Journal article
Circadian variability patterns predict and guide premature ventricular contraction ablation procedural inducibility and outcomes
Heart rhythm, Vol.15(1), pp.99-106
01/2018
DOI: 10.1016/j.hrthm.2017.07.034
PMID: 28765087
Abstract
Infrequent intraprocedural premature ventricular complexes (PVCs) may impede radiofrequency catheter ablation (RFA) outcome, and pharmacologic induction is unpredictable.
The purpose of this study was to determine whether PVC circadian variation could help predict drug response.
Consecutive patients referred for RFA with detailed Holter monitoring and frequent monomorphic PVCs were included. Patients were divided into 3 groups based on hourly PVC count relationship to corresponding mean heart rate (HR) during each of the 24 hours on Holter: fast-HR-dependent PVC (F-HR-PVC) type for a positive correlation (Pearson, P <.05), slow-HR-dependent PVC (S-HR-PVC) type for a negative correlation, and independent-HR-PVC (I-HR-PVC) when no correlation was found.
Fifty-one of the 101 patients (50.5%) had F-HR-PVC, 39.6% I-HR-PVC, and 9.9% S-HR-PVC; 30.7% had infrequent intraprocedural PVC requiring drug infusion. The best predictor of infrequent PVC was number of hours with PVC count <120/h on Holter (area under the curve 0.80, sensitivity 83.9%, specificity 74.3%, for ≥2 h). Only F-HR-PVC patients responded to isoproterenol. Isoproterenol washout or phenylephrine infusion was successful for the 3 S-HR-PVC patients, and no drug could increase PVC frequency in the 12 I-HR-PVC patients. Long-term RFA success rate in patients with frequent PVCs at baseline (82.9%) was similar to those with infrequent PVC who responded to a drug (77.8%; P = .732) but significantly higher than for those who did not respond to any drug (15.4%; P <.0001).
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.
Details
- Title: Subtitle
- Circadian variability patterns predict and guide premature ventricular contraction ablation procedural inducibility and outcomes
- Creators
- David Hamon - Hôpitaux Universitaires Henri MondorGuillaume Abehsira - Assistance Publique – Hôpitaux de ParisKai Gu - Nanjing Medical UniversityAlbert Liu - David Geffen School of Medicine at UCLAMarie Sadron Blaye-Felice - University Hospital Rangueil, Department of Cardiology, Toulouse, FranceSophie Billet - Hôpital RangueilThomas Kambur - Indiana University – Purdue University IndianapolisMohammed Amer Swid - David Geffen School of Medicine at UCLANoel G. Boyle - David Geffen School of Medicine at UCLAGopi Dandamudi - Indiana University – Purdue University IndianapolisPhilippe Maury - Hôpital RangueilMinglong Chen - Jiangsu Province HospitalJohn M. Miller - Indiana University – Purdue University IndianapolisNicolas Lellouche - Hôpitaux Universitaires Henri-MondorKalyanam Shivkumar - David Geffen School of Medicine at UCLAJason S. Bradfield - David Geffen School of Medicine at UCLA
- Resource Type
- Journal article
- Publication Details
- Heart rhythm, Vol.15(1), pp.99-106
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.hrthm.2017.07.034
- PMID
- 28765087
- ISSN
- 1547-5271
- eISSN
- 1556-3871
- Language
- English
- Date published
- 01/2018
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984691512202771
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