PVC Variability and Impact on Meeting Expert Consensus Cutoffs of ≥10,000 PVCs/day and ≥15% PVCs

Abstract

ABSTRACTBackgroundFrequent 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.Methods606 patients with 14 day ZIO® monitor datasets with ≥10,000 PVCs on at least one day were identified (2014 Guidelines Cohort). Of these patients, 325 had at least one day of ≥15% PVCs (2017 Guidelines Cohort). Analysis was performed on these cohorts to investigate the impact of PVC variability on meeting guideline thresholds.ResultsWithin the 2014 Guidelines Cohort, mean daily PVC burden was 12,188±8,300 [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 <5,000 and <1,000 PVCs, respectively. Even patients with days of 0 PVCs (0.5%) were observed. 72h monitoring detected 69% of patients with ≥10,000 PVCs/24h with an additional 2-4% of patients crossing the threshold each additional day. A bimodal distribution of 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) vs “high frequency/high PVC” (14/14 above-threshold days/mean 24,580 PVCs those days). The 2017 Guidelines Cohort demonstrated similar findings.ConclusionDaily 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.