Journal article
Premature ventricular contraction diurnal profiles predict distinct clinical characteristics and beta‐blocker responses
Journal of cardiovascular electrophysiology, Vol.30(6), pp.836-843
06/2019
DOI: 10.1111/jce.13944
PMID: 30964570
Abstract
Introduction
Frequent premature ventricular complexes (PVCs) can lead to symptoms, such as cardiomyopathy and increased mortality. Beta‐blockers are recommended as first‐line therapy to reduce PVC burden; however, the response is unpredictable. The objective of this study is to determine whether PVC diurnal‐variability patterns are associated with different clinical profiles and predict drug response.
Methods
Consecutive patients with frequent PVCs (burden ≥ 1%), referred for Holter monitoring between 2014 and 2016, were included. Follow‐up Holters, when available, were assessed after beta‐blocker initiation to assess response (≥50% reduction). Patients were divided into three groups on the basis of relationship between hourly PVC count and mean HR during each of the 24 Holter hours: (1) fast‐HR‐dependent‐PVC (F‐HR‐PVC) for positive correlation (Pearson, P < 0.05), (2) slow‐HR‐dependent‐PVC (S‐HR‐PVC) for a negative, and (3) independent‐HR‐PVC (I‐HR‐PVC) when no correlation was found.
Results
Of the 416 patients included, 50.2% had F‐HR‐PVC, 35.6% I‐HR‐PVC, and 14.2% S‐HR‐PVC with distinct clinical profiles. Beta‐blocker therapy was successful in 34.0% patients overall: patients with F‐HR‐PVC had a decrease in PVC burden (18.8 ± 10.4% to 9.3 ± 6.6%, P < 0.0001; 62% success), I‐HR‐PVC had no change (18.4 ± 17.9% to 20.6 ± 17.9%, P = 0.175; 0% success), whereas S‐HR‐PVC had an increase in burden (14.6 ± 15.3% to 20.8 ± 13.8%, P = 0.016; 0% success). The correlation coefficient was the only predictor of beta‐blocker success (AUC = 0.84, sensitivity = 100%, specificity = 67.7%; r ≥ 0.4).
Conclusions
A simple analysis of Holter PVC diurnal variability may provide incremental value to guide clinical PVC management. Only patients displaying a F‐HR‐PVC profile benefited from beta‐blockers. An alternative strategy should be considered for others, as beta‐blockers may have no effect or can even be harmful.
Details
- Title: Subtitle
- Premature ventricular contraction diurnal profiles predict distinct clinical characteristics and beta‐blocker responses
- Creators
- David Hamon - Hôpitaux Universitaires Henri MondorMohammed Amer Swid - David Geffen School of Medicine at UCLAPradeep S. Rajendran - David Geffen School of Medicine at UCLAAlbert Liu - David Geffen School of Medicine at UCLANoel G. Boyle - David Geffen School of Medicine at UCLAKalyanam Shivkumar - David Geffen School of Medicine at UCLAJason S. Bradfield - David Geffen School of Medicine at UCLA
- Resource Type
- Journal article
- Publication Details
- Journal of cardiovascular electrophysiology, Vol.30(6), pp.836-843
- DOI
- 10.1111/jce.13944
- PMID
- 30964570
- ISSN
- 1045-3873
- eISSN
- 1540-8167
- Number of pages
- 8
- Grant note
- Federation Francaise de Cardiologie; National Institute of Health
- Language
- English
- Date published
- 06/2019
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984694745902771
Metrics
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