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BACKGROUND: Ventricular premature complex (VPC) is one of the most common ventricular arrhythmias. The presence of VPC is associated with an increased risk of heart failure (HF). METHOD: We designed a single-center, retrospective, and large population-based cohort to clarify the role of VPC burden in long-term prognosis in Taiwan. We analyzed the database from the National Cheng Kung University Hospital-Electronic Medical Record (NCKUH-EMR) and NCKUH-Holter (NCKUH-Holter). A total of 19,527 patients who underwent 24-h Holter ECG monitoring due to palpitation, syncope, and clinical suspicion of arrhythmias were enrolled in this study. RESULTS: The clinical outcome of interests involved 5.65% noncardiovascular death and 1.53% cardiovascular-specific deaths between 2011 and 2018. Multivariate Cox regression analysis, Fine and Gray's competing risk model, and propensity score matching demonstrated that both moderate (1,000-10,000/day) and high (>10,000/day) VPC burdens contributed to cardiovascular death in comparison with a low VPC burden (<1,000/day). CONCLUSION: A higher VPC burden via Holter ECG is an independent risk factor of cardiovascular mortality.
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BACKGROUND: Epidemiological evidence has shown an association between ambient fine particulate matter (PM2.5) exposure and cardiovascular mortality. Increased ventricular premature complex (VPC) burden can cause left ventricular dilatation and dysfunction. We aimed to investigate the relationship between acute PM2.5 exposure and VPC burden in patients without structural heart disease. METHODS: We reviewed 26 820 patients who underwent 24-hour Holter electrocardiogram (ECG) recordings between 1 Jan 2013 and 1 Dec 2016. We enrolled patients with significant idiopathic (structurally normal heart) VPC burden defined as ≥30 VPCs/h (Lown grade 2) who had at least two Holter ECG recordings. The VPC burden between the studies on high and low PM2.5 exposure dates was compared in 24 and 12 hours time periods. RESULT: Sixty-seven patients (31 men, 56.49 ± 18.35 years) were enrolled. Patients were exposed to 25.63 ± 11.47 and 14.66 ± 7.51 µg/m 3 of PM2.5 during the high and low study dates, respectively. The overall VPC counts (10,490.69 ± 10,681.63/day) and burden (10.22% ± 10.17%) were significantly higher on the days with higher PM2.5 exposure compared with low PM2.5 exposure dates (8293.31 ± 9009.09; P = 0.014% and 9.14% ± 12.73%, P = 0.012, respectively). Compared with low PM2.5 exposure dates, the VPC burden on high exposure dates was significantly higher from 9 am to 9 pm (5.85% ± 6.41% vs 4.84% ± 6.97%; P = 0.025) but not at nocturnal periods. CONCLUSION: Our study demonstrated a significantly higher VPC burden on high PM2.5 exposure date. The burden was increased in the daytime but not at nighttime. This result suggests that daytime PM2.5 exposure may be associated with ventricular arrhythmia burden in the healthy population.
Asunto(s)
Electrocardiografía Ambulatoria , Frecuencia Cardíaca/efectos de los fármacos , Exposición por Inhalación/efectos adversos , Material Particulado/efectos adversos , Complejos Prematuros Ventriculares/diagnóstico , Potenciales de Acción , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tamaño de la Partícula , Valor Predictivo de las Pruebas , Factores de Riesgo , Taiwán , Factores de Tiempo , Complejos Prematuros Ventriculares/inducido químicamente , Complejos Prematuros Ventriculares/fisiopatologíaRESUMEN
Objective To investigate the change of heart rate turbulence in patients with chronic heart failure and relationship to age、LVEF、LVED、heart rate before ventricular premature complex (VPC)、coupling interval、compensatory interval、the number and origin of VPC.Methods HRT was measured in 30 CHF patients and 30 healthy controls.HRT onset and slope were measured by the original definitions using Holter records and compared with the clinical factors.Results The HRT TS was significantly lower in patients wtih heart failure than in control (3.17?2.03vs9.64?6.47,P