Review ArticleVentricular Ectopy in Patients With Left Ventricular Dysfunction: Should It Be Treated?
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VPCs are Prevalent in CHF
The frequency of VPCs varies widely depending on the clinical characteristics of the subjects enrolled in the study and the type of recording technique employed (Table 1). In healthy adults free of CHF or CAD, VPC incidence on 0.5–1-minute resting electrocardiographic (ECG) strips is ∼1%.19, 20 VPCs are much more frequent in patients with CHF. In subjects referred for exercise testing, ∼8% of those following a clinical presentation of heart failure presented with ≥1 VPC on the resting ECG
VPCs Can Worsen or Cause Heart Failure
Often, VPCs produce no significant or minimal blood pressure in healthy subjects and in patients with reduced cardiac function (Fig. 1). Frequent VPCs have been demonstrated to be associated with impaired systolic and diastolic function of the heart in subjects without significant structural heart diseases.24, 29, 35, 36, 37
A large community-based cohort study has shown that VPCs were often associated with CHF.24 CHF was seen in 10% of subjects enrolled during an average follow-up period of
Predisposing Factors of VPC-Induced Cardiomyopathy
It can be reasonably expected that a high VPC density is more likely to be associated with tachycardia-induced cardiomyopathy.35 A VPC burden of >24% was independently associated with VPC-induced cardiomyopathy,44 but VPC-induced cardiomyopathy has also been observed even in patients with as few as 5,500 daily VPCs.16
In addition to a high VPC burden, other characteristics such as greater VPC QRS width (≥140 ms), persistent VPC duration, burden of interpolated VPCs, presence of NSVT, multiform
Mechanisms Underlying VPC-Induced LV Dysfunction and CHF
VPCs may contribute to LV dysfunction and development of CHF through several potential mechanisms. Inter- and/or intraventricular dyssynchrony is deemed to be particularly important. The evidence that patients with fascicular VPCs, which excite the ventricles more physiologically with less LV dyssynchrony, rarely had a reduced LVEF45 supports this hypothesis. A study using 2-dimensional speckle tracking imaging found homogeneous reductions in global and segmental strain in the radial and
VPCs Are Associated With Increased Mortality in CHF
Many studies have shown that VPCs are associated with higher arrhythmic risk31, 54, 55 and total mortality rate in patients with LV dysfunction, but this has not been observed by some other investigators.56, 57 A recent meta-analysis study suggests that NSVT contributes to risk stratification for sudden cardiac death (SCD) independently from LVEF.58
It has been shown that preexercise resting VPCs were associated with a 5.48-fold increased risk of cardiovascular mortality in patients with a
Antiarrhythmic Treatment of VPCs Fails to Improve Survival in CHF
In the 2006 American College of Cardiology/American Heart Association/European Society of Cardiology guidelines for management of patients with ventricular arrhythmias and prevention of SCD, VPC suppression for reduction of death is not recommended in either the post–myocardial infarction (MI) patients or patients with nonischemic DCM.1 This recommendation is based on the assumption that ventricular arrhythmias during ambulatory recordings in patients with CHF are not considered to specifically
Elimination of VPCs Can Improve Cardiac Function
A majority of cardiologists may choose to treat VPCs aggressively when VPC-induced cardiomyopathy is suspected. Even for primary cardiomyopathy-induced VPCs, we recommend that these frequent PVCs be aggressively treated as primary arrhythmia, because they can worsen heart failure, contribute (particularly NSVT) to SCD, and be responsible for nonresponse to CRT therapy, as discussed earlier.
Summary
VPCs are one of the most common arrhythmias in the general population, and their incidence increases in the presence of congestive heart failure and/or other forms of structural heart disease. Frequent VPCs are associated with deterioration of cardiac function and may lead to VPC-induced cardiomyopathy. VPC-induced inter- and/or intraventricular dyssynchrony is thought to be responsible for VPC-induced LV dysfunction. In advanced CHF, VPCs and CHF may provoke each other to create a vicious
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Arrhythmia-Induced Cardiomyopathy: JACC State-of-the-Art Review
2019, Journal of the American College of CardiologyCitation Excerpt :PVCs are more frequently associated with post-myocardial infarction, coronary heart disease, and dilated CM and HF (30,34). Furthermore, almost one-half of patients with HF class II and III had frequent PVCs (>1,000 PVCs/day) (34). Clinical studies have found high PVC burden associated with LV dysfunction, increased risk of systolic HF (hazard ratio [HR]: 1.48 to 1.8) and mortality (HR: 1.31) (35–41) even after adjusting for age and other ECG abnormalities (30).
Assessment of energy expenditure, physical activity and sleep pattern in patients with frequent symptomatic ventricular ectopic beats
2016, Nutrition Clinique et MetabolismeCitation Excerpt :VEBs is one of the most common arrhythmias in daily clinical practice. Although frequent VEBs might be associated with myocardial hypertrophy, cardiomyopathy and ischemic heart disease, it can be seen in patients without structural heart disease as well [8–12]. Symptomatic frequent VEBs can also impair quality of life.
EHRA/HRS/APHRS Expert Consensus on Ventricular Arrhythmias
2014, Heart RhythmCitation Excerpt :For a patient with non-ischaemic dilated cardiomyopathy, the prognostic significance of NSVT is uncertain and no studies have provided precise guidance for treatment in this group of patients.75 The occurrence of NSVT in patients with an implanted ICD is associated with an increased frequency of shocks and all-cause mortality.76 For these patients, programming the ICD to a long VT detection time and a high ventricular fibrillation (VF) detection rate may be especially important.77,78
EHRA/HRS/APHRS expert consensus on ventricular arrhythmias
2014, Journal of ArrhythmiaCitation Excerpt :For a patient with non-ischaemic dilated cardiomyopathy, the prognostic significance of NSVT is uncertain and no studies have provided precise guidance for treatment in this group of patients [75]. The occurrence of NSVT in patients with an implanted ICD is associated with an increased frequency of shocks and all-cause mortality [76]. For these patients, programming the ICD to a long VT detection time and a high ventricular fibrillation (VF) detection rate may be especially important [77,78].
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The first 2 authors contributed equally to this work.
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