The relationship between symptoms and QRS duration in patients with idiopathic ventricular premature complex

Abstract

Aim: Premature ventricular complexes are one of the most common arrhythmias and, when not treated, can cause serious complications such as dilated cardiomyopathy and ventricular tachycardia. In our study, we investigated the relationship between QRS duration and symptoms in patients with idiopathic premature ventricles complex (IPVC). Material and Methods: This is a multicenter, cross-sectional study involving 242 consecutive patients with more than 1,000 idiopathic PVC and normal QRS duration in 24-hour Holter follow-up who attended cardiology clinics in 18 different centers between January 2019 and May 2019. The relationship between the QRS durations was investigated by dividing the patients into 2 groups as symptomatic (n: 128) and asymptomatic (n: 114). Result: The average age of 242 patients was 51 ± 13 and 52.4% (127) of them were male patients. In the symptomatic IPVC group, sinus QRS duration, PVC QRS duration, coupling interval, and prematurity index were statistically significantly higher than the asymptomatic IPVC group. In the multivariate logistic regression analysis, a significant relationship was found between the sinus QRS duration (odds ratio (OR) = 1.3, 95% confidence interval (CI) = 1.01-1.05, p = 0.002) and symptoms in patients with IPVC. In the ROC analysis performed to show the power of sinus QRS duration in predicting symptoms in patients with IPVC, Area Under Curve (AUC) value was found as = 0.547 95% CI: 0.454-0.640, p = 0.320 (Figure 1). Conclusion: In patients with IPVC; The prolonged sinüs QRS duration was found to be superior to other parameters in patients being symptomatic.

Keywords

• Idiopathic premature ventricular complex
• coupling interval
• QRS time

Idyopatik ventriküler prematür komplexli hastalarda semptomlar ile QRS zamanı arasındaki ilişki

Abstract

Amaç: Prematüre ventriküler kompleksler (PVC' ler) en sık karşılaşılan aritmilerden biridir ve tedavi edilmediğinde dilate kardiyomyopati, ventriküler taşikardi gibi ciddi komplikasyonlara neden olmaktadır. Çalışmamızda İdiopatik premature ventrikeler komplexi (IPVC) olan hastalarda QRS süresi ile semptom arasındaki ilişkiyi araştırdık. Gereç ve yöntem: Ocak 2019 ile Mayıs 2019 tarihleri arasında on dokuz farklı merkezde kardiyoloji kliniklerine başvuran 24 saatlik holter izleminde 1.000'den fazla idiyopatik PVC'si ve normal QRS süresi olan 242 ardışık hastanın dahil edildiği çok merkezli, kesitsel bir çalışmadır. Hastaların semptomlarına göre semptomatik (n: 128) ve asemptomatik (n:114) olarak 2 gruba ayrılarak QRS süreleri arasındaki ilişki araştırıldı. Bulgular: 242 hastanın yaş ortalaması 51±13’ di ve %52,4 (127)’ ü erkek cinsiyetteki hastalardan oluşmaktaydı. Semptomatik IPVC grubunda asemptomatik IPVC gruba göre sinüs QRS süresi, PVC QRS süresi, coupling intervali ve prematürite indexi istatiksel anlamlılıkla daha yüksekti. Yapılan multivariete lojistik regresyon analizinde IPVC’ li hastalarda sinüs QRS süresi ile (odds ratio (OR) = 1.3, 95% confidence interval (CI) = 1.01-1.05, p=0.002) semptom arasında anlamlı ilişki saptandı. IPVC'li hastalarda sinüs QRS süresinin semptomları öngörmedeki gücünü göstermek için yapılan ROC analizinde Area Under Curve (AUC) değeri = 0,547 %95 GA: 0.454-0.640, p = 0.320 olarak saptandı (Şekil 1). Sonuç: IPVC’ li hastalarda; uzamış sinus QRS süresi olması hastaların semptomatik olmasında diğer parametrelerden daha üstün saptanmıştır

Keywords

• Idiopathic premature ventricular complex
• coupling interval
• QRS time

References

1. 1. Conti CR. Ventricular arrhythmias: a general cardiologist’s assessment of therapies in 2005. Clin Cardiol 2005; 28: 314 –6.
2. 2. Pytkowski M, Maciag A, Jankowska A, Kowalik I, Kraska A, Farkowski MM, Golicki D, Szwed H. Quality of life improvement after radiofrequency catheter ablation of outflow tract ventricular arrhythmias in patients with structurally normal heart. Acta Cardiol 2012; 67: 153–9.
3. 3. Chugh SS, Shen W, Luria DM, Smith HC. First evidence of premature ventricular complex-induced cardiomyopathy: a potentially reversible cause of heart failure. J Cardiovasc Electrophysiol 2000; 11: 328–9.
4. 4. Kyoung-Min Park, Sung Il Im, Kwang Jin Chun, Jin Kyung Hwang, Seung-Jung Park, June Soo Kimet al Coupling Interval Ratio Is Associated with Ventricular Premature Complex-Related Symptoms. Korean Circulation Journal 2015; 45: 294-300
5. 5. Kamakura S, Shimizu W, Matsuo K, Taguchi A, Suyama K, Kurita T, Aihara N, Ohe T, Shimomura K: Localization of optimal ablation site of idiopathic ventricular tachycardia from right and left ventricular outflow tract by body surface ECG. Circulation 1998; 98: 1525-33.
6. 6. Enriquez, A., Baranchuk, A., Briceno, D., Saenz, L., & Garcia, F. [2019]. How to use the 12‐lead ECG to predict the site of origin of idiopathic ventricular arrhythmias. Heart Rhythm 2019; 16: 1538-44.
7. 7. Lang RM, Bierig M, Devereux RB et al. Recommendations for chamber quantification: A report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. Journal of the American Society of Echocardiography 2005; 18: 1440–63.
8. 8. Baser K, Bas HD, LaBounty T et al. Recurrence of PVCs in patients with PVC‐ induced cardiomyopathy. Heart Rhythm: the Official Journal of the Heart Rhythm Society 2015; 12: 1519–23.

9. 9. Von Rotz M, Aeschbacher S, Bossard M, Schoen T, Blum S, Schneider Conen D. Risk factors for premature ventricular contractions in young and healthy adults. Heart 2017; 103: 702–707.
10. 10. Stewart RA, Young AA, Anderson C, Teo KK, Jennings G, Cowan BR. Relationship between QRS duration and left ventricular mass and volume in patients at high cardiovascular risk. Heart 2011; 97: 1766–1770.
11. 11. Chan DD, Wu KC, Loring Z et al. Comparison of the Relation BetweenLeft Ventricular Anatomy and QRS Duration in Patients With Cardiomyopathy With Versus Without Left Bundle Branch Block. Am J Cardiol 2014; 113: 1717–22.
12. 12. Hakacova N, Steding K, Engblom H, Sjögren J, Maynard C, Pahlm O. Aspects of Left Ventricular Morphology Outperform Left Ventricular Mass for Prediction of QRS Duration. Ann Noninvasive Electrocardiol 2010; 15: 124–129.
13. 13. Bacharova L, Szathmary V, Svehlikova J, Mateasik A, Gyhagen J, Tysler M. The effect of conduction velocity slowing in left ventricular midwall on the QRS complex morphology: a simulation study. J Electrocardiol 2016; 49: 164–170.
14. 14. Roberts WC, Filardo G, Ko JM et al. Comparison of Total 12-Lead QRS Voltage in a Variety of Cardiac Conditions and Its Usefulness in Predicting Increased Cardiac Mass. Am J Cardiol 2013; 112: 904–9.
15. 15. Fagard RH, Staessen JA, Thijs L et al. Prognostic Significance of Electrocardiographic Voltages and Their Serial Changes in Elderly With Systolic Hypertension. Hypertension 2004; 44: 459–64.
16. 16. Bacharova L, Szathmary V, Kovalcik M, Mateasik A. Effect of changes in left ventricular anatomy and conduction velocity on the QRS voltage and morphology in left ventricular hypertrophy: a model study. J Electrocardiol 2010; 43: 200–8.
17. 17. Chan C-P, Zhang Q, Yip GW-K et al. Relation of Left Ventricular Systolic Dyssynchrony in Patients With Heart Failure to Left Ventricular Ejection Fraction and to QRS Duration. Am J Cardiol 2008; 102: 602–5.
18. 18. Bleeker GB, Schalij MJ, Molhoek SG et al. Relationship Between QRS Duration and Left Ventricular Dyssynchrony in Patients with EndStage Heart Failure. J Cardiovasc Electrophysiol 2004; 15: 544–9.
19. 19. Niu H, Hua W, Zhang S et al. Prevalence of Dyssynchrony Derived from Echocardiographic Criteria in Heart Failure Patients with Normal or Prolonged QRS Duration. Echocardiography 2007; 24: 348–352.
20. 20. Bleeker GB, Schalij MJ, Molhoek SG et al. Frequency of left ventricular dyssynchrony in patients with heart failure and a narrow QRS complex. Am J Cardiol 2005; 95: 140–2.
21. 21. Cho G-Y, Song J-K, Park W-J et al. Mechanical Dyssynchrony Assessed by Tissue Doppler Imaging Is a Powerful Predictor of Mortality in Congestive Heart Failure With Normal QRS Duration. J Am Coll Cardiol 2005; 46: 2237–43.
22. 22. Yu C-M, Yang HUA, Lau C-P et al. Regional Left Ventricle Mechanical Asynchrony in Patients with Heart Disease and Normal QRS Duration. Pacing Clin Electrophysiol 2003; 26: 562–70.