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Characteristics of ventricular premature contractions and their clinical course
Y Fujimoto1, Y Hirokane, M Fukuki
1First Department of Internal Medicine, Tottori University School of Medicine, Yonago, Japan.
Insights
Frequent ventricular premature contractions (VPCs) with longer, varied coupling intervals may indicate poor prognosis. However, Lown grade 2 VPCs might predict spontaneous regression in some patients.
Area of Science:
- Cardiology
- Electrophysiology
- Clinical Medicine
Background:
- Frequent ventricular premature contractions (VPCs), exceeding 1,000 beats/day, are common.
- Prognostic indicators for patients with frequent VPCs require further elucidation.
Purpose of the Study:
- To investigate the prognostic significance of VPC characteristics in patients with frequent VPCs.
- To identify predictors of cardiac death and spontaneous regression in this population.
Main Methods:
- A 4-year follow-up study of 100 patients with frequent VPCs.
- Classification of patients into survival (idiopathic or with underlying disease) and cardiac death groups.
- Analysis of VPC frequency, Lown grade, coupling interval (mean and standard deviation).
- Serial Holter monitoring in 40 patients to assess changes in VPCs.
Main Results:
- No significant difference in daily VPC counts between outcome groups.
- Higher prevalence of Lown grade 4a or 4b VPCs in patients with underlying diseases and those who died from cardiac causes.
- Significantly longer mean and greater standard deviation of coupling intervals in the cardiac death group compared to the idiopathic VPC survival group.
- Spontaneous decrease in VPCs observed in 13 patients, predominantly Lown grade 2.
Conclusions:
- Longer and more varied ventricular premature contraction coupling intervals may predict a poor cardiac outcome.
- Lown grade 2 VPCs might be associated with spontaneous regression of frequent VPCs.
Abstract:
One hundred patients with frequent (> 1,000 beats/day) ventricular premature contractions (VPCs) were followed for 4 years. All of the patients, except those with non-cardiac death (n = 8), were classified into 3 groups based on their outcome. Group A consisted of 29 patients with idiopathic VPCs who survived the study period. Group B consisted of 49 patients with underlying diseases who survived the study period. Group C consisted of 14 patients who suffered cardiac death. There was no significant difference in the daily number of VPCs. However, groups B and C had more patients with Lown grade 4a or 4b VPCs than group A. The mean coupling interval was significantly longer in group C than in group A, and the standard deviation of the coupling interval was significantly larger in group C than in group A. Forty patients underwent serial Holter monitorings to assess changes in the number of VPCs. VPCs spontaneously decreased in 13 patients, while the other 27 patients continued to have frequent VPCs. Most of these 13 patients were classified as Lown grade 2. The results suggest that in patients with frequent VPCs, longer and more varied coupling intervals may predict a poor prognosis, and Lown grade 2 may predict a spontaneous regression.