Premature ventricular complexes: Assessing burden density in a large national cohort to better define optimal ECG
Andrew Krumerman1, Luigi Di Biase2, Edward Gerstenfeld3
1Northwell Health, Mount Kisco, New York.
Insights
Longer electrocardiographic monitoring improves accuracy in assessing premature ventricular contraction (PVC) burden. Extended monitoring is crucial for understanding ventricular tachycardia patterns and patient risk.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Device Technology
Background:
- Premature ventricular contraction (PVC) burden is a significant risk factor for heart failure and cardiovascular mortality in patients with structural heart disease.
- Accurate evaluation of PVC burden is essential for risk stratification and management.
Purpose of the Study:
- To determine the optimal duration of electrocardiographic monitoring for characterizing PVC burden.
- To identify clinical factors associated with frequent PVCs and nonsustained ventricular tachycardia.
Main Methods:
- Analysis of commercial electrocardiographic patch data from 106,705 patients (June 2011-April 2022).
- Inclusion criteria: age >18 years, PVC burden ≥5%, wear period ≥13 days.
- PVC burden categorized as low (<10%), moderate (10% to <20%), and high (≥20%).
Main Results:
- Mean error in PVC burden assessment decreased with longer monitoring duration (2.9% at 24h to 0.7% at 10 days).
- Higher PVC burden observed in males and patients >65 years.
- Ventricular tachycardia episodes increased with higher PVC burden (P < .0001).
Conclusions:
- Ambulatory monitoring beyond 24 hours, particularly 7 days or more, enhances the accuracy of PVC burden assessment.
- Prolonged cardiac monitoring is necessary due to variations in ventricular tachycardia frequency and duration based on initial PVC density.
Background:
Premature ventricular contraction (PVC) burden is a risk factor for heart failure and cardiovascular death in patients with structural heart disease. Long-term electrocardiographic monitoring can have a significant impact on PVC burden evaluation by further defining PVC distribution patterns.
Objective:
This study aimed to ascertain the optimal duration of electrocardiographic monitoring to characterize PVC burden and to understand clinical characteristics associated with frequent PVCs and nonsustained ventricular tachycardia in a large US cohort.
Methods:
Commercial data (iRhythm's Zio patch) from June 2011 to April 2022 were analyzed. Inclusion criteria were age >18 years, PVC burden ≥5%, and wear period ≥13 days. PVC burden cutoffs were determined on the basis of AHA/ACC/HRS guidelines for very frequent PVCs (10,000-20,000 during 24 hours). Patients were assigned to categories by PVC densities: low, <10%; moderate, 10% to <20%; and high, ≥20%. Mean measured error was assessed at baseline and daily until the wear period's end for overall PVC burden and different PVC densities.
Results:
Analysis of 106,705 patch monitors revealed a study population with mean age of 70.6 ± 14.6 years (33.6% female). PVC burden was higher in male patients and those >65 years of age. PVC burden mean error decreased from 2.9% at 24 hours to 1.3% at 7 days and 0.7% at 10 days. Number of ventricular tachycardia episodes per patient increased with increasing PVC burden (P < .0001).
Conclusion:
Extending ambulatory monitoring beyond 24 hours to 7 days or more improves accuracy of assessing PVC burden. Ventricular tachycardia frequency and duration vary by initial PVC density, highlighting the need for prolonged cardiac monitoring.
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