Evaluation of premature ventricular complexes during in-hospital ECG monitoring as a predictor of ventricular tachycardia in an intensive care unit cohort.
Sukardi Suba, Thomas J Hoffmann, Kirsten E Fleischmann and 6 others
PMID 37127543WHAT IT FOUND
In 445 ICU patients, none of six premature ventricular complex alarm types measured 24 hours before ventricular tachycardia were associated with VT once other patient factors were considered.
PVC alarms may not predict VT, but the study was too small to rule out a link.
Key findings
01None of the six monitor-defined PVC types was associated with ventricular tachycardia in either unadjusted or adjusted analyses.
02Patients with ventricular tachycardia were more likely to have a cardiovascular diagnosis, reduced left ventricular ejection fraction, ischemic heart disease, prior coronary intervention or bypass, or heart failure than patients without ventricular tachycardia.
03Patients with ventricular tachycardia had in-hospital cardiac arrest more often (14.6% vs. 1.0%), but the death difference (18.8% vs. 10.1%) was not significant.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The PVC alarms were not annotated, so it is unknown whether PVC events were true or false or whether PVCs were missed. The sample was small for the main question, with very wide uncertainty around PVC estimates, so a real association could have been missed. Only 11 patients had in-hospital cardiac arrest, making that outcome especially underpowered. Data came from one quaternary academic medical center, three ICU types, and one ECG vendor, so results may not apply elsewhere. Only ICU patients were studied, so it is unknown whether findings apply to non-ICU patients. 61.3% of left ventricular ejection fraction measurements and 21.3% of baseline 12-lead ECG PVC presence were missing, though multiple imputation was used. The analysis did not examine specific ECG features such as QT interval, prematurity index, morphology, bundle branch block, left ventricular hypertrophy, or ischemia. Death analysis could be biased because time of death varied and could occur after the 24-hour PVC period.
Declared interests
The authors declared no conflicts of interest. The article is tagged as receiving NIH and non-U.S. government research support.
The easy way to misread this
Do not conclude that PVC alarms should be disabled. The study did not show any PVC type predicted ventricular tachycardia, but it was small and uncertain, and it included a case where an R-on-T PVC led to ventricular tachycardia that deteriorated into ventricular fibrillation.