The Impact of the Spatial Distribution of Ventricular Extrasystoles on Implantable Cardioverter-Defibrillator Recipients.

Abstract

Introduction: Premature ventricular complexes (PVC) are a common phenomenon observed in both normal and pathological heart conditions. However, they do not always behave in the same way. Different PVCs present with varying QRS morphologies, mechanisms, and origin sites. These differences may imply distinct prognoses. To date, the impact of the three-dimensional distribution of PVCs across the heart on the prognosis of ICD recipients has not been adequately investigated.

Material and methods: We conducted an ambidirectional cohort study. Patients underwent two twelve-lead ambulatory ECG recordings during follow-up. The spatial distribution of PVCs was analyzed using the algorithm proposed by Kuchar et al. The impact of this spatial distribution on clinical variables was assessed using mixed generalized models.

Results: Fifty-five patients were enrolled, with a mean follow-up time of 41.12 ± 13.48 months. All patients underwent two 12-lead ambulatory ECG recordings. The median PVC count was 91.5. PVCs were classified according to the algorithm proposed by Kuchar et al. PVCs arising from exit sites located in the intermediate left ventricle were associated with a higher number of therapies (odds ratio [OR]: 4.78; 95% confidence interval [CI], 1.19-19.26; p = 0.028) and prolonged QRS duration. PVCs with exit sites located in the septal region were associated with higher NYHA functional classes (OR: 2.22 [95% CI: 1.08-4.44]; p = 0.030). No statistically significant interaction was found between PVC topography and gender, number of ATP episodes, ATP success rate, or number of shock episodes.

Conclusion: The spatial distribution of PVCs influenced the prognosis of ICD recipients.