Catheter Ablation -> Ventricular Arrhythmias -> Electrocardiography D-PO06 - Poster Session VI (ID 26) Poster

D-PO06-085 - Utility Of Circadian Variability Patterns In Differentiating Origins Of Premature Ventricular Complexes Arising From Left Ventricles (ID 1356)

Disclosure
 M. Chen: Nothing relevant to disclose.

Abstract

Background: Premature ventricular complexes (PVCs) exhibit circadian fluctuation.
Objective: To determine whether PVCs arising from different origins exhibit specific circadian patterns.
Methods: We analyzed Holter recordings from patients with monomorphic PVCs who underwent catheter ablation. PVC circadian patterns were classified into 3 types, i.e. fast-heart rate (HR)-dependent (F-PVC), slow-HR-dependent (S-PVC) and HR-independent (I-PVC). PVC origins were determined intra-procedurally.
Results: Circadian patterns remained consistent among repeated Holter recordings in 93% cases. In a retrospective cohort of 407 patients, F-PVC and S-PVC typically exhibited diurnal and nocturnal predominance, respectively. Despite decreased circadian fluctuation, I-PVC generally had heavier nocturnal than diurnal burden. PVCs originated from aortic sinus of Valsalva (ASV) were predominately I-PVC, while most PVCs arising from left ventricular outflow tract (LVOT) were F-PVC. Using diurnal/nocturnal PVC burden ratio 0.92 as the cutoff value to distinguish LVOT from ASV origins achieved 97% sensitivity, the utility of which was further verified in a perspective cohort of ASV and LVOT PVC patients with 89% (16/18) accuracy (Fig 1). In addition, PVCs from left anterior fascicle were predominant S-PVC, while those from posterior hemibranch were mostly F-PVC. In contrast, the PVC circadian distributions were similar among origins from right ventricles.
Conclusion: The circadian patterns exhibit origin specificity in PVCs from left ventricles. A simple analysis of Holter monitoring provides additional information regarding PVC localization in planning the ablation procedure.
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