Effect of burden and origin sites of premature ventricular contractions on left ventricular function by 7-day Holter monitor

摘要

Recent studies have shown that premature ventricular contractions(PVCs) could enlarge the heart,but its risk factors are incompletely understood as a single 24-hour recording cannot reflect the true PVC burden due to day-to-day variability.Our purpose was to investigate the effect of burden and origin sites on left ventricular(LV) function in patients with PVCs by 7-day Holter electrocardiography(ECG).From May 2012 to August2013,112 consecutive patients with PVCs were recruited from the authors' affiliated hospital.All patients received2-dimensional transthoracic echocardiography,12-lead routing ECG and 7-days Holter ECG.Serum N-terminal probrain natriuretic peptide(NT-proBNP) levels were measured.A total of 102 participants with PVCs were included in the final analysis.Origin of PVCs from the tricuspid annulus had the highest burden and NT-proBNP level.LV papillary muscle had a higher LV ejection fraction(EF) level and a lower LV end-systolic dimension(ESD) than other PVC foci(P<0.05).The high burden group had a higher LV end-diastolic dimension(EDD) and LVESD but lower LVEF than the other two groups(P<0.05).Female,older age,physical work,and history of PVCs had a significantly positive correlation with symptoms.Male,older age,physical work,and high burden were positive predictors of enlarged LVEDD,LVESD and higher serum NT-proBNP level,but lower LVEF.Seven-day dynamic ECG Holter monitor showed the true PVC burden on patients with PVCs.PVCs with a lower burden or origin from the LV papillary muscle and the fascicle were relatively benign,while PVCs with a higher burden or origin from the tricuspid annulus may lead to cardiac dysfunction.