Relation between ventricular premature complexes and sudden cardiac death in apparently healthy men

https://doi.org/10.1016/0002-9149(87)90348-1Get rights and content

Abstract

The association between ventricular premature complexes (VPCs) detected on a rest 2-minute lead I electrocardiographic rhythm strip and sudden cardiac death (SCD), occurring within 1 hour of onset of symptoms, was evaluated in a prospective study of 15,637 apparently healthy white men, aged 35 to 57 years, at the first screening examination (1973 to 1975) to determine eligibility for the Multiple Risk Factor Intervention Trial in Minneapolis/St. Paul, Minnesota. The prevalence of any VPC was 4.4% (681 of 15,637). Over an average follow-up period of 7.5 years, a total of 381 deaths occurred. Of these, 34% (131 of 381) were ascribed to coronary artery disease (CAD) and 31% of the CAD deaths (41 of 131) occurred suddenly.

The presence of any VPC was associated with a significantly higher risk for SCD (adjusted relative risk = 3.0; p < 0.025). On the other hand, the presence of any VPC was not associated with any significant increase in the risk of non-SCD or of total deaths from CAD (adjusted relative risks = 1.0 and 1.6, respectively). When VPC characteristics such as frequency (2 or more uniform VPCs every 2 minutes) and complexity (multiforms, pairs, runs, R-on-T) were examined, those with frequent or complex VPCs were at a significantly increased risk of SCD (adjusted relative risk = 4.2; p < 0.005), whereas for non-SCD no significant increase in risk was found (adjusted relative risk = 1.6; p = 0.28). The data also suggest that the presence of frequent/ complex VPCs carries a greater risk for SCD in men younger than 50 years of age than in those 50 years or older.

The specificity of VPCs to SCD may bear an etiologic association and merits a careful evaluation of otherwise healthy men who demonstrate VPCs, particularly frequent/complex, on a short-term electrocardiographic recording.

References (40)

  • LA Cobb et al.

    A decade's experience with out-of hospital resuscitation

    Mod Concepts Cardiovasc Dis

    (1980)
  • WJ Bashe et al.

    Pathology of atherosclerotic heart disease in sudden death

  • L Kuller et al.

    The burden of the community. Demographic characteristics and trends in arteriosclerotic heart disease mortality: sudden death and myocardial infarction

  • WB Kannel et al.

    Precursors of sudden coronary death. Factors related to the incidence of sudden death

    Circulation

    (1975)
  • B Lows et al.

    Approaches to sudden death from coronary heart disease

    Circulation

    (1971)
  • E Hinkle

    Short-term risk factors for sudden death

  • AJ Moss et al.

    Ventricular ectopic beats and their relation to sudden and non-sudden cardiac death after myocardial infarction

    Circulation

    (1979)
  • W Ruberman et al.

    Ventricular premature complexes and sudden death after myocardial infarction

    Circulation

    (1981)
  • BN Chiang et al.

    Relationship of premature systoles to coronary heart disease and sudden death in the Tecumseh epidemiologic study

    Ann Intern Med

    (1969)
  • M Rodstein et al.

    Mortality study of the significance of extrasystoles in an insured population

    Circulation

    (1971)
  • Cited by (100)

    • Risk stratification in patients with frequent premature ventricular complexes in the absence of known heart disease

      2020, Heart Rhythm
      Citation Excerpt :

      Furthermore, reversible left ventricular dysfunction often is caused by frequent PVCs and is not indicative of intrinsic structural heart disease. However, some epidemiologic studies in patients with PVCs and apparently normal hearts have reported an increased risk of adverse outcomes.2–5 In this series of patients with frequent PVCs referred for ablation in the absence of known or apparent heart disease, we assessed the prevalence of myocardial scarring with cardiac magnetic resonance (CMR) imaging and the value of programmed ventricular stimulation (PVS) for risk stratification of patients with frequent PVCs.

    View all citing articles on Scopus
    1

    Dr. Abdalla's present address: University of North Dakota School of Medicine, Department of Internal Medicine, c/o V.A. Medical Center, North Elm and 21st Avenue, Fargo, North Dakota 58102.

    View full text