Premature Ventricular Contraction Location and Incident Heart Failure
Thomas A Dewland1, David G Rosenthal1, Edward P Gerstenfeld1
1Department of Internal Medicine, Division of Cardiology, Electrophysiology Section, University of California-San Francisco, San Francisco, California, USA.
JACC. Clinical Electrophysiology
|September 18, 2025
Summary
Premature ventricular contractions (PVCs) from the left ventricle or epicardium increase heart failure risk. This study analyzed PVC origins in a large population, finding specific locations are linked to higher heart failure incidence.
Area of Science:
- Cardiology
- Epidemiology
- Electrophysiology
Background:
- The anatomical distribution of premature ventricular contractions (PVCs) and their association with heart failure risk is understudied in general populations.
- Previous research has primarily focused on individuals with existing arrhythmia-related conditions.
Purpose of the Study:
- To describe the epidemiology of PVC origins.
- To determine if the anatomical location of PVCs is independently associated with the risk of developing heart failure.
Main Methods:
- Analysis of ambulatory adults without prevalent heart failure from the CHS and ARIC cohorts.
- Assessment of anatomical PVC location using baseline 12-lead electrocardiogram (ECG) morphology by expert reviewers.
Main Results:
- Out of 20,590 participants, 2.1% had PVCs. The most common origins were the left ventricle (49%), outflow tract (27%), and right ventricle (22%).
- Over 19.2 years, PVCs were linked to increased heart failure risk (HR: 1.43).
- PVCs from the epicardium (HR: 2.98) and left ventricle (HR: 1.59) showed the highest adjusted risk for incident heart failure.
Conclusions:
- In a large population, ventricular ectopy is most often located in the left ventricle.
- PVCs originating from the left ventricle and epicardial areas are associated with a significantly higher risk of incident heart failure.
More Related Videos
Related Concept Videos
01:17Pathophysiology of Heart Failure
3.0K
Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
3.0K
01:27Heart Failure I: Introduction
710
Heart failure refers to a clinical syndrome caused by structural or functional cardiac disorders that prevent the heart from pumping an adequate amount of blood to meet the body's metabolic needs. This condition often arises from myocardial infarction or ischemia, leading to decreased cardiac output, reduced tissue perfusion, impaired gas exchange, fluid volume imbalance, and decreased functional ability.Heart failure can result from disruptions in the mechanisms that regulate cardiac output...
710
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
471
Arrhythmia is a condition characterized by an irregular heart rhythm, with ECG changes that differ based on its origin and nature. The types of arrhythmias discussed below include atrial, junctional, and ventricular arrhythmias.Atrial ArrhythmiasPremature Atrial Complexes (PACs): PACs are early atrial beats caused by stress, caffeine, alcohol, electrolyte imbalances, hypoxia, hyperthyroidism, or certain medications (e.g., bronchodilators and decongestants). The ECG shows early P waves with an...
471
01:29Heart Failure II: Pathophysiology
734
Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
734
01:26Heart Failure III: Clinical Manifestations
511
Heart failure (HF) manifests primarily as dyspnea, fatigue, and fluid retention, resulting in peripheral and pulmonary edema. Symptoms may vary depending on which ventricle is more affected, left or right.Left-Sided Heart FailureAlso known as left ventricular failure, this condition results from the left ventricle's inability to fill or eject sufficient blood into the systemic circulation. It leads to pulmonary congestion, which occurs when the left ventricle fails to eject blood effectively...
511
01:30Heart Failure IV: Classification and Diagnostic Evaluation
323
Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...
323