Download QRS-duration of premature ventricular contractions relates to

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QRS duration of premature ventricular
contractions relates to
serious arrhythmic events in patients
with outflow tract arrhythmia
Øyvind H. Lie, Jørg Saberniak, Lars A. Dejgaard, Finn Hegbom,
Ole-Gunnar Anfinsen, Thor Edvardsen, Kristina H. Haugaa
Dept. of Cardiology and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, and
Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Background



When structural heart disease is excluded,
premature ventricular contractions (PVCs)
an ventricular tachycardia (VT) originating
from the outflow tracts (OT) are
considered benign
However, some patients with outflow
tract arrhythmia (OTA) experience serious
arrhythmic events
The origin of PVCs may have impact on
the severity of arrhythmia


A RVOT free wall PVC origin is suggested by a
QRS ratio ≥ 1.9
No means of risk stratification exists
Aim
 To study the relationship between serious
arrhythmic events and
electrocardiographic indices in patients
with OTA, aiming to identify characteristics
associated with an adverse outcome
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Methods
 OTA was defined on 12lead ECGs
 QRS ratio and PVC
morphology were
assessed to suggest the
origin of ectopy, and
categorized as RVOT free
wall or septal RVOT
 Serious arrhythmic events
were defined as sustained
VT requiring acute medical
attention and/or true
syncope
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Results
Table: Characteristics of 52 patients with outflow tract arrhythmia, without and with serious arrhythmic events. Values are mean ± SD unless otherwise stated. P-values are
calculated by unpaired student t-test when appropriate. §Median (range), compared by Mann-Whitney U test. BSA = body surface area; EF = left ventricular ejection fraction; GLS
= left ventricular global longitudinal strain; LVIDd = left ventricular internal diameter in diastole; PVC = premature ventricular contractions; RVOT = right ventricular outflow tract
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Results

The QRS ratio optimally recognized
subjects with events when > 1.76
(AUC 0.86, p<0.001)
 A QRS ratio of more than 1.9, associated with a
RVOT free wall PVC origin, was more frequently
observed in patients with events (p<0.001)
 7 of 9 patients with RVOT free wall morphology had
serious events (vs. 4 of 41 with septal RVOT morphology)
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Conclusion
 Although OTA is considered a benign condition, one fifth of
referred patients had serious arrhythmic events
 these patients more frequently had a RVOT free wall PVC origin
 The increased QRS ratio associated with a RVOT free wall
PVC origin may represent a more malignant phenotype of
OTA
E-mail: [email protected]
Disclosures: None