Advancing age and male sex predict left ventricular outflow tract origin in idiopathic PVCs
M Botis, D Tsiachris, K Vlachos, N Stratopoulos, I Doundoulakis, C K Antoniou, A Kordalis, S Kotoulas, A Laina, L I Bartsioka, N Argyriou, A E Karanikola, G Botis, K TsioufisAbstract
Introduction
Idiopathic premature ventricular contractions (PVCs) is a frequently encountered clinical arrhythmia. Current guidelines define idiopathic PVCs as those occurring in the absence of structural heart disease. Among the most frequent sites of PVCs origin are the right ventricular outflow tract (RVOT) and the left ventricular outflow tract (LVOT).
Purpose
The study aimed to investigate factors related with the origin of the arrhythmia either from the RVOT or LVOT.
Material and Methods
We included 156 patients (55 women, men age 54.6 ± 16.6), who underwent successful idiopathic PVC ablation, originating from either RVOT or LVOT, as determined by 3-D electroanatomical mapping, from 2015 to 2025, in three tertiary centers. Multivariate logistic regression models were developed, to correlate the patients age and gender with the site of the arrhythmia origin.
Results
The site of origin was identified as the RVOT in 65 patients and the LVOT in 91 patients. Both advancing age (Odds Ratio: 1.04, 95% C.I. 1.02 - 1.07, p < 0.001, per year increase) and male gender (Odds Ratio: 2.79, 95% C.I. 1.36 – 5.83, p < 0.001) were independently associated with an arrhythmia origin from the LVOT, rather the RVOT, in the multivariate model (Figure 1). The age difference among the two sites of origin is also illustrated in Figure 2. No differences were noted in the 24-hour burden among RVOT and LVOT originating arrhythmias (19.9% vs 21.6%, p = 0.3). Procedural duration was similar (130.4 vs 117.1 min, p = 0.24) for RVOT and LVOT originating arrhythmias, respectively. Activation mapping yielded greater prematurity, in absolute values, in PVCs arising from the RVOT (30.14 ± 10.8 vs 25.31 ± 9.89 msec, p = 0.01).
Conclusions
Increasing age and male gender are positively correlated with LVOT- originating PVCs, compared with RVOT-originating arrhythmias. The finding could aid to PVCs catheter ablation pre- procedural planning.Figure 1Figure 2