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RR interval analysis based on a newly developed PC program as a predictor of interventions in implantable
Michał Lewandowski1, Ilona Kowalik1
1National Institute of Cardiology, Warszawa, Poland.
Insights
Premature ventricular complexes (PVCs) characteristics, including their number and short cycle lengths, along with short-long-short sequences, predict implantable cardioverter-defibrillator (ICD) interventions. This RR interval analysis offers a potential method for identifying patients at risk of life-threatening arrhythmias.
Area of Science:
- Cardiology
- Biomedical Engineering
- Data Science in Medicine
Background:
- Sudden cardiac death prediction remains a critical clinical challenge.
- Ventricular ectopic activity, specifically premature ventricular complexes (PVCs), is being investigated as a potential predictive marker for adverse cardiac events.
Purpose of the Study:
- To analyze whether premature ventricular complexes (PVCs) serve as a risk factor for interventions in patients with implantable cardioverter-defibrillators (ICDs).
- To explore the predictive value of PVC characteristics and short-long-short (SLS) sequences in identifying patients who experience appropriate ICD interventions.
Main Methods:
- RR interval series analysis was performed on 184 patients with ICDs, divided into those receiving appropriate interventions (Group A, n=101) and controls (Group B, n=83).
- Key parameters analyzed included the number of PVCs per 4000 RR cycles, PVC coupling intervals, PVCs with very short (180-220 ms) and short (220-280 ms) cycle lengths (CL), and the incidence of short-long-short (SLS) sequences.
- A novel computer program, PCRR, was utilized for RR interval analysis.
Main Results:
- Patients with appropriate ICD interventions (Group A) exhibited a significantly higher number of PVCs/4000 RR cycles (263 ±32 vs. 43 ±17, p < 0.0001).
- Group A also showed significantly shorter mean PVC CL (320 ±13 vs. 400 ±38, p = 0.029), a higher number of PVCs with very short CL (1 ±0.4 vs. 0.1 ±0.1, p = 0.028) and short CL (5 ±1.2 vs. 0.6 ±0.4, p = 0.0007).
- The incidence of SLS sequences was markedly higher in Group A (94% of patients) compared to Group B (33% of patients, p < 0.0001).
Conclusions:
- Significant differences in PVC characteristics and SLS sequences distinguish patients with appropriate ICD interventions from controls.
- The RR interval analysis, particularly using the PCRR program, demonstrates potential as a simple method to predict PVC burden and life-threatening arrhythmias.
- These findings suggest that detailed analysis of PVCs and associated sequences can aid in risk stratification for sudden cardiac death.
Background:
Prediction of sudden cardiac death remains a significant challenge. There is some evidence that ventricular ectopic activity could be regarded as a predictive marker.
Objectives:
We carried out an analysis to explore whether premature ventricular complexes (PVCs) are a risk factor in implantable cardioverter-defibrillator (ICD) interventions.
Material And Methods:
The study method was a RR interval series analysis (n = 184) of arrhythmic events and controls from the ICD. Study group consisted of patients with a mean age of 55 ±27 years; 74% of them were male, 85% were secondary prevention patients, 62% had coronary artery disease (CAD), 15% hypertropic cardiomyopathy (HCM), 15% dilated cardiomyopathy (DCM), and 8% diseases of other etiology. The mean follow-up time was 64 months (range: 3-126 months). The study population was divide into patients with at least 1 appropriate intervention ventricular tachycardia/ventricular fibrillation (VT/VF) (group A, n = 101) and controls without interventions (group B, n = 83). The number of PVC/4000 RR cycles, the shortest coupling intervals between a PVC and preceding R as well as the number of PVCs of very short (180-220 ms), short (220-280 ms) and different cycle lengths (CL) as well as the incidence of short-long-short (SLS) sequences were compared.
Results:
The number of PVCs/4000 RR cycles was significantly higher in group A (263 ±32 compared to 43 ±17, p < 0.0001). The mean shortest PVC CL was significantly shorter in group A (320 ±13 compared to 400 ±38, p = 0.029). The number of PVCs with a very short CL was 1 ±0.4 compared to 0.1 ±0.1 (p = 0.028). The number of PVCs with a short CL was 5 ±1.2 compared to 0.6 ±0.4 (p = 0.0007) in groups A and B, respectively. The incidence of SLS sequences was significantly higher in group A than in group B (67 (94% of patients) and 4 (33% of patients) respectively (p < 0.0001)).
Conclusions:
Significant differences were found in the characteristics of PVCs and SLS sequences between patients with appropriate ICD interventions and controls. A newly developed basic computer program called PCRR was applied for RR interval analysis. This simple method could be a predictor of PVC burden and life-threatening arrhythmias in different populations.
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