Factors associated with the development of premature ventricular complex induced cardiomyopathy

Premature ventricular complexes (PVCs) are the most common ventricular arrhythmia. PVCs are generally benign, though some patients with a significant burden can develop a PVC induced cardiomyopathy (PIC) characterized by left ventricular dysfunction and chamber dilatation. Though some risk factors, like male sex, PVC burden, epicardial PVCs, as well as others, have been identified, the development of PIC is incompletely understood.

The aim of this study is to identify factors associated with the development of PIC.

All patients who underwent successful PVC ablation since 2000 were identified. Patients were included if there was sufficient data regarding medical and PVC history, echocardiography, and the ablation procedure. We compared those with preserved ejection fraction (EF), defined as EF>50%, to those with reduced ejection fraction, or EF <50% at time of ablation in a univariate analysis. Chi-square analysis was performed for categorical variables while a two-sided t-test compared continuous variables.

A total of 226 patients were identified, of whom 153 (67.7%) had preserved EF and 73 (32.3%) had reduced EF . Demographic factors associated with reduced EF included advanced age (P=0.007) and male sex (P<0.001). Mineralocorticoid agonist, renin-angiotensin system antagonists, and digoxin use are associated with reduced EF, though potentially confounded given current guidelines for heart failure. Group 1 anti-arrhythmic use was associated with preserved EF. Coronary artery disease was the only comorbidity to be associated with reduced EF (P=0.002). Palpitations (P=0.007) and other symptoms (P=0.006) were associated with preserved EF. A longer sinus QRS (P<0.001) and underlying baseline conduction disorder (P<0.001) were associated with reduced EF.

The development of PIC may be associated with certain demographic, medication, conduction, and clinical factors.