Performance of cardiac implantable electronic devices in detecting premature ventricular contraction burden

BACKGROUND: Frequent premature ventricular contractions (PVCs) can cause or exacerbate cardiomyopathy. At-risk patients often have cardiac implantable electronic devices (CIEDs) for treating bradycardia or ventricular arrhythmias. Many modern CIEDs also collect objective data about arrhythmias, including PVCs. However, the performance of CIEDs for quantifying PVC burden remains unclear. OBJECTIVE: This study aimed to determine the performance of CIEDs for quantifying PVC burden compared with ambulatory cardiac monitoring, which is the standard of care. METHODS: We identified adult patients at Vanderbilt University Medical Center with CIEDs who underwent concurrent ambulatory cardiac monitoring with Holter or mobile cardiac telemetry. Patients who received PVC ablations or antiarrhythmic medication changes during the CIED interrogation period of interest were excluded. The study population included a total of 439 patients and 571 instances of concurrent device monitoring. We then developed ordinal regression models to investigate the differences in detected PVC burdens between the 2 device groups. RESULTS: The median PVC burden detected by ambulatory monitoring and CIED was 1.90% (Q1-Q3, 0.10%-9.65%) and 0.61% (Q1-Q3, 0.02%-4.36%), respectively. In general, PVC burden detected by CIED underestimated that detected by ambulatory monitoring. Furthermore, when the PVC burden detected by the ambulatory monitor is ≥15%, the probability of a CIED also detecting a burden of ≥15% is approximately 11%. CONCLUSION: CIEDs underestimate PVC burden compared with ambulatory cardiac monitoring. Clinicians should not solely rely on PVC data from CIEDs to rule out a clinically relevant PVC burden.