title: Ventricular premature depolarization QRS duration as a new marker of risk for the development of ventricular premature depolarization-induced cardiomyopathy.
abstract: BACKGROUND
  Frequent ventricular premature depolarizations (VPDs) can cause cardiomyopathy (CMP). The mechanisms underlying its development remain unclear, with VPD burden being only a weak predictor of risk.
  
  
  OBJECTIVE
  To determine whether VPD QRS duration at the time of initial presentation could predict risk for the subsequent development of CMP in patients with normal left ventricular ejection fraction (LVEF).
  
  
  METHODS
  From consecutive patients referred for ablation between January 1, 2006, and April 2, 2013, with ≥10% VPDs on 24-hour Holter monitoring, we identified 45 patients with normal LVEF and an electrocardiogram of the targeted VPD, who were then followed for at least 6 months (median 14 months; interquartile range [IQR] 8-32 months) before intervention. We excluded patients with structural or genetic heart disease.
  
  
  RESULTS
  Of the 45 patients, 28 (62%) maintained normal LVEF and 17(38%) developed VPD-induced CMP. VPD burden was similar (26.5% [IQR 19.3%-39.5%] vs 26.0% [IQR 16.4%-41.0%]; P = 0.4) between the 2 groups. Patients who developed VPD-induced CMP had significantly longer VPD QRS duration (159 ms vs 142 ms; P < .001) and a longer sinus QRS duration (97 ms vs 89 ms; P = .04). A VPD QRS duration of ≥153 ms best predicted development of VPD CMP (82% sensitivity and 75% specificity). Longer VPD QRS duration and a non-outflow tract site of VPD origin were independent risk factors for left ventricular dysfunction after multivariate analysis.
  
  
  CONCLUSIONS
  VPD QRS duration longer than 153 ms and a non-outflow tract site of origin might be useful predictors of the subsequent development of VPD-induced CMP.
authors.affiliation: Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Lidia
authors.initials: L
authors.lastname: Carballeira Pol
authors.affiliation: Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Marc W
authors.initials: MW
authors.lastname: Deyell
authors.affiliation: Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David S
authors.initials: DS
authors.lastname: Frankel
authors.affiliation: Cardiology Department, Pasteur University Hospital, Nice, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Benhayon
authors.affiliation: Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Cardiology Department, Pasteur University Hospital, Nice, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Squara
authors.affiliation: Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: William
authors.initials: W
authors.lastname: Chik
authors.affiliation: Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Maria
authors.initials: M
authors.lastname: Kohari
authors.affiliation: Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Rajat
authors.initials: R
authors.lastname: Deo
authors.affiliation: Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: francis.marchlinski@uphs.upenn.edu.
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
mesh_terms: D009202:Cardiomyopathies / Q000209:etiology*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012306:Risk; D013318:Stroke Volume; D013997:Time Factors; D018879:Ventricular Premature Complexes / Q000150:complications* / Q000503:physiopathology
keywords: CMP; Cardiomyopathy; ECG; EF; Electrocardiogram; IQR; LV; LVEDD; LVEF; MRI; VPD; Ventricular arrhythmia; Ventricular outflow tract; Ventricular premature depolarizations; cardiomyopathy; ejection fraction; electrocardiogram; interquartile range; left ventricle/ventricular; left ventricular ejection fraction; left ventricular end-diastolic diameter; magnetic resonance imaging; ventricular premature depolarization