Italy: Changes in Holter exam findings after diagnosis in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) are associated with the risk of sustained ventricular arrhythmias, states a recent study in JAMA Cardiology. The findings suggest that a follow-up strategy using yearly Holter monitoring can be utilized for assessing the arrhythmic risk of patients with ARVC.
A high burden of premature ventricular contractions (PVCs) at disease diagnosis has been linked to an overall higher risk of ventricular arrhythmias in ARVC. There is a scarcity of data on dynamic modification of PVC burden at follow-up with Holter monitoring and its impact on arrhythmic risk in ARVC. To fill this knowledge gap, Alessio Gasperetti, Johns Hopkins University School of Medicine, Baltimore, Maryland, and colleagues aimed 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 ARVC patients in a cohort study.

For this purpose, the researchers enrolled patients with a definite ARVC diagnosis, available Holter monitoring results at disease diagnosis, and at least 2 additional results of Holter monitoring during follow-up. Enrollment was done from 6 ARVC registries in North America and Europe. Data collection was done from June 1 to September 15, 2021.
The association between prespecified variables retrieved at each Holter monitoring follow-up and sustained ventricular arrhythmias occurring within 12 months after that Holter examination was assessed using a mixed logistical model.
Variables retrieved at each Holter monitoring follow-up include overall PVC burden; the presence of nonsustained ventricular tachycardia [NSVT]; and use of β-blockers and class III antiarrhythmic drugs.
Based on the study, the following were the key findings:
In 169 enrolled patients with ARVC (mean age, 36.3 years; 95 men), a total of 723 Holter examinations (median, 4 per patient) were performed during a median follow-up of 54 months and detected 75 PVC spikes and 67 sustained ventricular arrhythmias.
The PVC burden decreased significantly from the first to the second Holter examination (mean, 2906 PVCs per 24 hours).
A 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 researchers conclude, "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."
Reference:
Gasperetti A, Cappelletto C, Carrick R, et al. Association of Premature Ventricular Contraction Burden on Serial Holter Monitoring With Arrhythmic Risk in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy. JAMA Cardiol. Published online February 23, 2022. doi:10.1001/jamacardio.2021.6016