Elsevier

Heart Rhythm

Volume 9, Issue 1, January 2012, Pages 92-95
Heart Rhythm

Clinical
General
Relation of symptoms and symptom duration to premature ventricular complex–induced cardiomyopathy

https://doi.org/10.1016/j.hrthm.2011.08.015Get rights and content

Background

Frequent idiopathic premature ventricular complexes (PVCs) can result in a reversible form of cardiomyopathy. In this study, the determinants of PVC-induced left ventricular (LV) dysfunction were assessed.

Methods

The subjects of this study were 241 consecutive patients (115 men [48%], mean age 48 ± 14 years) referred for ablation of frequent PVCs. One hundred eighty patients (75%) experienced palpitations and 61 (25%) did not. The PVC burden was determined by 24-hour Holter monitoring, and echocardiograms were performed to assess LV function. An LV ejection fraction of <50% was considered abnormal.

Results

LV ejection fraction (mean 0.36 ± 0.09) was present in 76 of 241 patients (32%). There was a higher prevalence of males among the patients with PVC cardiomyopathy compared to patients with normal LV function (51/76 [67%] vs 64/165 [39%]; P <.0001). The mean PVC burden was significantly higher in patients with PVC cardiomyopathy than in patients with normal LV function (28% ± 12% vs 15% ± 13%; P <.0001). Among symptomatic patients, those with cardiomyopathy had a significantly longer duration of palpitations (135 ± 118 months) compared with patients with normal LV function (35 ± 52 months; P <.0001). The proportion of asymptomatic patients was significantly higher in the presence of cardiomyopathy (36/76, 47%) than in normal LV function (25/165, 15%; P <.0001). Symptom duration of 30 to 60 months, symptom duration >60 months, the absence of symptoms, and the PVC burden in asymptomatic patients were independent predictors of impaired LV function (adjusted odds ratio [95% confidence interval]: 4.0 [1.1–14.4], 20.1 [6.3–64.1], 13.1 [4.1–37.8], and 2.1 [1.2–3.6], respectively).

Conclusions

The duration of palpitations and the absence of symptoms are independently associated with PVC-induced cardiomyopathy.

Section snippets

Patients characteristics

The subjects of this retrospective study were 241 consecutive patients (115 men, age: 48 ± 14 years, left ventricular [LV] ejection fraction: 0.52 ± 0.12) with frequent PVCs referred for catheter ablation between April 1999 and December 2010. One hundred eighty patients experienced palpitations and 61 patients did not. The 61 patients without palpitations were defined as being asymptomatic. LV dysfunction was present in 76 patients who had a mean ejection fraction of 0.36 ± 0.09 (Table 1).

The

Baseline characteristics

Seventy-six patients (32%) had cardiomyopathy. Bivariate analysis showed male gender (P <.001), PVC burden (P <.001), duration of palpitations in symptomatic patients (P <.001), and asymptomatic status (P <.001) to be associated with cardiomyopathy. Patients with cardiomyopathy were more often taking an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker (P <.001), but both groups had similar rates of digoxin (P = .65) and amiodarone (P = .68) usage. The mean PVC burden

Symptom duration and PVC cardiomyopathy

This is the first study to demonstrate that patients with PVC cardiomyopathy have a significantly longer duration of symptoms compared with patients without cardiomyopathy. This suggests that frequent PVCs over a period of years rather than months may be required to result in cardiomyopathy. Prior studies with short follow-up failed to demonstrate a substantial impact on ejection fraction over time.6 The higher likelihood of cardiomyopathy developing in asymptomatic patients is not surprising,

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Dr Bogun and Dr Oral have received a grant from the Leducq Foundation.

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