The Diagnostic Utility of Holter Monitoring in Catecholaminergic Polymorphic Ventricular Tachycardia
Borna Naderi1, Brianna Davies1, Habib Khan2
1Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Holter monitoring can help diagnose catecholaminergic polymorphic ventricular tachycardia (CPVT). A threshold of 76% maximum heart rate during monitoring identified CPVT with 69% sensitivity and 94% specificity.
Area of Science:
- Cardiology
- Electrophysiology
- Genetics
Background:
- Holter monitoring is commonly used in heart rhythm clinics, sometimes raising suspicion for catecholaminergic polymorphic ventricular tachycardia (CPVT).
- While not a primary diagnostic tool for CPVT, its ubiquitous use warrants investigation into its utility.
Purpose of the Study:
- To explore the diagnostic value of Holter monitoring in identifying catecholaminergic polymorphic ventricular tachycardia (CPVT).
- To determine if specific Holter monitoring parameters can differentiate CPVT patients from healthy individuals.
Main Methods:
- Retrospective cohort study analyzing off-therapy Holter monitoring data.
- Included 13 ryanodine receptor 2-positive CPVT patients and 34 healthy controls.
- Utilized the Edwards method to correlate heart rate during Holter monitoring with exertion and analyzed premature ventricular contractions (PVCs) during adrenergic and nonadrenergic states.
Main Results:
- PVC burden differed between groups, but ambient PVCs were uncommon in CPVT patients.
- CPVT patients exhibited higher PVC counts, predominantly during adrenergic stress (>76% maximum heart rate).
- A threshold of 76% maximum heart rate demonstrated an area under the receiver operating characteristic curve of 0.84 for identifying CPVT during adrenergic states.
Conclusions:
- Holter monitor PVC counts alone are insufficient for diagnosing CPVT due to the disease's adrenergic nature.
- Quantifying PVC prevalence above a 76% heart rate threshold identified CPVT with 69% sensitivity and 94% specificity.
- This method aids in differentiating CPVT patients by focusing on PVCs during adrenergic stress.
Background:
Holter monitoring may raise suspicion of an underlying catecholaminergic polymorphic ventricular tachycardia (CPVT) diagnosis. Although not a primary investigation for CPVT, Holter monitoring is ubiquitously used as a diagnostic tool in the heart rhythm clinic.
Objectives:
The objective of this study was to explore Holter monitoring in CPVT diagnosis.
Methods:
This retrospective cohort study analyzed off-therapy Holter monitoring from 13 ryanodine receptor 2-positive CPVT and 34 healthy patients from the Canadian Hearts in Rhythm Organization national registry. Using the Edwards method, the ratio of ambient-maximum heart rate during Holter monitoring was correlated with exertion level to separate premature ventricular contractions (PVCs) during periods of adrenergic and nonadrenergic stress. A receiver operating characteristic curve analysis determined the optimal threshold for isolating CPVT-induced PVCs during adrenergic states.
Results:
PVC burden differed between groups (P = 0.001) but was within population norm, suggesting ambient PVCs are uncommon in CPVT. CPVT patients had higher PVC counts than healthy controls (P = 0.002), with a different distribution based on adrenergic state. The optimal threshold for separating PVCs into periods of adrenergic and nonadrenergic stress in CPVT patients was 76% of the maximum heart rate during the monitoring period. Compared with healthy controls, CPVT patients had a higher PVC count, limited to periods of adrenergic stress, defined by >76% maximum heart rate threshold (P = 0.002; area under the receiver operating characteristic curve: 0.84). Below this threshold, there was no significant PVC difference (P = 0.604).
Conclusions:
Holter monitor PVC counts alone are inadequate for CPVT diagnosis, owing to the adrenergic nature of the disease. Quantifying PVC prevalence at a heart rate threshold >76% identified CPVT with moderate sensitivity (69%) and high specificity (94%).
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