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Initial Holter Electrocardiogram Index to Predict the Burden of Subsequent Persistent Premature Ventricular Complex
Gaku Izumi1, Satoru Shida2, Norio Kobayashi3
1Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University.
Insights
A wide range in heart rate intervals (RRrange) on an initial electrocardiogram (ECG) may predict persistent premature ventricular complexes (PVCs) in children. This finding helps identify children needing closer monitoring for ongoing PVCs.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Cardiac Arrhythmias
Background:
- Asymptomatic premature ventricular complexes (PVCs) in children often resolve spontaneously.
- Predictive factors for the persistence of childhood PVCs remain largely unknown.
- This study investigates predictors of persistent PVCs in asymptomatic pediatric patients.
Purpose of the Study:
- To identify predictive factors for persistent premature ventricular complexes (PVCs) in children.
- To analyze Holter electrocardiogram (ECG) data from pediatric patients with asymptomatic PVCs.
- To determine if initial ECG parameters can forecast long-term PVC burden.
Main Methods:
- Retrospective analysis of Holter ECG data from 216 pediatric patients with asymptomatic PVCs (2010-2021).
- Multivariable analysis to assess predictive factors for subsequent PVC burden.
- Evaluation of indices including age, sex, PVC burden, PVC origin, and RR intervals (RRmin, RRmax, RRrange).
Main Results:
- The median follow-up was 5.1 years, with a significant decrease in overall PVC burden.
- Multivariate analysis identified RRrange (the difference between maximum and minimum RR intervals) as the sole independent predictor of a final PVC burden >10%.
- An RRrange of 600 ms demonstrated high predictive accuracy (AUC 0.920) for persistent PVCs.
Conclusions:
- A wide RRrange on the initial Holter ECG is a significant indicator for persistent PVCs in childhood.
- This finding may aid in stratifying risk and guiding management for pediatric patients with asymptomatic PVCs.
- Further research can explore the clinical implications of RRrange in pediatric arrhythmia management.
Background:
Asymptomatic premature ventricular complex (PVC) in childhood often disappears over time. However, predictive factors for persistent PVC are unknown. We examined predictive factors for persistent PVCs on initial Holter electrocardiogram (ECG) in pediatric patients with asymptomatic PVC.
Methods And Results:
The initial Holter ECG findings of untreated PVC patients (n=216) between 2010 and 2021 were examined. Multivariable analysis was performed to clarify predictive factors for subsequent persistent PVC burden for each index (age, sex, PVC burden, PVC origin, minimum and maximum mean RR intervals [RRmin and RRmax, respectively]) of the 3 heartbeats of baseline sinus rhythm immediately before the PVC. The median age at initial Holter ECG was 11.6 years (range 5.8-18.8 years), the PVC burden was 5.22% (range 0.01-44.21%), RRmin was 660 ms, RRmax was 936 ms, RRrange (=RRmax-RRmin) was 273 ms, and 15 (7%) PVC runs were identified. The median follow-up period was 5.1 years (range 0.8-9.4 years), and the final Holter PVC burden was 3.99% (range 0-36.38%). In multivariate analysis, RRrange was the only independent risk factor for predicting a final Holter PVC burden >10%, with an area under the curve of 0.920 using an RRrange of 600 ms as the cut-off value.
Conclusions:
A wide RRrange at the initial Holter ECG may be a predictive indicator for persistent PVC in childhood.
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