Ventricular Ectopy as a Predictor of Heart Failure and Death

Abstract

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.

Ectopy on a Single 12‐Lead ECG, Incident Cardiac Myopathy, and Death in the Community

“…Whereas this observation is consistent with previous data using Holter monitoring,5, 7 it underscores the impact that ectopy on a standard ECG might deliver. Of interest, much of the relationship between a PAC and subsequent death appeared to be mediated by incident AF.…”

“…Similarly, frequent premature ventricular contractions (PVCs) quantified by Holter studies are associated with incident HF and mortality 7, 8. Given evidence that successful ablation of PACs can eradicate AF9 and that successful ablation of frequent PVCs can normalize systolic dysfunction,10, 11 experts in the field now refer to ectopy as a cause of myopathy 12, 13, 14, 15, 16…”

Electrocardiographic Predictors of Heart Failure With Reduced Versus Preserved Ejection Fraction: The Multi‐Ethnic Study of Atherosclerosis

“…Although several reports have shown that findings on the routine ECG are associated with future HF events,8, 9, 10, 11, 12, 13, 14, 15, 16, 17 few have explored whether ECG predictors vary in their ability to distinguish between HFrEF and HFpEF. A recent examination from the Framingham Heart Study has shown that left ventricular hypertrophy and left bundle‐branch block are associated with HFrEF and that atrial fibrillation is associated with HFpEF 28.…”

Pericardial Fat Is Associated With the Risk of Ventricular Arrhythmia in Asian Patients

“…Previous studies showed that the incidence of VPBs was associated with cardiovascular events and all-cause death. 26, 27 Furthermore, another study reported that these risks may be increased in patients with concurrent frequent VPBs and couplet VPBs as recorded by 48-h Holter ECG monitoring. 28 Previous studies have reported that ventricular hypertrophy is associated with the incidence of ventricular arrhythmia, especially in patients with hypertrophic cardiomyopathy, 29 arrhythmogenic RV cardiomyopathy 30 and congestive heart failure.…”