Kim Juwon, Kim Ju Youn, Park Seung-Jung, On Young Keun, Park Kyoung-Min
Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea.
J Clin Med. 2024 Aug 24;13(17):5009. doi: 10.3390/jcm13175009.
: Limited data are available regarding the prognostic impact of premature ventricular complex (PVC) burden in patients with atrial fibrillation (AF). We sought to compare clinical outcomes in patients with AF according to PVC burden via 24 h Holter monitoring. : From January 2010 to December 2020, 4834 oral anticoagulant (OAC)-naïve non-valvular AF (NVAF) patients who underwent 24 h Holter monitoring were included for analysis. : Among the 4834 OAC-naïve NVAF patients, 2835 patients (58.6%) exhibited at least one PVC within a 24 h monitoring period, and 120 patients (2.5%) displayed a daily PVC burden exceeding 10%. In the follow-up echocardiography, patients with a daily PVC burden of ≥10% exhibited lower left ventricular ejection fraction, larger left atrial volume, and higher right ventricular systolic pressure and E/e' than those with a daily PVC burden of <10%. The risk of ischemic stroke (adjusted HR 2.332, = 0.015) and heart failure admission (adjusted HR 2.147, = 0.010) were significantly higher in the patients with a daily PVC burden of ≥10% than in those with a daily PVC burden of <10%. However, the incidence of cardiac death was not significantly different between the two groups. A daily PVC burden of ≥10% was independently associated with the risk of ischemic stroke in the OAC-naïve NVAF patients, irrespective of the CHADS-VASc score, AF type, and left atrial size. : The current results suggest that evaluating and monitoring the burden of PVCs in patients with NVAF is an important aspect of predicting stroke and heart failure admission.
关于室性早搏（PVC）负荷对心房颤动（AF）患者预后的影响，现有数据有限。我们试图通过24小时动态心电图监测，比较AF患者中根据PVC负荷的临床结局。：2010年1月至2020年12月，纳入4834例未服用口服抗凝剂（OAC）的非瓣膜性AF（NVAF）患者进行24小时动态心电图监测分析。：在4834例未服用OAC的NVAF患者中，2835例（58.6%）在24小时监测期内至少出现一次PVC，120例（2.5%）每日PVC负荷超过10%。在随访超声心动图中，每日PVC负荷≥10%的患者与每日PVC负荷<10%的患者相比，左心室射血分数较低，左心房容积较大，右心室收缩压和E/e'较高。每日PVC负荷≥10%的患者发生缺血性卒中（校正HR 2.332，P = 0.015）和心力衰竭住院（校正HR 2.147，P = 0.010）的风险显著高于每日PVC负荷<10%的患者。然而，两组的心脏性死亡发生率无显著差异。在未服用OAC的NVAF患者中，无论CHADS-VASc评分、AF类型和左心房大小如何，每日PVC负荷≥10%与缺血性卒中风险独立相关。：目前的结果表明，评估和监测NVAF患者的PVC负荷是预测卒中和心力衰竭住院的一个重要方面。
