Abstract 10221: Premature Ventricular Contractions in Chronic Thromboembolic Pulmonary Hypertension Undergoing Pulmonary Thromboendarterectomy Surgery

Abstract

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare and progressive subtype of severe pulmonary hypertension. Premature ventricular contractions (PVC) are common and can be a marker of cardiomyopathy. We aimed to describe the incidence, location and predictors of PVCs in CTEPH patients undergoing Pulmonary Thromboendarterectomy surgery (PTE). Hypothesis: PVCs are common in CTEPH patients and the right ventricle would be the most common location of PVCs. Methods: We reviewed the charts of 883 consecutive patients who were referred for PTE. 12-lead ECGs were reviewed for presence of PVC. Demographics, baseline lab and imaging were extracted from chart review. Predictors of PVCs were analyzed using multivariate backward logistic regression. PVC location was identified using standard location algorithms based on the 12-lead ECG. Results: Overall, 6.5% (n=57) of patients had PVCs. Surprisingly, the majority of PVCs originated from the left ventricle (75.4%, N=43). The most common location was non-outflow tracts with LV non-outflow tract (59.3%, N=34), followed by RV non-out tract (19.3%, N=11). Within the non-outflow tract region, the majority of the PVC location appeared to be septal related (moderator band, posterior fascicle or posterior medial papillary muscle). The mitral annulus was also a common location (15.8%, N=9). In a multivariate model, heart failure (OR 2.8, p=<0.01), coronary artery disease (CAD) (OR 2.8, p=<0.01), sleep apnea (OR 2.2, p=0.02) and obesity (OR 1.6, p=<0.01) increased the odds of having PVCs. Conclusions: PVCs are not uncommon in CTEPH patients undergoing PTE surgery. Overall, 6.5% of patients had PVCs with the majority originating in the left ventricle (75.4%). Using standard ECG criteria, the most common location was the LV non-outflow tract. Heart failure, CAD, sleep apnea and obesity increased the odds of having a PVC.