title: A New Combined Parameter to Predict Premature Ventricular Complexes Induced Cardiomyopathy: Impact and Recognition of Epicardial Origin.
abstract: Reversible premature ventricular complexes-induced cardiomyopathy (PVC-CMP) is a well-described, multi-factorial entity. Single predictors, such as PVC burden or QRS duration, may not apply equally to all patients in contemporary unselected populations including patients with structural heart disease (SHD) or with particular origin such as epicardial (EPI) PVC. We sought to evaluate clinical criteria associated with PVC-CMP notably focusing on the EPI origin impact and ECG recognition and the value of a new composite predictor of PVC-CMP, the PVC-CMP-Index.
  
  
  
  We studied 107 consecutive patients (69 men; mean age = 56 ± 16 years) with frequent PVC (23.1 ± 11.5%) referred for PVC ablation. Thirty-six patients (33.6%) had an underlying SHD and 25 patients (23.4%) an EPI PVC origin. After a mean follow-up of 22.7 ± 15.3 months, 72.9% achieved a long-term successful ablation and 54.2% had PVC-CMP. PVC-CMP prevalence was significantly higher in patients with an EPI compared to endocardial PVC focus (84.0% vs. 45.1%, respectively, P < 0.001). EPI PVC origin (OR = 68.7 IC95% [3.5-1363], P = 0.005), as well as SHD (OR = 12.3 IC95% [1.6-92.6], P = 0.015), was independent predictor of PVC-CMP. While PVC burden (AUC = 0.78) or PVC-QRS width (AUC = 0.68) independently predicted PVC-CMP, the PVC-CMP-Index (values ≥39) defined as: PVC burden (0-1) × PVC-QRS width (milliseconds) × a constant C (1.28 for SHD or 2 for ECG suggesting EPI origin based on our ECG 3-step algorithm), highly correlated with PVC-CMP (AUC = 0.91, sensitivity = 93%, specificity = 80%).
  
  
  
  We developed a new index, which incorporates PVC burden, QRS width, and presence of SHD or suspected EPI origin that best predicted PVC-CMP.
authors.affiliation: Federation de Cardiologie, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris and INSERM U955, Créteil, France.|UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
authors.forename: David
authors.initials: D
authors.lastname: Hamon
authors.affiliation: University Hospital Rangueil Toulouse, France.
authors.forename: Marie Sadron
authors.initials: MS
authors.lastname: Blaye-Felice
authors.affiliation: UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Bradfield
authors.affiliation: Federation de Cardiologie, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris and INSERM U955, Créteil, France.
authors.forename: Najia
authors.initials: N
authors.lastname: Chaachoui
authors.affiliation: UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
authors.forename: Roderick
authors.initials: R
authors.lastname: Tung
authors.affiliation: Gill Heart Institute and VAMC, Cardiology Division, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: Claude S
authors.initials: CS
authors.lastname: Elayi
authors.affiliation: UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
authors.forename: Marmar
authors.initials: M
authors.lastname: Vaseghi
authors.affiliation: Federation de Cardiologie, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris and INSERM U955, Créteil, France.
authors.forename: Tarvinder S
authors.initials: TS
authors.lastname: Dhanjal
authors.affiliation: UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
authors.forename: Noel G
authors.initials: NG
authors.lastname: Boyle
authors.affiliation: University Hospital Rangueil Toulouse, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Maury
authors.affiliation: UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
authors.forename: Kalyanam
authors.initials: K
authors.lastname: Shivkumar
authors.affiliation: Federation de Cardiologie, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris and INSERM U955, Créteil, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lellouche
mesh_terms: D000200:Action Potentials; D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D017115:Catheter Ablation; D016009:Chi-Square Distribution; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010496:Pericardium / Q000503:physiopathology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D018879:Ventricular Premature Complexes / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000601:surgery
keywords: ECG criteria; catheter ablation; coronary sinus; epicardial; induced cardiomyopathy; premature ventricular complexes