Analytics of long-term premature ventricular complexes using an insertable cardiac monitor

Abstract

Abstract Background Premature ventricular complexes (PVC) are associated with the development of cardiomyopathy, heart failure and pro-arrhythmia. PVC detection using insertable cardiac monitor (ICM) signal processing has recently been introduced. An ICM device capable of monitoring PVC burden over a longer period can be a useful tool for evaluating long-term PVC burden trends. Purpose This study evaluated the various long-term PVC burden trends from patients with implanted ICM capable of continuous PVC burden monitoring. Methods The ICM implemented PVC detection algorithm uses various combinations of long-short-long RR interval sequence and similarity and differences in R-wave morphology for three consecutive beats to detect single PVC events. For this study, long-term daily PVC burden trends from real-world patients implanted with ICM which has the capability of PVC detection using the implemented device PVC algorithm were analyzed from the de-identified Electronic Health Record (EHR) database linked with ICM device data warehouse. Examples of long-term PVC burden trends showing dynamic burden changes were evaluated and other PVC burden metrics such as maximum PVC burden, mean, and median PVC burden are analyzed from these ICM patients. Results PVC burden data from 1919 unique patients with implanted ICM were analyzed. 1814 patients with at least 90 days of available PVC burden were chosen for evaluation. There were 396,033 days with daily PVC burden data points that were evaluated with an average of 218 (SD=72) days with available PVC burden data per patient. The mean PVC burden which was defined as total PVC count divided by total days with ICM PVC detection enabled was 0.8 (SD=2.3) and median PVC burden was 0.02 (IQR 0-0.6). There were 6945 days (1.8%) with PVC burden values ≥10% in 168 unique patients (9.3%). 786 patients (43%) had a maximum daily PVC burden of ≤5% and 155 patients (9%) had maximum daily PVC burden between 6-10%. 107 patients (6%) had a maximum daily PVC burden between 11-20% and 40 patients (2%) had a maximum daily PVC burden >20%. The clinical history comparison of 1814 ICM patients based on a cutoff of a maximum daily PVC burden of 10% is shown in figure 1. Figure 2 shows examples of long-term daily PVC burden(%) trends from four different patients from this dataset showing dynamic PVC burden variabilities that only long-term monitoring of PVCs could detect. Conclusion PVC burden monitoring performed utilizing a unique PVC detection algorithm can provide longitudinal and long-term dynamic PVC burden trends in patients implanted with ICM. Dynamic changes in PVC burden may be associated with cardiac pro-arrhythmia or hospitalizations and requires further investigation.