Risk Stratification in Patients with Frequent Premature Ventricular Complexes in the Absence of Known Heart Disease

Abstract Background Frequent premature ventricular complexes (PVCs) can be an indicator of structural heart disease. Objective The objective of this study was to determine the prevalence of scarring detected by cardiac magnetic resonance imaging (DE-CMR) in patients with frequent PVCs without apparent structural heart disease and to determine the value of programmed ventricular stimulation for risk stratification in patients with frequent PVCs and myocardial scarring. Methods DE-CMR imaging was performed in patients without apparent heart disease who had frequent PVCs and who were referred for ablation. In the presence of scarring, scar volume was measured and correlated with outcome variables. All patients underwent programmed ventricular stimulation (PVS) and were monitored for the occurrence of ventricular arrhythmias (VAs). Logistic regression was used to compare imaging and procedural findings with long term outcomes with adjustment for post-ablation ejection fraction (EF) Results The study consisted of 272 patients (135 males, mean age: 52±15 years, EF: 52±12%). DE-CMR scar was found in 67 (25%) patients and 7(3%) were found to have inducible ventricular tachycardia (VT). The presence and amount of DE-CMR was related to the risk of long term VT independent of EF (HR 18.8(2.0-176.6], P=0.01 and HR 1.4[1.1-1.7]/cm3 scar, p Conclusion Preprocedural cardiac DE-CMR and programmed ventricular stimulation can be used to identify patients with frequent PVCs without apparent heart disease who are at risk of VT.