Premature ventricular contraction diurnal profiles predict distinct clinical characteristics and beta‐blocker responses

Introduction Frequent premature ventricular complexes (PVCs) can lead to symptoms, such as cardiomyopathy and increased mortality. Beta‐blockers are recommended as first‐line therapy to reduce PVC burden; however, the response is unpredictable. The objective of this study is to determine whether PVC diurnal‐variability patterns are associated with different clinical profiles and predict drug response. Methods Consecutive patients with frequent PVCs (burden ≥ 1%), referred for Holter monitoring between 2014 and 2016, were included. Follow‐up Holters, when available, were assessed after beta‐blocker initiation to assess response (≥50% reduction). Patients were divided into three groups on the basis of relationship between hourly PVC count and mean HR during each of the 24 Holter hours: (1) fast‐HR‐dependent‐PVC (F‐HR‐PVC) for positive correlation (Pearson, P < 0.05), (2) slow‐HR‐dependent‐PVC (S‐HR‐PVC) for a negative, and (3) independent‐HR‐PVC (I‐HR‐PVC) when no correlation was found. Results Of the 416 patients included, 50.2% had F‐HR‐PVC, 35.6% I‐HR‐PVC, and 14.2% S‐HR‐PVC with distinct clinical profiles. Beta‐blocker therapy was successful in 34.0% patients overall: patients with F‐HR‐PVC had a decrease in PVC burden (18.8 ± 10.4% to 9.3 ± 6.6%, P < 0.0001; 62% success), I‐HR‐PVC had no change (18.4 ± 17.9% to 20.6 ± 17.9%, P = 0.175; 0% success), whereas S‐HR‐PVC had an increase in burden (14.6 ± 15.3% to 20.8 ± 13.8%, P = 0.016; 0% success). The correlation coefficient was the only predictor of beta‐blocker success (AUC = 0.84, sensitivity = 100%, specificity = 67.7%; r ≥ 0.4). Conclusions A simple analysis of Holter PVC diurnal variability may provide incremental value to guide clinical PVC management. Only patients displaying a F‐HR‐PVC profile benefited from beta‐blockers. An alternative strategy should be considered for others, as beta‐blockers may have no effect or can even be harmful.