Key result
Higher heart rate variability LF/HF ratio independently predicted right versus left ventricular outflow tract PVC origin (OR 5.74, 95% CI 1.88-17.55, p=0.002; AUC 0.75).
Why the study?
Heart rate variability is linked to premature ventricular complexes, but its role in patients with frequent premature ventricular complexes originating from the ventricular outflow tract remains unclear.
Does 24-hour Holter heart rate variability (specifically the LF/HF ratio) differ in patients with frequent outflow tract PVCs compared to healthy controls and distinguish RVOT from LVOT originating foci?
Case-Control (n=212)
Yes
Does 24-hour Holter heart rate variability (specifically the LF/HF ratio) differ in patients with frequent outflow tract PVCs compared to healthy controls and distinguish RVOT from LVOT originating foci?
Patients with frequent outflow tract PVCs have impaired heart rate variability compared to healthy controls, and an elevated LF/HF ratio (≥1.795) on 24-hour Holter monitoring serves as an independent, non-anatomical predictor to help distinguish RVOT from LVOT PVC origin prior to catheter ablation.
BACKGROUND: As an indicator of cardiac autonomic nervous activity, heart rate variability (HRV) is closely linked to premature ventricular complexes (PVCs). However, its role in patients with frequent PVCs originating from the ventricular outflow tract remains unclear. HYPOTHESIS: Here, we hypothesize that there may be alterations in HRV among patients with frequent PVCs originating from the ventricular outflow tract, which could play significant roles in the management of such patients. METHODS: A retrospective study was conducted, including 106 patients with frequent outflow tract PVCs and 106 healthy participants as controls. HRV was assessed based on the 24-hour Holter recording. The originating foci of PVCs were identified during radiofrequency catheter ablation. RESULTS: Patients with frequent outflow tract PVCs exhibited decreased levels of high frequency (HF), standard deviation of all NN intervals, and standard deviation of the average NN intervals, but increased ratios of low frequency to HF (LF/HF ratio), even after propensity score-matched analysis. Further investigation revealed that patients with PVCs originating from right ventricular outflow tract (RVOT) had much higher LF/HF ratios. Multivariate logistic regression analysis demonstrated that the LF/HF ratio was independently associated with PVCs originating from RVOT. Receiver operating characteristics curve indicated that the LF/HF ratio effectively determined the origin of PVCs (the area under the curve = 0.75, p < .001). CONCLUSIONS: Patients with frequent outflow tract PVCs exhibited impaired HRV. Additionally, the LF/HF ratio played a significant role in determining the origin of outflow tract PVCs.
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Zhang et al. (2023) conducted a case-control in Frequent idiopathic ventricular outflow tract premature ventricular complexes (OT-PVCs) (n=212). Heart rate variability LF/HF ratio vs. Healthy controls (and LVOT-PVC origin vs RVOT-PVC origin) was evaluated on Right ventricular outflow tract (RVOT) origin of premature ventricular complexes vs left ventricular outflow tract (LVOT) origin (OR 5.74, 95% CI 1.88-17.55, p=0.002). Higher heart rate variability LF/HF ratio independently predicted right versus left ventricular outflow tract PVC origin (OR 5.74, 95% CI 1.88-17.55, p=0.002; AUC 0.75).
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