Premature ventricular contractions in patients with an implantable cardioverter defibrillator cardiac resynchronization therapy device: Results from the UMBRELLA registry

Finn Akerström; Marta Pachón; José B Martínez-Ferrer; Javier Alzueta; Luisa Pérez; Ignacio Fernández Lozano; Anibal Rodríguez; Miguel A Arias

doi:10.1016/j.ipej.2020.03.003

Premature ventricular contractions in patients with an implantable cardioverter defibrillator cardiac resynchronization therapy device: Results from the UMBRELLA registry

Indian Pacing Electrophysiol J. 2020 May-Jun;20(3):91-96. doi: 10.1016/j.ipej.2020.03.003. Epub 2020 Mar 9.

Authors

Finn Akerström¹, Marta Pachón², José B Martínez-Ferrer³, Javier Alzueta⁴, Luisa Pérez⁵, Ignacio Fernández Lozano⁶, Anibal Rodríguez⁷, Miguel A Arias²

Affiliations

¹ Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain. Electronic address: finn.akerstrom@sll.se.
² Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain.
³ Cardiology Department, University Hospital Araba-Txagorritxu, Vitoria-Gasteiz, Alava, Spain.
⁴ Cardiology Department, Hospital Virgen de la Victoria, Málaga, Spain.
⁵ Cardiology Department, Hospital Universitario A Coruna, La Coruña, Spain.
⁶ Cardiology Department, Hospital Puerta de Hierro, Madrid, Spain.
⁷ Cardiology Department, Hospital Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain.

Abstract

Background: Premature ventricular contractions (PVC) are known to reduce the percentage of biventricular (BiV) pacing in patients with cardiac resynchronization (CRT), decreasing the clinical response. The aim of this study was to evaluate the prevalence of a high PVC burden, as well as therapeutic action (pharmacotherapy, catheter ablation or device programming), in a large CRT implantable-defibrillator (CRT-D) population.

Methods: Patients with a CRT-D device from the UMBRELLA multicenter prospective remote monitoring registry were included. The PVC count was collected from each remote monitoring transmission. Patients were divided into two high (≥1 transmission ≥200/≥400 PVC/h, respectively) and one low (all transmissions <200 PVC/h) PVC count groups. The PVC burden following a high PVC count transmission was calculated.

Results: Of 1268 patients, 135 (11%) and 43 (3.4%) presented high PVC count (≥200/≥400 PVC/h, respectively). The majority of patients in the high PVC groups were not treated (61 [79%] and 32 [74%], respectively. Considering the untreated patients in the high PVC groups, median PVC/h was 199 (interquartile range [IQR]: 196) and 271 (IQR: 330), respectively. The PVC burden (proportion of time with PVC/h ≥ 200/≥400) was 40% (IQR 70) and 29% (IQR 59), respectively.

Conclusion: A significant proportion of CRT-D patients presented a high PVC count, however, few received treatment. In the untreated patients with a high PVC count, the PVC burden during follow-up varied substantially. Several consecutive recordings of a high PVC count should be warranted before considering therapeutic action such as catheter ablation.

Keywords: Cardiac resynchronization therapy; Catheter ablation; Heart failure; Implantable cardioverter-defibrillator; Premature ventricular contractions; Remote monitoring.