Background
Frequent premature ventricular complexes (PVCs) can be an indicator of structural
heart disease.
Objective
The purpose of this study was to determine the prevalence of scarring detected by
delayed enhancement cardiac magnetic resonance (DE-CMR) imaging in patients with frequent
PVCs without apparent structural heart disease and to determine the value of programmed
ventricular stimulation (PVS) for risk stratification in patients with frequent PVCs
and myocardial scarring.
Methods
DE-CMR imaging was performed in patients without apparent heart disease who had frequent
PVCs and were referred for ablation. In the presence of scarring, scar volume was
measured and correlated with outcome variables. All patients underwent PVS and were
monitored for the occurrence of ventricular arrhythmias. Logistic regression was used
to compare imaging and procedural findings with long-term outcomes, with adjustment
for postablation ejection fraction (EF).
Results
The study consisted of 272 patients (135 men; mean age 52 ± 15 years; EF 52% ± 12%).
DE-CMR scar was found in 67 patients (25%), and 7 (3%) were found to have inducible
ventricular tachycardia (VT). The presence and amount of DE-CMR were related to the
risk of long-term VT independent of EF (hazard ratio 18.8 [95% confidence interval]
[2.0–176.6], P = .01; and hazard ratio 1.4 [1.1–1.7] per cm3 scar, P <.001, respectively). The positive predictive value and negative predictive value
of PVS for VT during long-term follow-up were 71% and 100%, respectively.
Conclusion
Preprocedural cardiac DE-CMR and PVS can be used to identify patients with frequent
PVCs without apparent heart disease who are at risk for VT.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart RhythmAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Long-term follow-up of asymptomatic healthy subjects with frequent and complex ventricular ectopy.N Engl J Med. 1985; 312: 193-198
- Ventricular ectopy as a predictor of heart failure and death.J Am Coll Cardiol. 2015; 66: 101-109
- Prognostic implications of asymptomatic ventricular arrhythmias: the Framingham Heart Study.Ann Intern Med. 1992; 117: 990-996
- Relation between ventricular premature complexes and sudden cardiac death in apparently healthy men.Am J Cardiol. 1987; 60: 1036-1042
- Relation of atrial and/or ventricular premature complexes on a two-minute rhythm strip to the risk of sudden cardiac death (the Atherosclerosis Risk in Communities [ARIC] study).Am J Cardiol. 2011; 107: 151-155
- Results and efficiency of programmed ventricular stimulation with four extrastimuli compared with one, two, and three extrastimuli.Circulation. 1994; 90: 2827-2832
- An improved MR imaging technique for the visualization of myocardial infarction.Radiology. 2001; 218: 215-223
- Optimized cardiac magnetic resonance imaging inversion recovery sequence for metal artifact reduction and accurate myocardial scar assessment in patients with cardiac implantable electronic devices.World J Radiol. 2018; 10: 100-107
- Radiofrequency ablation of frequent, idiopathic premature ventricular complexes: comparison with a control group without intervention.Heart Rhythm. 2007; 4: 863-867
- Cardiac mortality of premature ventricular complexes in healthy people in Japan.J Cardiol. 2010; 56: 23-26
- The prognostic significance of premature ventricular complexes in adults without clinically apparent heart disease: a meta-analysis and systematic review.Heart. 2012; 98: 1290-1298
- Association between midwall late gadolinium enhancement and sudden cardiac death in patients with dilated cardiomyopathy and mild and moderate left ventricular systolic dysfunction.Circulation. 2017; 135: 2106-2115
Article info
Publication history
Published online: September 30, 2019
Footnotes
This research was supported by funding from the French National Research Agency (ANR) under Grant Agreements Equipex MUSIC ANR-11-EQPX-0030 and IHU LIRYC ANR-10-IAHU-04; and from the European Research Council under Grant Agreement ERC no. 715093.
Identification
Copyright
© 2019 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
