(P140) SCREENING FOR FREQUENT VENTRICULAR ECTOPY AMONG PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION

Background: Frequent premature ventricular complexes (PVCs) can contribute to left ventricular dysfunction in patients with heart failure with reduced ejection fraction (HFrEF). Existing observational studies support a role for PVC-specific therapy, regardless of etiology of HFrEF. Targeting frequent PVCs could serve as an incremental therapeutic approach to enhance outcomes in HFrEF. However, the prevalence and impact of frequent PVCs in the general HFrEF population is unclear.

The purpose of this study was to 1) assess the use of screening ambulatory ECG monitoring and 2) determine the prevalence of frequent PVCs (≥10% or ≥10,000/24 hours) in a general HFrEF population referred to a tertiary heart function clinic.

METHODS AND RESULTS: This single-center cohort study included HFrEF patients referred to St. Paul’s Hospital Heart Function Clinic from November 2019 to April 2021. Ambulatory ECG monitoring data within 12 months before or 6 months after the initial referral were reviewed. Exclusion criteria included pre-existing antiarrhythmic therapy and prior PVC ablation. Data were collected from electronic medical records, echocardiograms, ECG reports, and CMRI studies.

We identified 256 new HFrEF referrals, mean age 65.8 years, 25% female, 62% non-ischemic etiology, median NYHA class 2 and median LVEF 28%. Of these, 31.3% (80/256) underwent screening ambulatory ECG monitoring (figure). Of those monitored, 42.5% had ≥1% PVCs, with 15.1% having ≥10% PVCs. There were no consistent clinical predictors of frequent PVCs apart from a trend of increased frequency as the LVEF declined. Notably, etiology of HFrEF (ischemic versus non-ischemic) was not a predictor. Additionally, 23.3% had other potentially actionable findings on monitoring (new atrial fibrillation, non-sustained VT without frequent PVCs, sinus node dysfunction).

Conclusion: This study reveals a substantial care gap in the use of screening ambulatory ECG monitoring to detect frequent PVCs in HFrEF patients. The current findings suggest that almost 1 in 6 patients with HFrEF may have very frequent PVCs (≥10,000/day) and may benefit from PVC-specific therapy.