Electrocardiographic characteristics for predicting idiopathic right ventricular outflow tract premature ventricular complex-induced cardiomyopathy
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In spite of several proposed predictors for premature ventricular complex (PVC)-induced cardiomyopathy (PVC-CMP), the specific ECG features of idiopathic right ventricular outflow tract (RVOT) PVC-CMP remain unknown.
A total of 130 patients (49 males, mean age 44 years) with symptomatic and drug-refractory idiopathic RVOT PVCs undergoing radiofrequency catheter ablation (RFCA) were enrolled. The patients were categorized into two groups, including those with and without RVOT PVC-CMP (left ventricular ejection fraction (LVEF) < 50%, n = 25 and LVEF ≥ 50%, n = 105, respectively). The 12-lead PVC morphologies were assessed.
Patients with RVOT PVC-CMP had a lower LVEF (42 ± 5% vs. 60 ± 7%, P < 0.01) and higher PVC burden (24 ± 14% vs. 15 ± 11%, P = 0.02) when compared to patients without RVOT PVC-CMP. The PVC features in those with PVC-CMP displayed a significantly wider QRS duration (143 ± 14 ms vs. 132 ± 17 ms, P < 0.01) and higher peak deflection index (PDI; 0.60 ± 0.07 vs. 0.55 ± 0.08, P < 0.01). A multivariate analysis demonstrated that the QRS duration (odds ratio (OR) 1.130, 95% confidence interval (CI) 1.020–1.253, P = 0.02) and PDI (OR 1.240, 95% CI 1.004–1.532, P = 0.04) were independently associated with RVOT PVC-CMP. Based on the receiver-operating characteristic analysis, a QRS duration > 139 ms and PDI > 0.57 could predict RVOT PVC-CMP (area under the curve (AUC) 0.710 and AUC 0.690, respectively). The elimination and suppression of PVCs by RFCA resulted in the recovery of the LVEF in RVOT PVC-CMP.
The ECG parameters, including a wider QRS duration and higher PDI, could predict the development of RVOT PVC-CMP, which could be effectively treated by RFCA.
KeywordsElectrocardiography Ventricular arrhythmia Premature ventricular complex-induced cardiomyopathy Catheter ablation
This work was supported by the Center for Dynamical Biomarkers and Translational Medicine, Ministry of Science and Technology (grant no. MOST 106-2314-B-075-006-MY3, MOST 106-2314-B-010-046-MY3, MOST 106-2314-B-075-073-MY3, MOST 104-2314-B-010-063-MY2, MOST 104-2314-B-075-089-MY3), Research Foundation of Cardiovascular Medicine, TVGH-NTUH Joint Research Program (grant no. VGHUST105-G7-9-1, VGHUST105-G7-4-1, VGHUST104-G7-3-1), Szu-Yuan Research Foundation of Internal Medicine, and Taipei Veterans General Hospital (grant no. V104B-018, V104E7-001, V104C-121, V104C-109, V105B-014, V105C-122, V105C-116, V106C-158, V106B-010, V106C-104, V107B-014, V107C-060, and V107C-054).
Compliance with ethical standards
Conflict of interest disclosures
All authors have no conflicts of interest to declare.
This study was conducted at the Taipei Veterans General Hospital in Taiwan and was approved by the institutional review board of the Taipei Veterans General Hospital and Department of Health, Taiwan (IRB no. 2014-10-004BC).
Informed consent was obtained from all individual participants included in the study.
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