Arrhythmias and conduction disturbance
Ventricular Arrhythmias and Risk of Death and Acute Myocardial Infarction in Apparently Healthy Subjects of Age ≥55 Years

https://doi.org/10.1016/j.amjcard.2005.11.067Get rights and content

Increased ventricular ectopic activity and even more complex arrhythmias are not uncommon in subjects without apparent heart disease. However, their prognostic significance has been controversial and not updated in recent years. The prevalence and prognostic significance of different ventricular arrhythmias were studied in a cohort of middle-aged and elderly subjects without apparent heart disease. Six hundred seventy-eight men and women aged 55 to 75 years without a history of heart disease or stroke were included. Baseline examinations included physical examinations, fasting laboratory testing, and 48-hour ambulatory electrocardiographic monitoring. All patients were followed for up to 5 years. Combined events were defined as all-cause mortality or acute myocardial infarction. A cardiovascular event was defined as cardiovascular death or acute myocardial infarction. In total, 84% had 0 to 10 ventricular premature complexes (VPCs)/hour, 8% had 11 to 30 VPCs/hour, and 8% had >30 VPCs/hour; 10.8% had ≥1 run of ≥3 VPCs. Frequent VPCs (≥30/hour) was a significant predictor of combined (hazard ratio 2.47, 95% confidence interval 1.29 to 4.68, p = 0.006) and cardiovascular (hazard ratio 2.85, 95% confidence interval 1.16 to 7.0, p = 0.023) event rates, after adjustment for conventional risk factors. Runs of ≥4 VPCs/day or ≥2 doublets/day were also associated with a poor prognosis, but only in the presence of frequent VPCs. The detection of a single VPC on standard electrocardiography was a significant predictor of frequent VPCs and an independent predictor of events (hazard ratio 2.6, 95% confidence interval 1.02 to 6.66, p = 0.045). In conclusion, apparently healthy, middle-aged and elderly subjects with frequent VPCs (≥30/hour) have a poor prognosis. According to current guidelines, strict risk-factor modification and primary prevention are justified in these high-risk subjects.

Section snippets

Methods

This study is part of the Copenhagen Holter study, which aimed to address the value of 48-hour Holter recording in risk assessment in middle-aged and elderly men and women with no apparent heart disease, especially in relation to other risk factors. Details of the study population and methods have been previously published.6, 7 In summary, in 2 well-defined regions of Copenhagen, all men aged 55 years and all men and women aged 60, 65, 70, and 75 years received a questionnaire (n = 2,969)

Results

The baseline characteristics of the participants of this study are listed in Table 1. The mean successful ECG recording time was 42.8 ± 4.9 hours. Only 9 subjects (1.3%) had recording times <24 hours. The minimum and maximum recording times were 17.2 and 49.2 hours. In total, 29,032 hours of ECG monitoring were performed. The median follow-up time was 53 months (interquartile range 51 to 55). During this time, 66 events (54 deaths and 12 AMIs) were recorded: 23 in 281 women (8.2%) and 43 in 397

Discussion

In this study, we demonstrated that middle-aged and elderly subjects with no apparent cardiac disease and increased ventricular ectopic activity of ≥30 VPCs/hour are at a >2.5-fold increased risk for death and AMI over 5 years. This was mostly evident in men and subjects with Framingham risk scores greater than average. We detected this kind of arrhythmia in 9% of all men (35 of 397), and 25% of all events occurred in this small group. The increased risk remained significant after correction

Acknowledgment

We wish to thank laboratory technician Kirsten Andersen, BS, for her helpfulness and excellent assistance.

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    This study was supported by grants from the Danish Heart Foundation, Copenhagen, Denmark.

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