Clinical implications of premature ventricular contractions and ventricular tachycardia: a population-based approach

Background

Ventricular arrhythmias (VAs), premature ventricular contractions (PVCs) and ventricular tachycardia (VT), comprise important causes of cardiovascular morbidity and mortality in the general population. However, contemporary data on temporal trends in incidence, management, and prognosis are limited.

Purpose

We sought to estimate incidence, treatment patterns, and long-term outcomes of VAs in Denmark from 2011 to 2023.

Methods

Using Danish nationwide clinical databases, we identified adults with a first-time diagnosis of PVC or VT between 2011 and 2023. Annual incidence rates (IRs) per 100,000 individuals were calculated. Trends in ICD implantation, VA ablation, and anti-arrhythmic drugs (AADs) were examined. All-cause mortality up to 10 years after index-date was estimated using the Aalen–Johansen estimator.

Results

The IR of VAs increased from 2011 through 2016 and remained relatively stable with small year-to-year variations during the remaining study period until 2023 (IR 52, 95% CI 50-53 per 100.000 individuals in 2011 to IR 72, 95% CI 70-75 in 2016). (Figure 1) The increase in overall VA diagnoses during the period was driven by an increased rate of PVC cases (IR 31, 95% CI 29-33 per 100.000 individuals in 2011 to IR 51, 95% CI 49-53 in 2016) while the VT IR remained relatively stable.

Patients with PVCs were younger than patients with VT (median age 62 years, interquartile range [IQR] 49-73 vs. 68 years, IQR 57-76) with more female patients in the PVC group (52% vs. 28%). The prevalence of structural heart disease (including ischemic heart disease) was much lower in patients with PVCs compared with VT (30% vs 69%).

In terms of VA management, ICD implantation was much less common in patients with PVCs than VT (2% vs 43%) with an increase during the study period in patients with VT (38% in 2011 to 54% in 2023). VA ablation was less frequent in PVCs than VT (4 % vs 9%) with increased use during the study period, most notable in patients with VT (4% in 2011 to 10% in 2023).

The use of AADs was much less common in patients with PVCs than VT (2% vs. 25%), which remained stable during the study period with the predominant AAD being amiodarone

The overall mortality in patients with VAs was markedly lower in patients with PVCs than VT. (Figure 2) As such, we observed a lower 10-year mortality in patients with PVCs compared with VT (19.4%, 95% CI 18.6-20.2 vs 43.3%, 95% CI 42.0-44.7). The risk of mortality was notably lower in patients without underlying structural heart disease.

We found no differences in the prognosis following a VA diagnosis over time during the study period (2011-2023) as the 1-year mortality remained unchanged.

Conclusion

Across 2011–2023, VA incidence increased due to rising PVC diagnoses, while VT incidence and mortality remained stable. Despite expanded use of modern therapies such as ICD implantation and catheter ablation, mortality remained significant and largely unchanged over timeFigure 1- VA Incidence ratesFigure 2- Prognosis