Premature Ventricular Contraction Location and Incident Heart Failure

BACKGROUND: The anatomical distribution of spontaneous ventricular ectopy and the risk of heart failure associated with premature ventricular contraction (PVC) location has not been studied outside the narrow group of individuals presenting for arrhythmia-related clinical care. OBJECTIVES: This study sought to describe the epidemiology of PVC site of origin and to determine whether PVC anatomical location is independently associated with incident heart failure risk. METHODS: Ambulatory adults without prevalent heart failure were identified from the CHS (Cardiovascular Health Study) and the ARIC (Atherosclerosis Risk in Communities Study) cohorts. Anatomical PVC location was assessed by 2 expert reviewers using baseline 12-lead electrocardiogram (ECG) morphology. RESULTS: Among 20,590 participants, 427 (2.1%) demonstrated at least 1 PVC on baseline ECG. Ventricular ectopy was localized to the left ventricle in 49% of participants, outflow tract in 27%, right ventricle in 22%, and epicardium in 2%. Over a mean follow-up of 19.2 years, ventricular ectopy on baseline ECG was associated with an increased adjusted risk of heart failure (HR: 1.43; 95% CI: 1.20 to 1.70; P < 0.001). Adjusted risk of incident heart failure was highest for PVCs arising from the epicardium (HR: 2.98; 95% CI: 1.12 to 7.95; P = 0.029) and the left ventricle (HR: 1.59; 95% CI: 1.30 to 1.94; P < 0.001). CONCLUSIONS: In a large population-based cohort, ventricular ectopy was most frequently localized to the left ventricle. Individuals with ectopy arising from the left ventricle and from epicardial locations experienced a higher likelihood of incident heart failure compared with those without PVCs or those with PVCs from other locations.