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Utility of Circadian Variability Patterns in Differentiating Origins of Premature Ventricular Complexes.

ABSTRACT: Background:Premature ventricular complexes (PVCs) exhibit circadian fluctuation. We determine if PVCs of different origin exhibit specific circadian patterns. Methods:We analyzed Holter recordings from patients with monomorphic PVCs who underwent catheter ablation. PVC circadian patterns were classified as fast-heart rate- (HR-) dependent (F-PVC), slow-HR-dependent (S-PVC), or HR-independent (I-PVC). PVC origins were determined intraprocedurally. Results:In a retrospective cohort of 407 patients, F-PVC and S-PVC typically exhibited diurnal and nocturnal predominance, respectively. Despite decreased circadian fluctuation, I-PVC generally had heavier nocturnal than diurnal burden. PVCs of left anterior fascicle origin were predominantly S-PVC, while those of posterior hemibranch origin were mostly F-PVC. PVCs originating from the aortic sinus of Valsalva (ASV) were predominantly I-PVC, while most PVCs arising from the left ventricular outflow tract (LVOT) were F-PVC. Using a diurnal/nocturnal PVC burden ratio of 0.92 as the cutoff value to distinguish LVOT from ASV origin achieved 97% sensitivity and, as further verification, an accuracy of 89% (16/18) in a prospective cohort of patients with PVCs originating from either ASV or LVOT. In contrast, PVCs originating from right ventricles, such as right ventricular outflow tract, did not show distinct circadian patterns. Conclusions:The circadian patterns exhibit origin specificity for PVCs arising from left ventricles. An analysis of Holter monitoring provides useful information on PVC localization in ablation procedure planning.

SUBMITTER: Chen M

PROVIDER: S-EPMC7647775 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Utility of Circadian Variability Patterns in Differentiating Origins of Premature Ventricular Complexes.

Chen Mu M Wang Qunshan Q Sun Jian J Zhang Peng-Pai PP Li Wei W Zhang Rui R Mo Bin-Feng BF Chen Tai-Zhong TZ Wan Juyi J Xu Dong-Zhu DZ Aonuma Kazutaka K Li Yi-Gang YG

Journal of interventional cardiology 20201030

<h4>Background</h4>Premature ventricular complexes (PVCs) exhibit circadian fluctuation. We determine if PVCs of different origin exhibit specific circadian patterns.<h4>Methods</h4>We analyzed Holter recordings from patients with monomorphic PVCs who underwent catheter ablation. PVC circadian patterns were classified as fast-heart rate- (HR-) dependent (F-PVC), slow-HR-dependent (S-PVC), or HR-independent (I-PVC). PVC origins were determined intraprocedurally.<h4>Results</h4>In a retrospective ...[more]

PMID: 33177963

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Project description:Background The ventricular premature complexes (PVCs) originating from the superior right ventricular outflow tract (RVOT) have high success rates by catheter ablation. It may not be the same when the origin is in the inferior RVOT. Objective To identify electrocardiographic (ECG) characteristics that predict the site for successful ablation of PVCs originating in the inferior RVOT. Methods Of 309 consecutive patients with symptomatic PVCs despite medical therapy, 124 had PVCs originating from the RVOT, and 107 RVOT cases without structural heart disease and no bundle branch block in sinus rhythm were enrolled in the study. Among them, 74 have a superior RVOT origin, and 33 have an inferior RVOT origin. Results The proportion with multiple morphologies of PVC was significantly higher in the inferior RVOT group than in the superior RVOT group (24.24 vs. 6.76%, P = 0.011). The QRS duration of PVCs with an inferior RVOT origin was more expansive than PVCs with a superior RVOT origin (162.42 ± 19.69 ms vs. 140.90 ± 11.30 ms; P < 0.001). Furthermore, the QRS wave in V1 in patients in the inferior RVOT group was more likely to have a negative delta wave at the onset of the QRS (27.27 vs. 1.39%, P < 0.001). We found that the areas under the receiver-operating characteristic curve (AUCs) for PVC diagnosis with an inferior RVOT origin ranged from 0.812 to 0.841 depending on ECG features, with the highest AUC for the QRS duration of PVCs and the amplitude of R waves in lead II. These ECG indices had good predictability for judging the origin of PVCs in the RVOT; the best threshold for the QRS duration of PVCs was 145 ms, and the best thresholds for the amplitude of R waves in leads II, III, and aVF were 1.35, 1.35, and 1.15 mV, respectively. Conclusion When evaluating a patient with PVCs, the source is likely to be the inferior RVOT if the ECG presentation conforms to the morphological characteristics of the RVOT, meanwhile, the QRS wave is relatively broad and polymorphic, and the main waves in limb leads (II, III, and aVF) are upward with low amplitude.

Project description:BACKGROUND:Premature complexes are common electrocardiographic findings in daily clinical practice that require further evaluation. Investigation may sometimes be complex and expensive. The aim of our study was to analyze variables associated with premature beats identified in outpatients referred from a primary care facility. MATERIALS AND METHODS:We performed a cross-sectional study of 407 outpatients (aged 55.8±11years; 56% women) who were followed by general practitioners and were referred for resting 12-lead electrocardiograms for a routine clinical follow-up. After signing informed consent, patients answered a questionnaire and underwent physical examinations, laboratory diagnostics, transthoracic echocardiograms and 24-hour Holter monitoring to evaluate for the presence of premature complexes. After the univariate analyses, logistic regression analyses were performed with adjustment for age, sex, and cardiovascular diseases. RESULTS:Premature complexes distribution revealed that they were frequent but with low density. Premature atrial complexes (? 4/hours) were associated with age (Odds Ratio (OD) = 1.030, Confidence Interval (CI) 95% = 1.002 ? 1.059, p = 0.029), brain natriuretic peptide (BNP) levels > 20mg/dL (OR = 4.489, 95%CI = 1.918 ? 10.507, p = 0.0005), intraventricular blocks (OR = 4.184, 95%CI = 1.816 ? 9.406, p = 0.0005) and left atrial diameter (OR = 1.065, 95%CI = 1.001 ? 1.134, p = 0.046). Premature ventricular complexes (? 5/hour) were related to age (OR = 1.032, 95%CI = 1.010 ? 1.054, p = 0.004), the use of calcium channel blockers (OR = 2.248, 95%CI = 1.019 ? 4.954, p = 0.045), HDL-cholesterol levels (OR = 0.971, 95%CI = 0.951 ? 0.992, p = 0.007), BNP levels > 20mg/dL (OR = 2.079, 95%CI = 0.991 ? 0.998, p = 0.033), heart rate (OR = 1.019, 95%CI = 1.001 ? 1.038, p = 0.041), left ventricular hypertrophy (OR = 2.292, 95%CI = 1.402 ? 3.746, p = 0.001) and left ventricular ejection fraction (OR = 0.938, 95%CI = 0.900 ? 0.978, p = 0.002). CONCLUSIONS:Premature complexes had low density and were associated with BNP levels > 20mg/dL, lower levels of HDL-cholesterol, left atrial enlargement and ventricular hypertrophy. The identification of premature complexes on 24-hour Holter monitor recordings of outpatients in a primary public healthcare setting was associated with uncontrolled cardiovascular risk factors that may be addressed with medical advice and therapy in a primary care setting.

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Utility of Circadian Variability Patterns in Differentiating Origins of Premature Ventricular Complexes.

Publications

Utility of Circadian Variability Patterns in Differentiating Origins of Premature Ventricular Complexes.

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