reports were reviewed retrospectively. Prospective clinical evaluation included physical examination, 5-min electrocardiogram, 24-h Holter, echocardiography, and laboratory tests. Pedigree data were examined for mode of inheritance.

RESULTS

Based on necropsy reports, SCD occurred at a median age of 12 months (range, 2.0-32.0 months) without any previous clinical signs and usually in rest. No evidence of structural cardiac disease was found; arrhythmia-related death was suspected. Clinical evaluation and 24-h Holter showed ventricular arrhythmia (VA) in 14 apparently healthy Leonbergers (median age, 18 months; range, 12-42 months). Severity of VA varied from infrequent couplets/triplets to frequent complexity (couplets, triplets, nonsustained ventricular tachycardias,VTs) characterized by polymorphology. During follow-up, two dogs with polymorphic VT died. Although breed specificity and high prevalence indicate a heritable disease, based on available pedigree data, the mode of inheritance could not be determined.

CONCLUSIONS

Sudden cardiac death in young Leonbergers is associated with malignant VA characterized by complexity and polymorphic nature. Diagnosis is based on 24-h Holter monitoring. Pedigree analysis suggests that the arrhythmia is familial.

Role of Cardiac Magnetic Resonance Imaging in Patients with Idiopathic Ventricular Arrhythmias

Ventricular Arrhythmias (VAs) may present with a wide spectrum of clinical manifestations ranging from mildly symptomatic frequent premature ventricular contractions to lifethreatening events such as sustained ventricular tachycardia, ventricular fibrillation and sudden cardiac death. Myocardial scar plays a central role in the genesis and maintenance of re-entrant arrhythmias which are commonly associated with Structural Heart Diseases (SHD) such as ischemic heart disease, healed myocarditis and non-ischemic cardiomyopathies. However, the arrhythmogenic substrate may remain unclear in up to 50% of the cases after a routine diagnostic workup, comprehensive of 12-lead surface ECG, transthoracic echocardiography and coronary angiography/ computed tomography. Whenever any abnormality cannot be identified, VAs are referred as to "idiopathic". In the last decade, Cardiac Magnetic Resonance (CMR) imaging has acquired a growing role in the identification and characterization of myocardial arrhythmogenic substrate, not only being able to accurately and reproducibly quantify biventricular function, but, more importantly, providing information about the presence of myocardial structural abnormalities such as myocardial fatty replacement, myocardial oedema, and necrosis/ fibrosis, which may otherwise remain unrecognized. Moreover, CMR has recently demonstrated to be of great value in guiding interventional treatments, such as radiofrequency ablation, by reliably identifying VA sites of origin and improving long-term outcomes. In the present manuscript, we review the available data regarding the utility of CMR in the workup of apparently "idiopathic" VAs with a special focus on its prognostic relevance and its application in planning and guiding interventional treatments.

Relation Between Ventricular Premature Complexes and Incident Heart Failure

Ventricular premature complexes (VPCs) may represent a reversible cause of heart failure (HF); however, the type of patients most prone remains unknown. This study leverages a large population-based database to examine interactions that might prove clinically useful in risk-stratifying patients with VPCs. We used the California Healthcare Cost and Utilization Project to identify patients with VPCs and incident systolic HF from January 1, 2005, to December 31, 2009. We calculated hazard ratios for predictors of incident systolic HF using multivariable Cox proportional hazard models. Interactions with known risk factors were studied. Of the 16.8 million patients experiencing 48.1 million hospitalizations, 35,817 (0.2%) had a VPC diagnosis and 198,818 (1.2%) developed systolic HF. Incidence of systolic HF was 62.8 per 1,000 patient-years (95% confidence interval [CI] 61.2 to 64.4) in those with and 6.1 per 1,000 patient-years (95% CI 6.1 to 6.2) in those without VPCs (p <0.001). After adjusting for potential confounders, VPCs were associated with a nearly twofold risk of systolic HF (HR 1.8, 95% CI 1.8 to 1.9, p <0.001). Interaction analyses revealed a stronger relation between VPCs and HF among those with fewer cardiovascular risk factors. A VPC diagnosis in younger patients (<65 years) without coronary artery disease, hypertension, diabetes, or atrial fibrillation exhibited a sixfold increased risk of systolic HF (HR 6.5, 95% CI 5.5 to 7.7, p <0.001). In conclusion, these results suggest that a diagnosis of VPCs independently predicts incident systolic HF. This effect is most pronounced in younger patients without co-morbidities, suggesting that VPCs may be an important cause of "idiopathic" HF.

Photoplethysmography-Based Method for Automatic Detection of Premature Ventricular Contractions

This work introduces a method for detection of premature ventricular contractions (PVCs) in photoplethysmogram (PPG). The method relies on 6 features, characterising PPG pulse power, and peak-to-peak intervals. A sliding window approach is applied to extract the features, which are later normalized with respect to an estimated heart rate. Artificial neural network with either linear and non-linear outputs was investigated as a feature classifier. PhysioNet databases, namely, the MIMIC II and the MIMIC, were used for training and testing, respectively. After annotating the PPGs with respect to synchronously recorded electrocardiogram, two main types of PVCs were distinguished: with and without the observable PPG pulse. The obtained sensitivity and specificity values for both considered PVC types were 92.4/99.9% and 93.2/99.9%, respectively. The achieved high classification results form a basis for a reliable PVC detection using a less obtrusive approach than the electrocardiography-based detection methods.

A 54-year-old woman with premature ventricular complexes and a rapidly changing ECG

Premature ventricular complexes (PVCs) are common findings in asymptomatic participants during ECG recordings. While most PVCs are treated conservatively, some patients may develop adverse cardiac events needing further investigations and definitive ablation by radiofrequency. Spectral strain ultrasonography has demonstrated ventricular dysfunction as a sequel to high burden PVCs, but the exact underlying pathophysiology is still uncertain. Cohort studies have associated PVCs with increased risks for overall cardiovascular morbidity and mortality, and yet consensus is still lacking for threshold in treating PVCs. Our case is that of a 54-year-old woman with an unusual bradycardiac presentation of PVCs and an ECG that changed rapidly within minutes.

The Association Between the Neutrophil-to-Lymphocyte Ratio and the Presence of Ventricular Premature Contractions in Young Adults

Inflammation has recently emerged in the pathogenesis of several cardiovascular disorders, including arrhythmias. The neutrophil-lymphocyte ratio (NLR) is a simple marker for the assessment of inflammatory status. Therefore, we aimed to investigate the relationship between the NLR and the ventricular premature contraction (VPC) existence. Patients aged between 18 and 40 years who were referred to the cardiology clinic were enrolled in the study. All patients' complete blood counts and 24-hour Holter recordings were analyzed. The NLR was higher within the VPC group compared to the control group (P < .001). According to the NLR tertiles, VPCs were more common in the higher NLR tertile (P < .001). A cutoff point of 1.80 for the NLR had 71% sensitivity and 60% specificity in predicting VPC in apparently healthy individuals. After multivariate analysis, only the NLR remained significant predictor of presence of VPC. In conclusion, the NLR is independently and significantly associated with VPC existence.