Key result
In a large registry of CRT-D patients, 11% presented a high premature ventricular contraction count (≥200 PVC/h), yet 79% of these patients received no therapeutic action to reduce the PVC burden.
Why the study?
PVCs reduce the percentage of BiV pacing and clinical response in CRT patients, but the prevalence of a high PVC burden and subsequent therapeutic actions in CRT-D recipients required evaluation.
What is the prevalence of high PVC burden and the frequency of therapeutic action in patients with a CRT-D device?
Observational (n=1,268)
Yes
What is the prevalence of high PVC burden and the frequency of therapeutic action in patients with a CRT-D device?
Answers are grounded in this paper and cite their sources.
A significant proportion of CRT-D patients experience high PVC burdens, but few receive targeted treatment, highlighting a potential gap in optimizing biventricular pacing.
BACKGROUND: Premature ventricular contractions (PVC) are known to reduce the percentage of biventricular (BiV) pacing in patients with cardiac resynchronization (CRT), decreasing the clinical response. The aim of this study was to evaluate the prevalence of a high PVC burden, as well as therapeutic action (pharmacotherapy, catheter ablation or device programming), in a large CRT implantable-defibrillator (CRT-D) population. METHODS: Patients with a CRT-D device from the UMBRELLA multicenter prospective remote monitoring registry were included. The PVC count was collected from each remote monitoring transmission. Patients were divided into two high (≥1 transmission ≥200/≥400 PVC/h, respectively) and one low (all transmissions <200 PVC/h) PVC count groups. The PVC burden following a high PVC count transmission was calculated. RESULTS: Of 1268 patients, 135 (11%) and 43 (3.4%) presented high PVC count (≥200/≥400 PVC/h, respectively). The majority of patients in the high PVC groups were not treated (61 [79%] and 32 [74%], respectively. Considering the untreated patients in the high PVC groups, median PVC/h was 199 (interquartile range [IQR]: 196) and 271 (IQR: 330), respectively. The PVC burden (proportion of time with PVC/h ≥ 200/≥400) was 40% (IQR 70) and 29% (IQR 59), respectively. CONCLUSION: A significant proportion of CRT-D patients presented a high PVC count, however, few received treatment. In the untreated patients with a high PVC count, the PVC burden during follow-up varied substantially. Several consecutive recordings of a high PVC count should be warranted before considering therapeutic action such as catheter ablation.
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Åkerström et al. (2020) conducted an observational in Heart failure with CRT-D device (n=1,268). High PVC count (≥200 PVC/h) vs. Low PVC count (<200 PVC/h) was evaluated on Prevalence of high PVC count (≥200 PVC/h). In a large registry of CRT-D patients, 11% presented a high premature ventricular contraction count (≥200 PVC/h), yet 79% of these patients received no therapeutic action to reduce the PVC burden.
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