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Published on: February 28, 2012
Performance of cardiac implantable electronic devices in detecting premature ventricular contraction burden
Matthew Elmo G Gayoso1, Giovanni Davogustto2, Robert L Abraham2
1Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Insights
Cardiac implantable electronic devices (CIEDs) underestimate premature ventricular contractions (PVCs) burden compared to standard monitoring. Relying solely on CIED data may miss clinically significant PVC burdens.
Area of Science:
- Cardiology
- Biomedical Engineering
- Electrophysiology
Background:
- Frequent premature ventricular contractions (PVCs) can worsen cardiomyopathy.
- Cardiac implantable electronic devices (CIEDs) are used for arrhythmias and collect data.
- The accuracy of CIEDs in quantifying PVC burden is not well understood.
Purpose of the Study:
- To evaluate the performance of CIEDs in quantifying PVC burden.
- To compare CIED data with ambulatory cardiac monitoring, the current standard of care.
Main Methods:
- Adult patients with CIEDs undergoing concurrent ambulatory cardiac monitoring were identified.
- Patients with recent PVC ablations or medication changes were excluded.
- Ordinal regression models compared PVC burden detected by CIEDs versus ambulatory monitoring in 439 patients.
Main Results:
- CIEDs detected a lower median PVC burden (0.61%) than ambulatory monitoring (1.90%).
- CIEDs generally underestimated PVC burden.
- A PVC burden ≥15% on ambulatory monitoring had only an 11% probability of being detected as such by a CIED.
Conclusions:
- CIEDs significantly underestimate PVC burden compared to ambulatory monitoring.
- Clinicians should not rely exclusively on CIED data to assess PVC burden.
Background:
Frequent premature ventricular contractions (PVCs) can cause or exacerbate cardiomyopathy. At-risk patients often have cardiac implantable electronic devices (CIEDs) for treating bradycardia or ventricular arrhythmias. Many modern CIEDs also collect objective data about arrhythmias, including PVCs. However, the performance of CIEDs for quantifying PVC burden remains unclear.
Objective:
This study aimed to determine the performance of CIEDs for quantifying PVC burden compared with ambulatory cardiac monitoring, which is the standard of care.
Methods:
We identified adult patients at Vanderbilt University Medical Center with CIEDs who underwent concurrent ambulatory cardiac monitoring with Holter or mobile cardiac telemetry. Patients who received PVC ablations or antiarrhythmic medication changes during the CIED interrogation period of interest were excluded. The study population included a total of 439 patients and 571 instances of concurrent device monitoring. We then developed ordinal regression models to investigate the differences in detected PVC burdens between the 2 device groups.
Results:
The median PVC burden detected by ambulatory monitoring and CIED was 1.90% (Q1-Q3, 0.10%-9.65%) and 0.61% (Q1-Q3, 0.02%-4.36%), respectively. In general, PVC burden detected by CIED underestimated that detected by ambulatory monitoring. Furthermore, when the PVC burden detected by the ambulatory monitor is ≥15%, the probability of a CIED also detecting a burden of ≥15% is approximately 11%.
Conclusion:
CIEDs underestimate PVC burden compared with ambulatory cardiac monitoring. Clinicians should not solely rely on PVC data from CIEDs to rule out a clinically relevant PVC burden.
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