Clinical Electrophysiology -> Ventricular Arrhythmias -> Experimental methods D-PO01 - Featured Poster Session (ID 11) Poster

D-PO01-007 - Objective Evidence That Longer Monitoring Periods Increase Detection Of Days With >10,000 PVCs, The Expert Consensus Cut-off For Consideration Of Catheter Ablation (ID 879)


Background: According to the 2014 EHRA/HRS/APHRS Expert Consensus on Ventricular Arrhythmias, patients with presumed PVC induced cardiomyopathy based on a single 24 hour PVC count >10,000 should be considered for catheter ablation. However, the daily variability of PVCs has not been characterized.
Objective: To analyze variability in multi-day sequential PVC recordings in patients with a documented recording of >10,000 PVCs in a given 24 hour period.
Methods: Patients with 14 consecutive day recordings with a PVC count >10,000 on at least one day were analyzed retrospectively. Data was provided anonymously by iRhythm from the Zio Patch mobile cardiac telemetry platform.
Results: 14 day PVC data from a cohort of 606 patients were analyzed (n=8,484 total patient-days). The average daily PVC count was 12,149 [minimum: 0 / maximum: 64,188] with a SD of 9,459. PVC counts within the same patient varied up to 25,000-fold during the 14 day observation period.
While all patients within this cohort qualified for PVC ablation by 2014 Expert Consensus, 62 total patients days (0.7%) had <10 PVCs, 148 total patient days (1.7%) had <100 PVCs, 494 total patient days (5.8%) had <1,000 PVCs, and 4,187 total patient days (49%) had less than 10,000 PVCs.
316 patients (52%) had at least 10,000 PVCs on monitor day one, correlating to a one-day Holter monitor. 377 patients (62%) had at least 10,000 PVCs on monitor day one or two, correlating to a two-day Holter monitor. By day seven, 494 patients (81.5%) had at least one day with a PVC count >10,000. By day twelve, 582 patients (96%) had at least one day with a PVC count >10,000.
Only 117 patients (19%) had all 14 days with >10,000 PVCs. Patients with up to 53,000 PVCs on a given day had days with <10,000 PVCs.
Conclusion: The daily PVC burden is highly variable with up to 25,000-fold variation during the 14 day observation period. Only patients with >53,000 PVC/day had no days with <10,000 PVCs. Extending monitoring beyond a one or two-day Holter will detect more patients qualifying for the >10,000 PVC/day cut-off as suggested by the 2014 Expert Consensus.