The prognostic significance of premature ventricular complexes in adults without clinically apparent heart disease: a meta-analysis and systematic review

Lee, Victor; Hemingway, Harry; Harb, Rami; Crake, Tom; Lambiase, Pier D.

doi:10.1136/heartjnl-2012-302005

Cited by 84 publications

(58 citation statements)

References 35 publications

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“…33 Although the clinical impact of these previously unknown arrhythmias in TAVR candidates remains to be elucidated, short episodes of AF/AT have been associated with an increased risk of stroke in patients with implantable devices and in the overall population, 11,34 and occurrences of ventricular arrhythmias and paroxysmal AVB have been described as predictors of sudden cardiac death and adverse cardiac events. 9,22,35 Interestingly, ≈1 in 10 TAVR candidates had a change in therapy related to the diagnosis of previously unknown arrhythmic events, highlighting the importance of monitoring such patients before the TAVR procedures. Whether or not early therapy in patients with paroxysmal events may be associated with a potential benefit in patients undergoing TAVR should be evaluated in future studies.…”

Section: Discussionmentioning

confidence: 99%

Arrhythmia Burden in Elderly Patients With Severe Aortic Stenosis as Determined by Continuous Electrocardiographic Recording

et al. 2015

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T he occurrence of new conduction abnormalities and the need for permanent pacemaker implantation (PPI) are frequent complications of transcatheter aortic valve replacement (TAVR) and may potentially jeopardize the use of this technology in a lower-risk and younger population. 1,2 In addition to the aortic stenosis itself, it has been shown that advanced age and comorbidities such as heart failure, hypertension, and diabetes mellitus, all of which are very frequent in candidates for TAVR, are associated with a high prevalence of left bundle-branch block (LBBB) and severe bradyarrhythmias, irrespective of TAVR.3-8 Furthermore, it is well known that these conduction disorders may be paroxysmal and asymptomatic 9 or lead to symptoms similar to those of aortic stenosis, and the occurrence of these abnormalities may therefore be overlooked unless ECG Background-This study sought to evaluate the prevalence of previously undiagnosed arrhythmias in candidates for transcatheter aortic valve replacement (TAVR) and to determine the impact on therapy changes and arrhythmic events after the procedure. Methods and Results-A total of 435 candidates for TAVR underwent 24-hour continuous ECG monitoring the day before the procedure. Newly diagnosed arrhythmias were observed in 70 patients (16.1%) before TAVR: paroxysmal atrial fibrillation (AF)/atrial tachycardia (AT) in 28, advanced atrioventricular block or severe bradycardia in 24, nonsustained ventricular tachycardia in 26, and intermittent left bundle-branch block in 3 patients. All arrhythmic events but one were asymptomatic and led to a therapy change in 43% of patients. In patients without known AF/AT, the occurrence of AF/AT during 24-hour ECG recording was associated with a higher rate of 30-day cerebrovascular events (7.1% versus 0.4%; P=0.030). Among the 53 patients with new-onset AF/AT after TAVR, 30.2% had newly diagnosed paroxysmal AF/AT before the procedure. In patients who needed permanent pacemaker implantation after the procedure (n=35), 31.4% had newly diagnosed advanced atrioventricular block or severe bradycardia before TAVR. New-onset persistent left bundle-branch block after TAVR occurred in 37 patients, 8.1% of whom had intermittent left bundle-branch block before the procedure. Conclusions-Newly diagnosed arrhythmias were observed in approximately a fifth of TAVR candidates, led to a higher rate of cerebrovascular events, and accounted for a third of arrhythmic events after the procedure. This high arrhythmia burden highlights the importance of an early diagnosis of arrhythmic events in such patients to implement the appropriate therapeutic measures earlier.

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Section: Discussionmentioning

confidence: 99%

Arrhythmia Burden in Elderly Patients With Severe Aortic Stenosis as Determined by Continuous Electrocardiographic Recording

et al. 2015

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“…Nonsustained VT Premature ventricular contractions (PVCs) and non sustained VT may be associated with occult structural heart disease and with longterm reduced survival in unselected populations. 253 Even in otherwise normal hearts, PVCs and nonsustained VT may over time lead to tachycardiainduced cardiomyopathy. 254 Further eval uation and treatment may be warranted in some situa tions 254 such as determining the origin of the VT, which may help guide further therapy such as ablation.…”

Section: Ventricular Tachycardiasmentioning

confidence: 99%

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Sandau¹,

Funk²,

Auerbach³

et al. 2017

Circulation

207

214

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Background and Purpose: This scientific statement provides an interprofessional, comprehensive review of evidence and recommendations for indications, duration, and implementation of continuous electro cardiographic monitoring of hospitalized patients. Since the original practice standards were published in 2004, new issues have emerged that need to be addressed: overuse of arrhythmia monitoring among a variety of patient populations, appropriate use of ischemia and QT-interval monitoring among select populations, alarm management, and documentation in electronic health records. Methods: Authors were commissioned by the American Heart Association and included experts from general cardiology, electrophysiology (adult and pediatric), and interventional cardiology, as well as a hospitalist and experts in alarm management. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Authors were assigned topics relevant to their areas of expertise, reviewed the literature with an emphasis on publications since the prior practice standards, and drafted recommendations on indications and duration for electrocardiographic monitoring in accordance with the American Heart Association Level of Evidence grading algorithm that was in place at the time of commissioning. Results: The comprehensive document is grouped into 5 sections: (1) Overview of Arrhythmia, Ischemia, and QTc Monitoring; (2) Recommendations for Indication and Duration of Electrocardiographic Monitoring presented by patient population; (3) Organizational Aspects: Alarm Management, Education of Staff, and Documentation; (4) Implementation of Practice Standards; and (5) Call for Research. Conclusions: Many of the recommendations are based on limited data, so authors conclude with specific questions for further research.

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“…Among these patients, ventricular ectopics are associated with worse cardiovascular outcomes if the patients are older and have higher cardiovascular risk, suggesting that the poor prognosis studies may have inadvertently included patients with occult structural heart disease, the population in which ventricular ectopics are known confer adverse outcomes. 9 While the study on a cohort of the Multiple Risk Factor Intervention Trial (MRFIT) 10 reported that the presence of ventricular ectopics identified on a rest two-minute ECG rhythm strip was associated with a high risk for sudden death in apparently healthy subjects over a 7.5 year follow-up. Similar outcomes were reported in apparently healthy subjects in the Framingham Heart Study 11 whereby ventricular ectopics were associated with a twofold increase in the risk of all cause mortality, myocardial infarction and cardiac death.…”

Section: Discussionmentioning

confidence: 99%

Ventricular ectopic beats in structurally normal heart: When to stop investigations

Zangana

2015

ZJMS

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The prognostic significance of premature ventricular complexes in adults without clinically apparent heart disease: a meta-analysis and systematic review

Cited by 84 publications

References 35 publications

Arrhythmia Burden in Elderly Patients With Severe Aortic Stenosis as Determined by Continuous Electrocardiographic Recording

Arrhythmia Burden in Elderly Patients With Severe Aortic Stenosis as Determined by Continuous Electrocardiographic Recording

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Ventricular ectopic beats in structurally normal heart: When to stop investigations

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