[Incidence and prognostic implication of repetitive ventricular premature contractions detected by Holter monitoring (author's transl)].

Incidence and prognostic significance of repetitive ventricular premature contractions in various cardiac diseases were evaluated retrospectively with 593 consecutive patients referred for the 24-hour continuous electrocardiographic monitoring (Holter monitoring). Primary cardiac diagnoses for 308 patients with structural heart diseases included previous myocardial infarction (MI) in 151 patients, angina pectoris in 34, congestive cardiomyopathy (COCM) in 21, valvular heart disease in 29, hypertensive heart disease (HHD) in 18, conduction disturbance in 28, and other cardiovascular abnormalities in 17 patients. Other 285 patients (48%) had no known structural heart disease. Repetitive ventricular premature contractions (VPCs) was defined as the occurrence of self-terminating two (couplet), three (triplet) or more consecutive VPCs without associated hemodynamic sequelae. Holter monitoring was done with simultaneous two-channel recordings. Repetitive VPCs were seen in 96 patients; 17% of patients with MI, 52% of COCM and 7% of no structural hart disease. Among 308 patients with structural heart disease, 91 had congestive heart failure and 42% of these had repetitive VPCs, whereas only 17% of patients without congestive heart failure had repetitive VPCs. Coronary arteriographic and ventriculographic findings were reviewed in 91 patients with previous MI. Neither the degree of coronary artery involvements nor left ventricular ejection fraction had influence on the occurrence of repetitive VPCs. Four hundreds and sixty-nine patients under the age of 69 years were followed from 6 to 36 months (mean 19 months). Thirteen patients including 5 cases with MI (4% of the cases with MI), 4 with COCM (21% of COCM) and 4 with other structural heart disease (4% of other disease) died suddenly in the follow-up period. In the patients followed, 72 had repetitive VPCs and 9 of them died suddenly. These 9 patients consisted of 4 patients with MI (25% of the cases with MI having repetitive VPCs), 4 with COCM (40% of COCM) and 1 with other structural heart disease (3% of other disease). Thus, patients with MI or COCM had higher incidence of repetitive VPCs and they are at a high risk for sudden cardiac death.