← Return to PVC’s with no end in sight.
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Heart Rhythm Conditions | Last Active: 21 hours ago | Replies (6)
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Replies to "@wcuro that’s interesting that your doc said 8% PVC burden is enough to cause problems. My..."
@kellyb1960 https://www.ahajournals.org/doi/10.1161/JAHA.122.027674
https://www.ccjm.org/content/83/7/524
This third article, fairly recent, gets to the nub of the question, how much of a PVC burden begins to invite pathology, and it's a longer read:
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.042434
I'll quote the most salient and relevant text as far as I am concerned:
'...It is clear that there are many patients with frequent PVCs who never go on to develop systolic dysfunction or clinical heart failure. There is therefore tremendous interest in identifying individuals at risk. Most of this work has arisen from series of patients presenting for catheter ablation of their PVCs, and more work needs to be done in the community-based settings to better inform decision making in the general population. Among patients presenting for clinical care for their heart failure and PVCs, a higher burden of PVCs has consistently been shown to be an important risk factor. It is important to emphasize the origins of this group (constrained to those presenting for clinical care, primarily to cardiologists), where the proportions of individuals with heart failure in the setting of PVCs is likely inflated in comparison with the general population. Although there is no clear single threshold cutoff, studies have suggested that optimal test characteristics for a PVC-induced cardiomyopathy occur at PVC burdens of 16% to 24%24,66 and that most cases of PVC-induced cardiomyopathy occur at burdens >10%.24,66–69 However, consistent with evidence that those with 6% PVCs can experience benefit in reducing their systolic dysfunction with catheter ablation, the reality is likely more complicated and nuanced, fitting with our previous community-based observation that the risk simply increases proportionally with burden...'
Note that a burden of 10% is stated as the usual demarcation point for most patients, but that some with burdens well under that may begin to slide into markedly poor cardiac health. So, the patient, as unique as each case is, really matters...not the articles, the policies, the insurance and its policies, etc.