New composite parameter has superior predictive power for tachycardiomyopathy in patients with frequent idiopathic premature ventricular complexes

Introduction: Frequent premature ventricular comple-xes (PVCs) may induce HFrEF and tachy(dyssynchrono) cardiomyopathy (tachyCMP) in patients with previous structural heart disease, as well as in previously normal hearts. High arrhythmic burden is considered the car-dinal predictor of tachyCMP development. However, other clinical and electrocardiographical parameters may modulate this risk.
Methods: A new composite parameter dependent on PVC burden, PVC QRS duration and PVC coupling in-terval, was mathematically defined. We retrospectively studied 61 patients referred for radiofrequency ablation (RFA) at the Clinical Emergency Hospital of Bucha-rest, with frequent PVCs refractory to at least one anti arrhythmic drug, symptomatic and/or with LV systolic dysfunction (LVEF <50%). Patients with transthoracic echocardiography (TTE) and/or MRI structural lesi-ons, with sustained ventricular tachycardia/supraven-tricular tachycardia or severe valvular disease were ex-cluded.
Results: Mean PVC burden was 25.80%±11.64 (35%± 8.16 in tachyCMP subgroup). Chronic PVC suppres-sion was achieved in 89.6% of patients with a mean of 1.44±0.7 procedures with 86.4% of patients requiring one procedure. Septal right ventricular outflow tract (RVOT) was the most frequent PVC origin (36.1%). Mean left ventricular ejection fraction (LVEF) in the ta-chyCMP group (7 patients) was 38%±5.26 which incre-ased 1 month after RF ablation to 54.6%±3.64 (87.35% of recovered LVEF), at 3 months to 56%±2.23 and at 6 months 57%±2.73. Non-tachyCMP group recovered LVEF, yet statistically insignificant. There was no pro-cedure-related mortality, but two cases of persistent complications were reported (both RF-induced RBBB), both dependent on PVC septal RV origin. Retrograde ventriculo-atrial conduction, male gender, non-sustai-ned VT, a higher BMI and a higher PVC burden were associated with tachyCMP development. The new pa-rameter predicted tachyCMP with higher specificity (83.8% vs. 62.2%) than PVC burden alone.
Conclusions: The composite parameter seems to pre-dict tachyCMP with higher specificity than PVC bur-den alone.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)