Risk stratification in patients with frequent premature ventricular complexes in the absence of known heart disease.
BACKGROUND
Frequent premature ventricular complexes (PVCs) can be an indicator of structural heart disease.


OBJECTIVE
The purpose of this study was to determine the prevalence of scarring detected by delayed enhancement cardiac magnetic resonance (DE-CMR) imaging in patients with frequent PVCs without apparent structural heart disease and to determine the value of programmed ventricular stimulation (PVS) for risk stratification in patients with frequent PVCs and myocardial scarring.


METHODS
DE-CMR imaging was performed in patients without apparent heart disease who had frequent PVCs and were referred for ablation. In the presence of scarring, scar volume was measured and correlated with outcome variables. All patients underwent PVS and were monitored for the occurrence of ventricular arrhythmias. Logistic regression was used to compare imaging and procedural findings with long-term outcomes, with adjustment for postablation ejection fraction (EF).


RESULTS
The study consisted of 272 patients (135 men; mean age 52 ± 15 years; EF 52% ± 12%). DE-CMR scar was found in 67 patients (25%), and 7 (3%) were found to have inducible ventricular tachycardia (VT). The presence and amount of DE-CMR were related to the risk of long-term VT independent of EF (hazard ratio 18.8 [95% confidence interval] [2.0-176.6], P = .01; and hazard ratio 1.4 [1.1-1.7] per cm3 scar, P <.001, respectively). The positive predictive value and negative predictive value of PVS for VT during long-term follow-up were 71% and 100%, respectively.


CONCLUSION
Preprocedural cardiac DE-CMR and PVS can be used to identify patients with frequent PVCs without apparent heart disease who are at risk for VT.
['Ghannam|Michael|M|', 'Siontis|Konstantinos C|KC|', 'Kim|Myra Hyungjin|MH|', 'Cochet|Hubert|H|', 'Jais|Pierre|P|', 'Eng|Mehdi Juhoor|MJ|', 'Attili|Anil|A|', 'Sharaf-Dabbagh|Ghaith|G|', 'Latchamsetty|Rakesh|R|', 'Jongnarangsin|Krit|K|', 'Morady|Fred|F|', 'Bogun|Frank|F|']
D005260:Female D006331:Heart Diseases D006352:Heart Ventricles D006801:Humans D015994:Incidence D019028:Magnetic Resonance Imaging, Cine D008297:Male D008875:Middle Aged D009206:Myocardium D012189:Retrospective Studies D018570:Risk Assessment D013318:Stroke Volume D014481:United States D016277:Ventricular Function, Left D018879:Ventricular Premature Complexes
Risk stratification Premature ventricular complex Programmed ventricular stimulation Catheter ablation Delayed enhancement cardiac magnetic resonance imaging