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PVC non-benign role in heart failure
This paper just came out. The first study to quantify PVC frequency and heart failure. I had read elsewhere that the cutoff for being concerned about heart failure risk from PVC at around 20,000 pvc/day. That appears to be way too high. PVC role in heart failure is apparently as important as BMI, diabetes, coronary artery disease and high blood pressure. PVCs are certainly not benign and existing AAD meds are contraindicated for PVCs.
http://content.onlinejacc.org/article.aspx?articleID=2383167
http://content.onlinejacc.org/article.aspx?articleID=2383167
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Thanks for that. Link worked and it is a very convincing presentation from an expert that ought to know. I am glad I am a slow lap swimmer and even slower runner. I still may have to cut back a bit.
There's data on runners, Their mortality / morbidity rates decline until about 10 - 15 miles per week at 10 minute pace. More than this and the rate start to go back up. People that train 50+ miles per week have the same rates at smokers with diabetes.
Check this TED talk https://youtu.be/Y6U728AZnV0
If the link gets removed, google "ted talk james o keefe"
Check this TED talk https://youtu.be/Y6U728AZnV0
If the link gets removed, google "ted talk james o keefe"
Your EF is great and you sound really healthy so good for you. If you are in PA, then Callans and Marchlinski are great resources to have around if you decide to do something about your PVCs. There just aren't many EPs around that do ablations on those things. 50 procedures/yr is considered a lot and required to be included in clinical trials. Don't know if you saw the article on espn regarding endurance training and heart issues for some people. My sister emailed me after I shared it and mentioned many of her life guard friends that are into endurance training are having heart issues as they got older.
http://espn.go.com/sports/endurance/story/_/id/13386980/velonews-endurance-athletes-damaging-their-hearts
http://espn.go.com/sports/endurance/story/_/id/13386980/velonews-endurance-athletes-damaging-their-hearts
I've had various classifications of PVCs originating in my RVOT. This has been going on for 30 years, since i was about 17. I've gone up and down on frequency. I've had bigeminy for fixed periods, frequent (6,000 per day), coupled (couplets), exercise induced, recovery induced, which continues to change. all kinds of crap.
My LVEF continues to measure about 74% and has not changed. I am 47. I do not have any blockages or muscle abnormalities. My calcium score is 0. My BP is normal. I do not smoke. My BMI is good. My cholesterol is good. My resting pulse is between 45-72. I am currently in a lull but had a flare back in march. I was evaluated by two EPs and turned away because it would do more harm than good right now, and I do understand this and accept it. I hate them, they haunt me.
I have a friend of mine, very very similar. He runs marathons.
My LVEF continues to measure about 74% and has not changed. I am 47. I do not have any blockages or muscle abnormalities. My calcium score is 0. My BP is normal. I do not smoke. My BMI is good. My cholesterol is good. My resting pulse is between 45-72. I am currently in a lull but had a flare back in march. I was evaluated by two EPs and turned away because it would do more harm than good right now, and I do understand this and accept it. I hate them, they haunt me.
I have a friend of mine, very very similar. He runs marathons.
I believe your question should be directed towards is_something_wrong, I didn't bring up Lown's scale.
From EM journal - Lown's scale for classification purposes, I assume when an EM/ER worker has to communicate with ER doctor during an acute event.
Grade 0 = No premature beats
Grade 1 = Occasional ( 30 per hour)
Grade 3 = Multiform
Grade 4 = Repetitive (A = Couplets, B = Salvos of = or > 3)
Grade 5 = R-on-T
How is this relevant to any long term study on the role of PVCs in heart failure when the volunteers are healthy at the start of the study?
Grade 0 = No premature beats
Grade 1 = Occasional ( 30 per hour)
Grade 3 = Multiform
Grade 4 = Repetitive (A = Couplets, B = Salvos of = or > 3)
Grade 5 = R-on-T
How is this relevant to any long term study on the role of PVCs in heart failure when the volunteers are healthy at the start of the study?
In your experience, what type(s) do you have and what does the distribution look like? Is it stable or does it change?
Add R/T and runs too, and you will get more than 30 combinations. Lown's scale sure have some weaknesses.
Anyway, it's only used to tell the severity of PVCs after a heart attack.
Anyway, it's only used to tell the severity of PVCs after a heart attack.
p.s., "frequent" then has sub categories of Bigeminy, Trigeminy, and Quadrageminy.
And I didn't even get into origin (RVOT, Junctional, posterior bundle,...)
All of these various types factor into the analysis of what's going on, and this analysis will lead to all sorts of different prognoses, etiology, and treatment.
Someone could have infrequent, unifocal, isolated PVCs originating in the RVOT which has a much different prognosis than someone with frequent coupled PVCs, with bigeminy, originating in the left apex.
Again, you are grouping these into one big bucket and that's not possible. It's over simplistic. perhaps the data correlates but there are other studies to refute it when analyzed at a more granular level.
And I didn't even get into origin (RVOT, Junctional, posterior bundle,...)
All of these various types factor into the analysis of what's going on, and this analysis will lead to all sorts of different prognoses, etiology, and treatment.
Someone could have infrequent, unifocal, isolated PVCs originating in the RVOT which has a much different prognosis than someone with frequent coupled PVCs, with bigeminy, originating in the left apex.
Again, you are grouping these into one big bucket and that's not possible. It's over simplistic. perhaps the data correlates but there are other studies to refute it when analyzed at a more granular level.
Frequent
infrequent
isolated
coupled
frequent-coupled
infrequent-coupled
then add unifocal or multifocal to each of those, so there's about 12,
infrequent
isolated
coupled
frequent-coupled
infrequent-coupled
then add unifocal or multifocal to each of those, so there's about 12,
Re the 10 different types of PVCs. Can you provide a reference or link. I want to learn more about that. Thanks.
Not origin, PVC type. There are about 10 different categories for PVCs. Does the study tease that apart or group everything into one big bucket? Does the study account for co-morbidity like diabetes?
RE - PACs
There is another manuscript under review by the same authors to address PACs and stroke related event risks over a long time period. They are looking at data from the CHS cohort too. The abstract and paper are not yet available. I will start a new subject when that becomes available. Judging by what's in the title "Wolf in Sheep's Clothing" it will not be good news either. When it rains ......
There was already some fore warning of this in the Danish registry - Copenhagen Holter Study.
There is another manuscript under review by the same authors to address PACs and stroke related event risks over a long time period. They are looking at data from the CHS cohort too. The abstract and paper are not yet available. I will start a new subject when that becomes available. Judging by what's in the title "Wolf in Sheep's Clothing" it will not be good news either. When it rains ......
There was already some fore warning of this in the Danish registry - Copenhagen Holter Study.
In the paper, PVC is measured by 24 hr Holter and PVC frequency is based upon that. The authors looked at frequency of PVC as an independent variable and not anything else. The volunteers all had healthy hearts and normal ejection fractions to start in 1989. And if they had PVCs, they were asymptomatic or else they would not be in the CHS cohort. You either accept their starting approach or you don't. Are you saying they should have done their analysis differently depending on where the PVC's are located? I don't know if they gathered that data for the folks that didn't end up in heart failure but still had PVCs. What they found though was that there was NO arbitrary threshold of increasing PVCs for telling someone that they don't have to worry about heart failure 15 years down the road. For practical purposes though, there is a difference of someone having increasing frequency of PVC at age 70 or age 50. You can email you comment to the senior author and see if he replies. Greg.***@****
Are you lumping isolated -infrequent PVCs In with your statement? Because it sounds to me like you are, and I disagree. I don't have access to the article and I couldn't find numbers in the abstract. this sounds like a long term study, and I don't see how they controlled for lifestyle and comorbidity.
It's already established that burning away frequent-coupled PVCs will improve LVEF. It's also been established that there are clasifications of PVC profiles that have the same mortality/morbidity rates as general populations.
You need to stop grouping PVCs into one bucket.
It's already established that burning away frequent-coupled PVCs will improve LVEF. It's also been established that there are clasifications of PVC profiles that have the same mortality/morbidity rates as general populations.
You need to stop grouping PVCs into one bucket.
PACs are upper chambers, the atrium. PVCs are from the main pumps, the ventricular.
The CHS cohort are volunteers that were healthy at the start of the data gathering in 1989. Many studies have been published regarding the data from this group. The referenced paper looked at PVC frequency history specifically as it relates to heart failure years later. If we are to tell people that PVCs are benign, that would be no different than telling them high blood pressure, BMI, diabetes, CAD are also benign when it comes to heart failure. Read and listen to the editorial response to the paper from Marchlinski. He is one of the top experts in the world on VT and heart failure. Clearly the old guidelines and 20,000 pvc/day rule of thumb have been thrown out of the window. Med school text will have to be updated. Abnormal PVC's are not caused by low EF - that doesn't make any sense. PVS's lead to cardiomyopathy which in turn causes EF to goes down and VT. That is definition of heart failure.
Yes I agree that we do need to do everything possible to have healthy habits and destress. Take mg and K supplements if that helps. Meditation and yoga if that helps. etc ... Moreover, it will be important to monitor that PVCs don't increase in frequency and that ejection fraction remains in a normal range over time.
I know we like tell people that come around here that everything is probably ok and that the are over reacting. That maybe true in many cases. Healthy life style is important and may be all that is needed for many. But there will be many unlucky ones as well and we need to be realistic about what needs to be done for them.
Yes I agree that we do need to do everything possible to have healthy habits and destress. Take mg and K supplements if that helps. Meditation and yoga if that helps. etc ... Moreover, it will be important to monitor that PVCs don't increase in frequency and that ejection fraction remains in a normal range over time.
I know we like tell people that come around here that everything is probably ok and that the are over reacting. That maybe true in many cases. Healthy life style is important and may be all that is needed for many. But there will be many unlucky ones as well and we need to be realistic about what needs to be done for them.
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I think it all depends on what's the cause and what's the effect. You won't believe how many people who are saying "I have a headache because my blood pressure is high". They can even measure their blood pressure during a headache and find out it's high. Does that prove that their headache is caused by high blood pressure?
No, there are several options:
1) The headache and the high blood pressure can share a common cause (like stress)
2) The blood pressure may be high because s/he is in pain.
etc..
I'm not surprised people with PVCs may have higher mortality and lower ventricular function than people without. It does NOT mean that the average guy with a healthy heart and some PVCs are at risk. PVCs are more common in the setting of heart diseases, which means that people included in the study who have PVCs also may have a heart disease.
It could also be that their PVCs are caused by low ejection fraction. PVCs are much more common in the setting of reduced EF or after heart attacks, or in other diseases linked to increased mortality (like electrolyte disturbances caused by kidney failure, etc.)
Since PVCs may be caused (not causing) by heart disease, I recommend everyone who experience them to visit their doctor for testing. But once heart disease is ruled out, I think you should go back to living a normal and healthy life without worrying.