title: Impact of QRS duration of frequent premature ventricular complexes on the development of cardiomyopathy.
abstract: BACKGROUND
  Patients with frequent premature ventricular complexes (PVCs) are at risk of developing reversible PVC-induced cardiomyopathy (rPVC-CMP). Not all determinants of rPVC-CMP are known.
  
  
  OBJECTIVE
  To assess the impact of the QRS duration of PVCs on the development of rPVC-CMP.
  
  
  METHODS
  In a consecutive series of 294 patients with frequent idiopathic PVCs referred for PVC ablation, the width of the PVC-QRS complex was assessed. The QRS width was correlated with the presence of rPVC-CMP.
  
  
  RESULTS
  The PVC-QRS width was significantly greater in patients with rPVC-CMP than in patients without rPVC-CMP (164 ± 20 ms vs 149 ± 17 ms; P < .0001). The site of origin of the PVC had an impact on the PVC-QRS width, with epicardial PVCs having the broadest QRS complexes. Patients with PVCs originating from the right ventricular outflow tract or the fascicles had the narrowest QRS complexes. After adjusting for PVC burden, symptom duration, and PVC site of origin, PVC-QRS width and an epicardial PVC origin were independently associated with rPVC-CMP. Based on receiver operator characteristics analysis, a QRS duration of >150 ms best differentiated patients with and without rPVC-CMP (area under the curve 0.66; sensitivity 80%; specificity 52%). The PVC burden for developing rPVC-CMP is significantly lower in patients with a PVC-QRS width of ≥150 ms than in patients with a narrower PVC-QRS complex (22% ± 13% vs 28% ± 12%; P < .0001).
  
  
  CONCLUSIONS
  Broader PVCs and an epicardial PVC origin are associated with the development of rPVC-CMP independent of the PVC burden.
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA.
authors.forename: Miki
authors.initials: M
authors.lastname: Yokokawa
authors.forename: Hyungjin Myra
authors.initials: HM
authors.lastname: Kim
authors.forename: Eric
authors.initials: E
authors.lastname: Good
authors.forename: Thomas
authors.initials: T
authors.lastname: Crawford
authors.forename: Aman
authors.initials: A
authors.lastname: Chugh
authors.forename: Frank
authors.initials: F
authors.lastname: Pelosi
authors.forename: Krit
authors.initials: K
authors.lastname: Jongnarangsin
authors.forename: Rakesh
authors.initials: R
authors.lastname: Latchamsetty
authors.forename: William
authors.initials: W
authors.lastname: Armstrong
authors.forename: Craig
authors.initials: C
authors.lastname: Alguire
authors.forename: Hakan
authors.initials: H
authors.lastname: Oral
authors.forename: Fred
authors.initials: F
authors.lastname: Morady
authors.forename: Frank
authors.initials: F
authors.lastname: Bogun
mesh_terms: D018780:Body Surface Potential Mapping / Q000379:methods; D009202:Cardiomyopathies / Q000209:etiology* / Q000473:pathology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left; D018879:Ventricular Premature Complexes / Q000150:complications* / Q000473:pathology