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 M. Miller, Nicolas Lellouche, Kalyanam Shivkumar, Jason S. Bradfield

Research output: Contribution to journalArticle

9 Scopus citations

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)
Pages (from-to)99-106
Number of pages8
JournalHeart Rhythm
Volume15
Issue number1
DOIs
StatePublished - Jan 2018

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Fingerprint Dive into the research topics of 'Circadian variability patterns predict and guide premature ventricular contraction ablation procedural inducibility and outcomes'. Together they form a unique fingerprint.

  • Cite this

    Hamon, D., Abehsira, G., Gu, K., Liu, A., Blaye-Felice Sadron, M., Billet, S., Kambur, T., Swid, M. A., Boyle, N. G., Dandamudi, G., Maury, P., Chen, M., Miller, J. M., Lellouche, N., Shivkumar, K., & Bradfield, J. S. (2018). Circadian variability patterns predict and guide premature ventricular contraction ablation procedural inducibility and outcomes. Heart Rhythm, 15(1), 99-106. https://doi.org/10.1016/j.hrthm.2017.07.034