Premature ventricular contraction diurnal profiles predict distinct clinical characteristics and beta-blocker responses

J Cardiovasc Electrophysiol. 2019 Jun;30(6):836-843. doi: 10.1111/jce.13944. Epub 2019 Apr 16.

Abstract

Introduction: Frequent premature ventricular complexes (PVCs) can lead to symptoms, such as cardiomyopathy and increased mortality. Beta-blockers are recommended as first-line therapy to reduce PVC burden; however, the response is unpredictable. The objective of this study is to determine whether PVC diurnal-variability patterns are associated with different clinical profiles and predict drug response.

Methods: Consecutive patients with frequent PVCs (burden ≥ 1%), referred for Holter monitoring between 2014 and 2016, were included. Follow-up Holters, when available, were assessed after beta-blocker initiation to assess response (≥50% reduction). Patients were divided into three groups on the basis of relationship between hourly PVC count and mean HR during each of the 24 Holter hours: (1) fast-HR-dependent-PVC (F-HR-PVC) for positive correlation (Pearson, P < 0.05), (2) slow-HR-dependent-PVC (S-HR-PVC) for a negative, and (3) independent-HR-PVC (I-HR-PVC) when no correlation was found.

Results: Of the 416 patients included, 50.2% had F-HR-PVC, 35.6% I-HR-PVC, and 14.2% S-HR-PVC with distinct clinical profiles. Beta-blocker therapy was successful in 34.0% patients overall: patients with F-HR-PVC had a decrease in PVC burden (18.8 ± 10.4% to 9.3 ± 6.6%, P < 0.0001; 62% success), I-HR-PVC had no change (18.4 ± 17.9% to 20.6 ± 17.9%, P = 0.175; 0% success), whereas S-HR-PVC had an increase in burden (14.6 ± 15.3% to 20.8 ± 13.8%, P = 0.016; 0% success). The correlation coefficient was the only predictor of beta-blocker success (AUC = 0.84, sensitivity = 100%, specificity = 67.7%; r ≥ 0.4).

Conclusions: A simple analysis of Holter PVC diurnal variability may provide incremental value to guide clinical PVC management. Only patients displaying a F-HR-PVC profile benefited from beta-blockers. An alternative strategy should be considered for others, as beta-blockers may have no effect or can even be harmful.

Keywords: Holter monitoring; autonomic nervous system; beta blocker; diurnal; premature ventricular complexes (PVCs).

Publication types

  • Comparative Study
  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Action Potentials
  • Adrenergic beta-Antagonists / therapeutic use*
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Arrhythmia Agents / therapeutic use*
  • Circadian Rhythm*
  • Clinical Decision-Making
  • Electrocardiography, Ambulatory
  • Female
  • Heart Rate / drug effects*
  • Humans
  • Male
  • Middle Aged
  • Patient Selection
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome
  • Ventricular Premature Complexes / diagnosis
  • Ventricular Premature Complexes / drug therapy*
  • Ventricular Premature Complexes / physiopathology

Substances

  • Adrenergic beta-Antagonists
  • Anti-Arrhythmia Agents