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

Hamon, David; Swid, Mohammed Amer; Rajendran, Pradeep S.; Liu, Albert; Boyle, Noel G.; Shivkumar, Kalyanam; Bradfield, Jason S.

doi:10.1111/jce.13944

Cited by 28 publications

(20 citation statements)

References 28 publications

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“…But beta-blockers may not have a therapeutic effect on various PVCs. Hamon et al 29 reported that only patients displaying a positive correlation between the heart rate and hourly PVC count (a fast-HR-dependent PVC profile) benefited from beta-blockers. However, Yu et al 30 reported that the number of night-time PVCs (a slow-HR-dependent PVC profile) was an independent predictor of decreased SDNN (β=−0.446, p=0.030) and increased LF/HF ratio (β=0.027, p=0.038), indicating the enhanced cardiac sympathetic activity as well.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and heart rate variability characteristics of premature ventricular contractions detected by 24-hour Holter among outpatients with palpitations in China: a cross-sectional study

Dong

Wang

et al. 2022

BMJ Open

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ObjectiveTo analyse the prevalence and heart rate variability (HRV) characteristics of premature ventricular contraction (PVC) detected by 24-hour Holter among Chinese outpatients with palpitations.DesignA cross-sectional study.SettingThis study was conducted in a tertiary hospital.ParticipantsA total of 4754 outpatients who received 24-hour Holter for palpitations.Main outcome measuresPrevalence, HRV time-domain and frequency-domain analyses of 24-hour Holter, and echocardiographic parameters were assessed. Propensity score matching (PSM) was applied to balance baseline variables (age, gender) to decrease the bias between comparison groups.ResultsThe prevalence of PVC was 67.7% (3220/4754), and was higher in men than women (69.9% vs 66.0%, p=0.004); the prevalence of frequent PVCs (PVC burden≥5%) was 7.7% (368/4754). Older patients had the highest frequency of PVC among all patients. However, among 3220 patients with PVC, younger patients’ PVC burden was much higher. Matched 1:1 by age and gender, the HRV time-domain parameters in patients with PVC were all lower than those in patients without PVC (all p<0.05); for the HRV frequency-domain parameters, the patients with frequent PVCs had a higher low frequency/high frequency (LF/HF) ratio (5.4 vs 2.8, p<0.001) than those with PVC burden less than 5%.ConclusionsThe prevalence of PVC and frequent PVCs were 67.7% and 7.7%, respectively, detected by 24-hour Holter among Chinese outpatients with palpitations. Decreased HRV time-domain parameters suggested the occurrence of PVC, and increased LF/HF ratio represented the imbalance of autonomic nervous system in patients with frequent PVCs. Further studies are needed to understand the HRV indexes in PVC patients.

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Section: Discussionmentioning

confidence: 99%

Prevalence and heart rate variability characteristics of premature ventricular contractions detected by 24-hour Holter among outpatients with palpitations in China: a cross-sectional study

Dong

Wang

et al. 2022

BMJ Open

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“…Although placebo did not reduce the PVC count, it significantly decreased symptoms, demonstrating a strong placebo effect. However, a recent study by Hamon et al (2019) describes that in a subgroup of patients the burden of PVCs can even be increased by beta-blockers, since usually PVCs are reduced at higher heart rates [ 23 ]. This might explain why the increase of PVCs in our study group is highest in the beta-blocker group.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Anti-Arrhythmic Drugs in Children With Idiopathic Frequent Symptomatic or Asymptomatic Premature Ventricular Complexes With or Without Asymptomatic Ventricular Tachycardia: a Retrospective Multi-Center Study

et al. 2021

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The aim of the study is to compare the efficacy of flecainide, beta-blockers, sotalol, and verapamil in children with frequent PVCs, with or without asymptomatic VT. Frequent premature ventricular complexes (PVCs) and asymptomatic ventricular tachycardia (VT) in children with structurally normal hearts require anti-arrhythmic drug (AAD) therapy depending on the severity of symptoms or ventricular dysfunction; however, data on efficacy in children are scarce. Both symptomatic and asymptomatic children (≥ 1 year and < 18 years of age) with a PVC burden of 5% or more, with or without asymptomatic runs of VT, who had consecutive Holter recordings, were included in this retrospective multi-center study. The groups of patients receiving AAD therapy were compared to an untreated control group. A medication episode was defined as a timeframe in which the highest dosage at a fixed level of a single drug was used in a patient. A total of 35 children and 46 medication episodes were included, with an overall change in PVC burden on Holter of -4.4 percentage points, compared to -4.2 in the control group of 14 patients. The mean reduction in PVC burden was only significant in patients receiving flecainide (− 13.8 percentage points; N = 10; p = 0.032), compared to the control group and other groups receiving beta-blockers (− 1.7 percentage points; N = 18), sotalol (+ 1.0 percentage points; N = 7), or verapamil (− 3.9 percentage points; N = 11). The efficacy of anti-arrhythmic drug therapy on frequent PVCs or asymptomatic VTs in children is very limited. Only flecainide appears to be effective in lowering the PVC burden.

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“…The latter binary definition for clinical response was chosen as previous literature has demonstrated that a reduction of ≥80% in PVC burden was sufficient to improve left ventricular function 13 . For patients with available hourly PVC count and mean heart rate, they were further stratified to three groups based on the presence of a relationship between PVC count and mean heart rate (HR) at baseline: (1) fast HR‐Dependent PVCs for those with a positive Pearson's correlation coefficient; (2) HR‐independent PVCs for those without a significant correlation with HR; (3) slow HR‐dependent PVCs for those with a negative Pearson's coefficient 19 …”

Section: Methodsmentioning

confidence: 99%

“…(1) fast HR-Dependent PVCs for those with a positive Pearson's correlation coefficient; (2) HR-independent PVCs for those without a significant correlation with HR; (3) slow HR-dependent PVCs for those with a negative Pearson's coefficient. 19…”

Section: Electrocardiographicmentioning

confidence: 99%

Effectiveness of medical therapy for treatment of idiopathic frequent premature ventricular complexes

Tang

Andrade

Hawkins

et al. 2021

Cardiovasc electrophysiol

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Introduction:The relative effectiveness of medical therapy compared with a conservative approach of monitoring in patients with idiopathic frequent premature ventricular complexes (PVCs) is uncertain. We evaluated the effectiveness of medical versus conservative therapy for frequent PVCs.Methods: Patients with frequent PVCs (≥5%) were prospectively enrolled in this cohort study between 2016 and 2020. In patients with normal cardiac function and no structural heart disease, those receiving medical therapy were compared with controls without therapy. Patients were followed longitudinally for change in PVC burden and with serial echocardiography.Results: Overall, 120 patients met inclusion criteria (mean: 56.5 ± 14.6 years, 54.2% female) with 53 on beta-blockers or calcium channel blockers (BBs/CCBs), 27 on Class I or III antiarrhythmic drugs (AADs), and 40 patients treated conservatively. Median initial PVC burden ranged from 15.5% to 20.6%. The median relative reduction of PVCs was 32.7%, 30.5%, and 81.3%, in the conservative therapy, BBs/CCBs, and AADs cohorts, respectively. AADs had greater PVC reduction compared with BBs/CCBs (p = 0.017) and conservative therapy (p = 0.045). PVC reduction to <1% was comparable across groups at 35.0%, 17.0%, 33.3%, respectively. Four patients (4/120, 3.3%) developed left ventricular dysfunction. Rates of adverse drug reactions and medication discontinuation were similar between groups, with no serious adverse events noted. Conclusion:In patients with idiopathic frequent PVCs, BB, and CCB have limited effectiveness in PVC reduction. Class I and III AADs have superior effectiveness for medical therapy in symptomatic patients, but only achieved complete PVC resolution suppression in one-third of patients.

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

Abstract: Introduction: Frequent premature ventricular complexes (PVCs) can lead to symptoms,

Cited by 28 publications

References 28 publications

Prevalence and heart rate variability characteristics of premature ventricular contractions detected by 24-hour Holter among outpatients with palpitations in China: a cross-sectional study

Prevalence and heart rate variability characteristics of premature ventricular contractions detected by 24-hour Holter among outpatients with palpitations in China: a cross-sectional study

The Efficacy of Anti-Arrhythmic Drugs in Children With Idiopathic Frequent Symptomatic or Asymptomatic Premature Ventricular Complexes With or Without Asymptomatic Ventricular Tachycardia: a Retrospective Multi-Center Study

Effectiveness of medical therapy for treatment of idiopathic frequent premature ventricular complexes

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