Hamon David, Swid Mohammed Amer, Rajendran Pradeep S, Liu Albert, Boyle Noel G, Shivkumar Kalyanam, Bradfield Jason S
UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, California.
Department of Cardiology, University Hospital Henri Mondor, Creteil, France.
J Cardiovasc Electrophysiol. 2019 Jun;30(6):836-843. doi: 10.1111/jce.13944. Epub 2019 Apr 16.
Frequent premature ventricular complexes (PVCs) can lead to symptoms, such as cardiomyopathy and increased mortality. Beta-blockers are recommended as first-line therapy to reduce PVC burden; however, the response is unpredictable. The objective of this study is to determine whether PVC diurnal-variability patterns are associated with different clinical profiles and predict drug response.
Consecutive patients with frequent PVCs (burden ≥ 1%), referred for Holter monitoring between 2014 and 2016, were included. Follow-up Holters, when available, were assessed after beta-blocker initiation to assess response (≥50% reduction). Patients were divided into three groups on the basis of relationship between hourly PVC count and mean HR during each of the 24 Holter hours: (1) fast-HR-dependent-PVC (F-HR-PVC) for positive correlation (Pearson, P < 0.05), (2) slow-HR-dependent-PVC (S-HR-PVC) for a negative, and (3) independent-HR-PVC (I-HR-PVC) when no correlation was found.
Of the 416 patients included, 50.2% had F-HR-PVC, 35.6% I-HR-PVC, and 14.2% S-HR-PVC with distinct clinical profiles. Beta-blocker therapy was successful in 34.0% patients overall: patients with F-HR-PVC had a decrease in PVC burden (18.8 ± 10.4% to 9.3 ± 6.6%, P < 0.0001; 62% success), I-HR-PVC had no change (18.4 ± 17.9% to 20.6 ± 17.9%, P = 0.175; 0% success), whereas S-HR-PVC had an increase in burden (14.6 ± 15.3% to 20.8 ± 13.8%, P = 0.016; 0% success). The correlation coefficient was the only predictor of beta-blocker success (AUC = 0.84, sensitivity = 100%, specificity = 67.7%; r ≥ 0.4).
A simple analysis of Holter PVC diurnal variability may provide incremental value to guide clinical PVC management. Only patients displaying a F-HR-PVC profile benefited from beta-blockers. An alternative strategy should be considered for others, as beta-blockers may have no effect or can even be harmful.
频发室性早搏（PVC）可导致诸如心肌病和死亡率增加等症状。β受体阻滞剂被推荐作为减轻PVC负荷的一线治疗药物；然而，其疗效难以预测。本研究的目的是确定PVC的昼夜变化模式是否与不同的临床特征相关，并预测药物反应。
纳入2014年至2016年间因动态心电图监测而转诊的频发PVC（负荷≥1%）的连续患者。如有随访动态心电图，在开始使用β受体阻滞剂后进行评估以评估反应（减少≥50%）。根据24小时动态心电图监测期间每小时PVC计数与平均心率之间的关系，将患者分为三组：（1）快速心率依赖性PVC（F-HR-PVC），呈正相关（Pearson相关系数，P<0.05）；（2）缓慢心率依赖性PVC（S-HR-PVC），呈负相关；（3）心率独立性PVC（I-HR-PVC），无相关性。
纳入的416例患者中，50.2%为F-HR-PVC，35.6%为I-HR-PVC，14.2%为S-HR-PVC，具有不同的临床特征。总体而言，β受体阻滞剂治疗在34.0%的患者中成功：F-HR-PVC患者的PVC负荷降低（从18.8±10.4%降至9.3±6.6%，P<0.0001；成功率62%），I-HR-PVC患者无变化（从18.4±17.9%降至20.6±17.9%，P=0.175；成功率0%），而S-HR-PVC患者的负荷增加（从14.6±15.3%增至20.8±13.8%，P=0.016；成功率0%）。相关系数是β受体阻滞剂治疗成功的唯一预测指标（曲线下面积=0.84，敏感性=100%，特异性=67.7%；r≥0.4）。
对动态心电图PVC昼夜变化进行简单分析可为指导临床PVC管理提供额外价值。只有表现为F-HR-PVC特征的患者从β受体阻滞剂中获益。对于其他患者应考虑替代策略，因为β受体阻滞剂可能无效甚至有害。
