PVC Variability and Impact on Meeting Expert Consensus Cutoffs of ≥ 10 000 PVCs/Day and ≥ 15% PVCs
Richard S. Amara, Justin Brilliant, Jason Appelbaum, Ameer Abutaleb, Rama Vunnam, Stephen R. Shorofsky, Jeffrey N. Rottman, Ardit Kacorri, Timm M. DickfeldABSTRACT
Background
Frequent PVCs have been associated with a reversible cardiomyopathy. Cutoffs of ≥ 10 000 PVCs/day and ≥ 15% PVCs have been suggested by the 2014 EHRA/HRS/APHRS and 2017 AHA/ACC/HRS Expert Consensus guidelines, respectively, for PVC suppression.
Objective
To investigate the impact of PVC variability on meeting guideline‐suggested PVC thresholds.
Methods
Six hundred and six patients with 14‐day ZIO monitor data sets with ≥ 10 000 PVCs on at least 1 day were identified (2014 guidelines cohort). Of these patients, 325 had at least 1 day of ≥ 15% PVCs (2017 guidelines cohort). Analysis was performed on these cohorts.
Results
Within the 2014 guidelines cohort, mean daily PVC burden was 12 188 ± 8300 [range 0–64 188]. Intra‐patient daily PVCs were highly variable (median 3.6‐fold change between max and min PVC days (Q1/3: 2.22/10.15) with instances of > 10 000‐fold change observed. 54.3% and 19.5% of patients had days with < 5000 and < 1000 PVCs, respectively. Even patients with days of 0 PVCs (0.5%) were observed. Seventy‐two hours of monitoring detected 69% of patients with ≥ 10 000 PVCs/24 h with an additional 2%–4% of patients crossing the threshold each additional day. A bimodal distribution of the number of days meeting PVC thresholds/corresponding PVC counts was observed, suggesting a previously unidentified pattern of distinct populations—“low frequency/low PVC” (≤ 3/14 above‐threshold days/mean 12 342 PVCs those days) versus “high frequency/high PVC” (14/14 above‐threshold days/mean 24 580 PVCs those days). The 2017 guidelines cohort demonstrated similar findings.
Conclusion
Daily PVC burdens vary greatly. More sensitive detection of guideline‐suggested cut‐offs requires prolonged monitoring. Novel potential PVC patterns may allow for better identification of candidates for PVC suppression.