Electrocardiographic Comparison of Ventricular Premature Complexes in Patients with Inherited Dilated Cardiomyopathy and in Patients with Ventricular Premature Complex induced Cardiomyopathy

Background: Ventricular premature complexes (VPCs) may contribute to left ventricular dysfunction and development of Dilated Cardiomyopathy (DCM). Elimination of VPCs by catheter ablation may restore left ventricular function in VPCs induced DCM. Inherited DCM is a frequent cause of heart failure and ventricular arrhythmia worldwide. VPCs incidence may increase in patients with Inherited DCM as well but left ventricular dysfunction won`t be reversed by VPCs elimination.

Objective: The purpose of this study was to evaluate whether electrocardiographic characteristics of VPCs in Patients with Inherited Dilated Cardiomyopathy distinguish patients with VPCs induced Cardiomyopathy.

Methods: We compared the electrocardiographic characteristic of VPCs during ECG and 12 leads holter in 19 patients with Inherited DCM (IDCM) with 18 patients with VPCs induced Cardiomyopathy (VPCsCM).

Results: VPCsCM patients had a significantly more VPCs per 24 hours (mean 8640 vs 3207, p< 0.02), more often exhibited left bundle branch block (LBBB) pattern with inferior axis morphology (15 of 18 (83%) vs 7 of 19 (37%), p< 0.01) and coupling interval less than 400 msec (33% vs 16% p=0.05). IDCM patients more often exhibited VPC QRS longer than 150 msec (50% vs 17% p=0.04) with earlier transition zone V1-3 (67% vs 20% p=0.03). Symptomatic VPCs appeared at higher rate in VPCsCM group (77% vs 21% p=0.001). Family history of sudden cardiac death was much more common in the IDCM patients. No stasistical differences were found in the ejection fraction, left ventricular end diastolic diameter and in the degree of mitral regurgitation among IDCM and VPCsCM patients.

Conclusions: Several electrocardiographic criteria can help distinguish VPCs originating from IDCM patients and VPCsCM patients.