Background Studies of patients presenting for catheter ablation suggest that premature ventricular contractions (PVCs) are a modifiable risk factor for congestive heart failure (CHF). The relationship between PVC frequency, incident CHF, and mortality in the general population remains unknown. Objectives The goal of this study was to determine whether PVC frequency ascertained using a 24-h Holter monitor is a predictor of LVEF decline, incident CHF, and death in a population-based cohort. Methods We studied the 1,139 Cardiovascular Health Study (CHS) participants randomly assigned to 24-h ambulatory electrocardiography (Holter) monitoring with a normal left ventricular ejection fraction (LVEF) and no history of CHF. PVC frequency was quantified using Holter studies, and LVEF was measured from baseline and 5-year echocardiograms. Participants were followed for incident CHF and death. Results Those in the upper quartile versus the lowest quartile of PVC frequency had a multivariable adjusted 3-fold greater odds of a 5-year LVEF decline (OR: 3.10, 95% CI: 1.42 to 6.77, p = 0.005), and, over a median follow-up >13 years, a 48% increased risk of incident CHF (HR: 1.48, 95% CI: 1.08 to 2.04, p = 0.02), and a 31% increased risk of death (HR: 1.31, 95% CI: 1.06 to 1.63, p = 0.01). Similar statistically significant results were observed for PVCs analyzed as a continuous variable. The specificity for the 15-year risk of CHF exceeded 90% when PVCs comprised at least 0.7% of ventricular beats. The population-level risk for incident CHF attributed to PVCs was 8.1% (95% CI: 1.2 to14.9%). Conclusions In a population-based sample, a higher frequency of PVCs was associated with LVEF decline, increased incident CHF, and increased mortality. Given the capacity to prevent PVCs through medical or ablation therapy, PVCs may represent a modifiable risk factor for CHF and death.

All patients aged ≥18 years who received care in a California emergency department, inpatient hospital unit, or ambulatory surgery setting between January 1, 2005

In this large, multicenter cohort of patients, dual-chamber ICD use was common. Dual-chamber device implantation was associated with increases in periprocedural complications and in-hospital mortality compared with single-chamber defibrillator selection.

Background Atrial fibrillation (AF) prediction models have unclear clinical utility given the absence of AF prevention therapies and the immutability of many risk factors. Premature atrial contractions (PACs) play a critical role in AF pathogenesis and may be modifiable. Objective To investigate whether PAC count improves model performance for AF risk. Design Prospective cohort study. Setting 4 U.S. communities. Patients A random subset of 1260 adults without prevalent AF enrolled in the Cardiovascular Health Study between 1989 and 1990. Measurements The PAC count was quantified by 24-hour electrocardiography. Participants were followed for the diagnosis of incident AF or death. The Framingham AF risk algorithm was used as the comparator prediction model. Results In adjusted analyses, doubling the hourly PAC count was associated with a significant increase in AF risk (hazard ratio, 1.17 [95% CI, 1.13 to 1.22]; P < 0.001) and overall mortality (hazard ratio, 1.06 [CI, 1.03 to 1.09]; P < 0.001). Compared with the Framingham model, PAC count alone resulted in similar AF risk discrimination at 5 and 10 years of follow-up and superior risk discrimination at 15 years. The addition of PAC count to the Framingham model resulted in significant 10-year AF risk discrimination improvement (c-statistic, 0.65 vs. 0.72; P < 0.001), net reclassification improvement (23.2% [CI, 12.8% to 33.6%]; P < 0.001), and integrated discrimination improvement (5.6% [CI, 4.2% to 7.0%]; P < 0.001). The specificity for predicting AF at 15 years exceeded 90% for PAC counts more than 32 beats/h. Limitation This study does not establish a causal link between PACs and AF. Conclusion The addition of PAC count to a validated AF risk algorithm provides superior AF risk discrimination and significantly improves risk reclassification. Further study is needed to determine whether PAC modification can prospectively reduce AF risk. Primary Funding Source American Heart Association, Joseph Drown Foundation, and National Institutes of Health.

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