Strategy using Holter monitoring may dynamically assess arrhythmic risk of ARVC patients: JAMA

A high PVC burden has also been associated with an increased risk of sustained ventricular arrhythmias and ICD interventions in patients with ARVC. ARVC is a progressive disease, and the weight of risk markers can vary during follow-up. Whether individual variations in PVC burden are associated with future arrhythmic events has not been investigated previously. Therefore, Dr Alessio Gasperetti and his team conducted a study to describe changes in the PVC burden and to assess whether serial Holter monitoring is dynamically associated with sustained ventricular arrhythmias during follow-up in patients with ARVC.

In this study, the researchers included 169 patients from 6 ARVC registries with a definite ARVC diagnosis, available Holter monitoring results at disease diagnosis, and at least 2 additional results of Holter monitoring during follow-up.

The major outcome assessed was the association between prespecified variables retrieved at each Holter monitoring follow-up (ie, overall PVC burden; the presence of sudden PVC spikes, defined as an absolute increase in PVC burden ≥5000 per 24 hours or a relative ≥75% increase, with an absolute increase of ≥1000 PVCs; the presence of nonsustained ventricular tachycardia [NSVT]; and use of β-blockers and class III antiarrhythmic drugs) and sustained ventricular arrhythmias occurring within 12 months. The researchers then assessed the Holter examination using a mixed logistical model.

Key findings of the study:

• Among169 patients with ARVC, the researchers noted 723 Holter examinations were performed during a median follow-up of 54 months. They detected 75 PVC spikes and 67 sustained ventricular arrhythmias.
• They found that the PVC burden decreased significantly from the first to the second Holter examination (mean, 2906 PVCs per 24 hours).
• They also found that the model including 24-hour PVC burden (odds ratio [OR] 1.50, PVC spikes (OR, 6.20), and NSVT (OR, 2.29) at each follow-up Holter examination was associated with sustained ventricular arrhythmia occurrence in the following 12 months.

The authors concluded, "These findings suggest that in patients with ARVC, changes in parameters derived from each Holter examination performed during follow-up are associated with the risk of sustained ventricular arrhythmias within 12 months of disease diagnosis."

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DOI: 10.1001/jamacardio.2021.6016