Circadian variability patterns predict and guide premature ventricular contraction ablation procedural inducibility and outcomes

Abstract

A simple analysis of Holter PVC circadian variability provides incremental value to guide pharmacologic induction of PVCs during RFA and predict outcome. Patients with infrequent I-HR-PVC had the least successful outcomes from RF ablation.

Premature ventricular contraction diurnal profiles predict distinct clinical characteristics and beta‐blocker responses

“…Increased sympathetic and parasympathetic activity estimated through heart rate variability parameters has been specifically described during the onset of PVCs displaying these respective profiles . We have previously demonstrated that patients with F‐HR‐PVC pattern responded with increased PVC frequency to isoproterenol infusion, a beta2‐receptor agonist; likewise, patients with S‐HR‐PVC responded to isoproterenol washout or phenylephrine, an α‐adrenergic agonist inducing a vagal baroreflex activation . On the other hand, there is a highly complex interplay between autonomic tone, HR and arrhythmogenesis .…”

“…Patients were divided into three groups on the basis of their hourly PVC relationship to the corresponding mean HR generated by Holter software during the index Holter monitoring, as previously described . A positive correlation of the hourly PVC number with the mean HR (Pearson, P < 0.05) was defined as fast HR‐dependent‐PVC (F‐HR‐PVC) type.…”

“…We recently utilized three diurnal PVC profiles on the basis of Holter monitoring that were highly effective in predicting PVC inducibility with isoproterenol challenge during electrophysiologic study . On the basis of this data, we hypothesized that this same PVC diurnal variation could help predict the likelihood that PVCs respond to beta‐blockers in an unselected outpatient clinical setting.…”

Premature Ventricular Complex-induced Cardiomyopathy

“…35 A recent study in patients with frequent monomorphic PVCs referred for radiofrequency ablation (RFA) hypothesised that PVC circadian variation may help predict PVC inducibility in the electrophysiology lab, facilitating the success of the ablation procedure. 36 In fact, those patients with fast heart rate dependent PVCs had the highest successful outcomes from RFA as they responded to isoproterenol during the procedure, while patients with no correlation between PVCs and mean heart rate had the least successful outcomes.…”

Approach to induce infrequent premature ventricular complexes

“…Given that idiopathic PVCs are thought mainly to be sensitive to adrenergic stimuli, the use of EPI seems to be a rational approach to consider in triggering PVCs. Yet, the variable circadian distribution of PVCs as demonstrated previously by Hamon et al, predicted the likelihood of drug response in the EP laboratory 2 . Patients were divided into three groups (fast‐heart‐rate [HR]‐dependent PVC; slow‐HR‐dependent PVC; and independent [HR] PVC) based on hourly PVC burden in relation to the corresponding mean HR during Holter recording.…”