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Frequent or complex ventricular ectopy in apparently healthy subjects: a clinical study of 25 cases
Insights
Frequent complex ventricular ectopy can occur in healthy individuals. This condition, often right ventricular in origin, typically resolves with exercise but is resistant to antiarrhythmic drugs.
Area of Science:
- Cardiology
- Electrophysiology
- Internal Medicine
Background:
- Asymptomatic ventricular ectopy (VE) of unknown cause presents a diagnostic challenge.
- Frequent or complex VE patterns in apparently healthy individuals warrant investigation for underlying cardiac abnormalities.
Purpose of the Study:
- To investigate the clinical characteristics and potential cardiac abnormalities in asymptomatic subjects with frequent or complex ventricular ectopy.
- To evaluate the response of ventricular ectopy to maximal exercise and antiarrhythmic drug regimens.
Main Methods:
- Prospective study of 25 asymptomatic subjects with electrocardiographically detected frequent/complex VE.
- Comprehensive cardiac evaluation including history, physical exam, laboratory tests, imaging, and electrophysiologic studies.
- Assessment of VE during maximal exercise testing, 24-hour Holter monitoring, and antiarrhythmic drug trials.
Main Results:
- Ventricular ectopy originated predominantly from the right ventricle in 19/25 subjects.
- VE disappeared during maximal exercise in 21/23 subjects.
- Frequent (mean 559 beats/hour) and complex VE patterns were consistently observed over 24 hours; antiarrhythmic drug regimens were largely ineffective.
Conclusions:
- A clinical syndrome of frequent, complex ventricular ectopy exists in apparently healthy individuals.
- The etiology and natural history of this syndrome remain undefined.
- Right ventricular origin and exercise-induced suppression are common features.
Abstract:
During 18 months, 25 asymptomatic apparently healthy subjects were consecutively studied because of electrocardiographic discovery of frequent (more than 3 beats/min) or complex (multiform, alternating or repetitive patterns) ventricular ectopy of unknown cause. History, physical examination, laboratory data, chest roentgenogram, vectorcardiogram, exercise testing, echocardiogram, His bundle electrogram and cardiac catheterization procedures were performed to detect cardiac abnormalities. Ventricular ectopy was studied with maximal exercise testing, 24 hour Holter recordings and antiarrhythmic drug regimens. The duration of ventricular ectopy ranged from 1 to 30 years (mean 6). Eighteen subjects had an apparently normal cardiac status, and seven had mild or suspected abnormalities. Ventricular ectopy was of predominantly right ventricular origin in 19 of 25 subjects, and disappeared during maximal exercise in 21 of 23 subjects. Characteristic frequent (mean 559 beats/hour) and complex (bigeminal, trigerminal or ventricular couplet) ectopic beats were consistently present in all subjects during a 24 hour diurnal cycle. Antiarrhythmic drug regimens were generally ineffective. Our data suggest that a clinical syndrome of frequent complex ventricular ectopy can occur in apparently healthy subjects. The etiology and natural history of this syndrome are undefined.