Circadian variability patterns predict and guide premature ventricular contraction ablation procedural inducibility and outcomes

David Hamon, Guillaume Abehsira, Kai Gu, Albert Liu, Marie Blaye-Felice Sadron, Sophie Billet, Thomas Kambur, Mohammed Amer Swid, Noel G. Boyle, Gopi Dandamudi, Philippe Maury, Minglong Chen, John Miller, Nicolas Lellouche, Kalyanam Shivkumar, Jason S. Bradfield

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Infrequent intraprocedural premature ventricular complexes (PVCs) may impede radiofrequency catheter ablation (RFA) outcome, and pharmacologic induction is unpredictable. Objective: The purpose of this study was to determine whether PVC circadian variation could help predict drug response. Methods: Consecutive patients referred for RFA with detailed Holter monitoring and frequent monomorphic PVCs were included. Patients were divided into 3 groups based on hourly PVC count relationship to corresponding mean heart rate (HR) during each of the 24 hours on Holter: fast-HR-dependent PVC (F-HR-PVC) type for a positive correlation (Pearson, P <.05), slow-HR-dependent PVC (S-HR-PVC) type for a negative correlation, and independent-HR-PVC (I-HR-PVC) when no correlation was found. Results: Fifty-one of the 101 patients (50.5%) had F-HR-PVC, 39.6% I-HR-PVC, and 9.9% S-HR-PVC; 30.7% had infrequent intraprocedural PVC requiring drug infusion. The best predictor of infrequent PVC was number of hours with PVC count <120/h on Holter (area under the curve 0.80, sensitivity 83.9%, specificity 74.3%, for ≥2 h). Only F-HR-PVC patients responded to isoproterenol. Isoproterenol washout or phenylephrine infusion was successful for the 3 S-HR-PVC patients, and no drug could increase PVC frequency in the 12 I-HR-PVC patients. Long-term RFA success rate in patients with frequent PVCs at baseline (82.9%) was similar to those with infrequent PVC who responded to a drug (77.8%; P = .732) but significantly higher than for those who did not respond to any drug (15.4%; P <.0001). Conclusion: A simple analysis of Holter PVC circadian variability provides incremental value to guide pharmacologic induction of PVCs during RFA and predict outcome. Patients with infrequent I-HR-PVC had the least successful outcomes from RF ablation.

Original languageEnglish (US)
JournalHeart Rhythm
DOIs
StateAccepted/In press - 2017

Fingerprint

Ventricular Premature Complexes
Polyvinyl Chloride
Catheter Ablation
Heart Rate
Pharmaceutical Preparations
Isoproterenol
Ambulatory Electrocardiography
Phenylephrine
Area Under Curve

Keywords

  • Autonomic nervous system
  • Circadian profile
  • Isoproterenol
  • Premature ventricular complexes
  • Radiofrequency ablation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Hamon, D., Abehsira, G., Gu, K., Liu, A., Blaye-Felice Sadron, M., Billet, S., ... Bradfield, J. S. (Accepted/In press). Circadian variability patterns predict and guide premature ventricular contraction ablation procedural inducibility and outcomes. Heart Rhythm. https://doi.org/10.1016/j.hrthm.2017.07.034

Circadian variability patterns predict and guide premature ventricular contraction ablation procedural inducibility and outcomes. / Hamon, David; Abehsira, Guillaume; Gu, Kai; Liu, Albert; Blaye-Felice Sadron, Marie; Billet, Sophie; Kambur, Thomas; Swid, Mohammed Amer; Boyle, Noel G.; Dandamudi, Gopi; Maury, Philippe; Chen, Minglong; Miller, John; Lellouche, Nicolas; Shivkumar, Kalyanam; Bradfield, Jason S.

In: Heart Rhythm, 2017.

Research output: Contribution to journalArticle

Hamon, D, Abehsira, G, Gu, K, Liu, A, Blaye-Felice Sadron, M, Billet, S, Kambur, T, Swid, MA, Boyle, NG, Dandamudi, G, Maury, P, Chen, M, Miller, J, Lellouche, N, Shivkumar, K & Bradfield, JS 2017, 'Circadian variability patterns predict and guide premature ventricular contraction ablation procedural inducibility and outcomes', Heart Rhythm. https://doi.org/10.1016/j.hrthm.2017.07.034
Hamon, David ; Abehsira, Guillaume ; Gu, Kai ; Liu, Albert ; Blaye-Felice Sadron, Marie ; Billet, Sophie ; Kambur, Thomas ; Swid, Mohammed Amer ; Boyle, Noel G. ; Dandamudi, Gopi ; Maury, Philippe ; Chen, Minglong ; Miller, John ; Lellouche, Nicolas ; Shivkumar, Kalyanam ; Bradfield, Jason S. / Circadian variability patterns predict and guide premature ventricular contraction ablation procedural inducibility and outcomes. In: Heart Rhythm. 2017.
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abstract = "Background: Infrequent intraprocedural premature ventricular complexes (PVCs) may impede radiofrequency catheter ablation (RFA) outcome, and pharmacologic induction is unpredictable. Objective: The purpose of this study was to determine whether PVC circadian variation could help predict drug response. Methods: Consecutive patients referred for RFA with detailed Holter monitoring and frequent monomorphic PVCs were included. Patients were divided into 3 groups based on hourly PVC count relationship to corresponding mean heart rate (HR) during each of the 24 hours on Holter: fast-HR-dependent PVC (F-HR-PVC) type for a positive correlation (Pearson, P <.05), slow-HR-dependent PVC (S-HR-PVC) type for a negative correlation, and independent-HR-PVC (I-HR-PVC) when no correlation was found. Results: Fifty-one of the 101 patients (50.5{\%}) had F-HR-PVC, 39.6{\%} I-HR-PVC, and 9.9{\%} S-HR-PVC; 30.7{\%} had infrequent intraprocedural PVC requiring drug infusion. The best predictor of infrequent PVC was number of hours with PVC count <120/h on Holter (area under the curve 0.80, sensitivity 83.9{\%}, specificity 74.3{\%}, for ≥2 h). Only F-HR-PVC patients responded to isoproterenol. Isoproterenol washout or phenylephrine infusion was successful for the 3 S-HR-PVC patients, and no drug could increase PVC frequency in the 12 I-HR-PVC patients. Long-term RFA success rate in patients with frequent PVCs at baseline (82.9{\%}) was similar to those with infrequent PVC who responded to a drug (77.8{\%}; P = .732) but significantly higher than for those who did not respond to any drug (15.4{\%}; P <.0001). Conclusion: A simple analysis of Holter PVC circadian variability provides incremental value to guide pharmacologic induction of PVCs during RFA and predict outcome. Patients with infrequent I-HR-PVC had the least successful outcomes from RF ablation.",
keywords = "Autonomic nervous system, Circadian profile, Isoproterenol, Premature ventricular complexes, Radiofrequency ablation",
author = "David Hamon and Guillaume Abehsira and Kai Gu and Albert Liu and {Blaye-Felice Sadron}, Marie and Sophie Billet and Thomas Kambur and Swid, {Mohammed Amer} and Boyle, {Noel G.} and Gopi Dandamudi and Philippe Maury and Minglong Chen and John Miller and Nicolas Lellouche and Kalyanam Shivkumar and Bradfield, {Jason S.}",
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AU - Hamon, David

AU - Abehsira, Guillaume

AU - Gu, Kai

AU - Liu, Albert

AU - Blaye-Felice Sadron, Marie

AU - Billet, Sophie

AU - Kambur, Thomas

AU - Swid, Mohammed Amer

AU - Boyle, Noel G.

AU - Dandamudi, Gopi

AU - Maury, Philippe

AU - Chen, Minglong

AU - Miller, John

AU - Lellouche, Nicolas

AU - Shivkumar, Kalyanam

AU - Bradfield, Jason S.

PY - 2017

Y1 - 2017

N2 - Background: Infrequent intraprocedural premature ventricular complexes (PVCs) may impede radiofrequency catheter ablation (RFA) outcome, and pharmacologic induction is unpredictable. Objective: The purpose of this study was to determine whether PVC circadian variation could help predict drug response. Methods: Consecutive patients referred for RFA with detailed Holter monitoring and frequent monomorphic PVCs were included. Patients were divided into 3 groups based on hourly PVC count relationship to corresponding mean heart rate (HR) during each of the 24 hours on Holter: fast-HR-dependent PVC (F-HR-PVC) type for a positive correlation (Pearson, P <.05), slow-HR-dependent PVC (S-HR-PVC) type for a negative correlation, and independent-HR-PVC (I-HR-PVC) when no correlation was found. Results: Fifty-one of the 101 patients (50.5%) had F-HR-PVC, 39.6% I-HR-PVC, and 9.9% S-HR-PVC; 30.7% had infrequent intraprocedural PVC requiring drug infusion. The best predictor of infrequent PVC was number of hours with PVC count <120/h on Holter (area under the curve 0.80, sensitivity 83.9%, specificity 74.3%, for ≥2 h). Only F-HR-PVC patients responded to isoproterenol. Isoproterenol washout or phenylephrine infusion was successful for the 3 S-HR-PVC patients, and no drug could increase PVC frequency in the 12 I-HR-PVC patients. Long-term RFA success rate in patients with frequent PVCs at baseline (82.9%) was similar to those with infrequent PVC who responded to a drug (77.8%; P = .732) but significantly higher than for those who did not respond to any drug (15.4%; P <.0001). Conclusion: A simple analysis of Holter PVC circadian variability provides incremental value to guide pharmacologic induction of PVCs during RFA and predict outcome. Patients with infrequent I-HR-PVC had the least successful outcomes from RF ablation.

AB - Background: Infrequent intraprocedural premature ventricular complexes (PVCs) may impede radiofrequency catheter ablation (RFA) outcome, and pharmacologic induction is unpredictable. Objective: The purpose of this study was to determine whether PVC circadian variation could help predict drug response. Methods: Consecutive patients referred for RFA with detailed Holter monitoring and frequent monomorphic PVCs were included. Patients were divided into 3 groups based on hourly PVC count relationship to corresponding mean heart rate (HR) during each of the 24 hours on Holter: fast-HR-dependent PVC (F-HR-PVC) type for a positive correlation (Pearson, P <.05), slow-HR-dependent PVC (S-HR-PVC) type for a negative correlation, and independent-HR-PVC (I-HR-PVC) when no correlation was found. Results: Fifty-one of the 101 patients (50.5%) had F-HR-PVC, 39.6% I-HR-PVC, and 9.9% S-HR-PVC; 30.7% had infrequent intraprocedural PVC requiring drug infusion. The best predictor of infrequent PVC was number of hours with PVC count <120/h on Holter (area under the curve 0.80, sensitivity 83.9%, specificity 74.3%, for ≥2 h). Only F-HR-PVC patients responded to isoproterenol. Isoproterenol washout or phenylephrine infusion was successful for the 3 S-HR-PVC patients, and no drug could increase PVC frequency in the 12 I-HR-PVC patients. Long-term RFA success rate in patients with frequent PVCs at baseline (82.9%) was similar to those with infrequent PVC who responded to a drug (77.8%; P = .732) but significantly higher than for those who did not respond to any drug (15.4%; P <.0001). Conclusion: A simple analysis of Holter PVC circadian variability provides incremental value to guide pharmacologic induction of PVCs during RFA and predict outcome. Patients with infrequent I-HR-PVC had the least successful outcomes from RF ablation.

KW - Autonomic nervous system

KW - Circadian profile

KW - Isoproterenol

KW - Premature ventricular complexes

KW - Radiofrequency ablation

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