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The Association Between the Pattern of Premature Ventricular Contractions and Heart Diseases: Assessment of Routine Electrocardiography in Health Examinations

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The Association Between the Pattern of Premature Ventricular Contractions and Heart Diseases: Assessment of Routine Electrocardiography in Health Examinations Journal of J Occup Health 2002; 44: 343–347 Occupational Health The Association between the Pattern of Premature Ventricular Contractions and Heart Diseases: Assessment of Routine Electrocardiography in Health Examinations Kazuhito HATANAKA1, Akira FUJINAMI2, Yoshihiro NISHIMOTO2, Nobuhiko ITO3 and Masahiko KOBAYASHI1 1Department of Forensic Medicine, Graduate School of Medicine, University of Tokyo, 2Central Health Institute of East Japan Railway Company and 3Department of Cardiology, JR Tokyo General Hospital, Japan Abstract: The Association between the Pattern of findings applied to the observations in asymptomatic Premature Ventricular Contractions and Heart subjects. Conclusion—It is suggested that the Diseases: Assessment of Routine population without heart disease primarily has the PVCs Electrocardiography in Health Examinations: of the LBBB pattern without axis deviation and the Kazuhito HATANAKA, et al. Department of Forensic analysis of the PVC patterns (bundle branch block Medicine, Graduate School of Medicine, University pattern) and of electrical axis deviation in routine ECG of Tokyo—Objective—Premature ventricular at a routine health examination is useful for diagnosing contractions (PVCs) were observed among patients heart disease. with heart diseases. It has been suggested that the (J Occup Health 2002; 44: 343–347) sporadic left bundle branch block (LBBB) pattern of PVCs observed in healthy subjects has no relevance Key words: Premature ventricular contractions, Heart to heart diseases and the presence of this type of PVC disease, Electrocardiography, Bundle branch block, was not associated with a poor prognosis. The aim of Electrical axis deviation this study is to present and evaluate the relationship between PVC patterns on routine electrocardiography Arrhythmia is one of the markers of heart disease. (ECG) and heart diseases. Methods: The subjects Premature ventricular contractions (PVCs) are the most examined were 201 employees from one company common type of arrhythmia and PVCs are suggested to be (male 192, female 9) with PVCs (Lown grading associated with heart diseases, such as ischemic heart classification 0 or 1). The patterns of PVCs were disease, cardiomyopathy, obstructive pulmonary disease classified into the following four categories regarding 1–3) the bundle branch block pattern and electrical axis and valvular disease . In ischemic heart disease, frequent, deviation: 1) the LBBB pattern without axis deviation multiform or early-coupling (R-on-T phenomenon) PVCs (135 subjects), 2) the LBBB pattern with left axis are regarded as warning arrhythmias4, 5). PVCs also occur deviation (29 subjects), 3) the right bundle branch block in relation to various stimuli such as electrolyte (RBBB) pattern without axis deviation (22 subjects) and imbalance, tension states and central and peripheral 4) the RBBB pattern with left axis deviation (15 autonomic stimulation6). Therefore, when PVCs are subjects). Results—The presence of subjective detected by electrocardiography (ECG), a close symptoms was not significant in each category. examination is often required to investigate the presence Prevalence of heart disease was 1) 14 (10.4%), 2) 10 of underlying disease. PVCs are also provoked by (34.5%), 3) 9 (40.9%) and 4) 7 (46.7%). The subjects smoking as well as caffeine or alcohol intake3, 6, 7), so that with the LBBB pattern without axis deviation had a lower they are frequently observed in a healthy population. incidence of having heart disease than subjects with other PVC patterns (p<0.05). In addition, similar Other studies have shown that PVCs in healthy subjects are sporadic and show no connection with heart disease8–13). Received Feb 8, 2002; Accepted June 13, 2002 In the PVCs of subjects without heart disease, the left Correspondence to: K. Hatanaka, Department of Forensic bundle branch block (LBBB) pattern varied from 60 to Medicine, Graduate School of Medicine, University of Tokyo, 7– 96% and the right bundle branch block (RBBB) pattern 3–1 Bunkyo-Ku, Hongo, Tokyo 113-0033, Japan varied from 4 to 33%10–12). In the PVCs of subjects with 344 J Occup Health, Vol. 44, 2002 heart disease, the LBBB pattern varied from 18 to 22% Table 1. Characterization of premature ventricular and the RBBB pattern varied from 73 to 83%12). In contraction in 201 subjects subjects without ischemic heart disease, the LBBB pattern Pattern of PVCs No. % of group was 74%, the RBBB pattern was 17% and both pattern were 9%13). In subjects with ischemic heart disease, the LBBB without AD 135 67.2 LBBB pattern was 35%, the RBBB pattern was 46% and LBBB with LAD 29 14.4 both were 19%13). In general, most PVC patterns in RBBB without AD 22 10.9 healthy subjects show an LBBB pattern. In addition to RBBB with LAD 15 7.5 the PVC pattern, it is also useful to make other observations regarding the presence or absence of heart Total 201 100 disease on routine ECG at a health examination. We Abbreviations: PVCs=premature ventricular contractions; therefore studied the degree of electrical axis deviation LBBB=left bundle branch block; RBBB=right bundle as a useful indicator. branch block; AD=axix deviation; LAD=left axis deviation. In the present study we analyzed sporadic PVC patterns (bundle branch block pattern) and electrical axis deviation in 201 subjects in routine ECGs. We also examined the association between PVC patterns, electrical axis investigated in each category and the symptoms deviation and the presence of heart disease. associated with PVCs were detected, such as palpitations, discomfort in the chest or feeling that the heart stopped Subjects and Methods during the long pause after PVCs6). The subjects of this study were 201 employees from Statistical significance was established by chi-square one company who had one or more PVCs on a routine analysis with Bonferroni correction for multiple 12-lead ECG obtained during a health examination. There comparisons. Statistical differences were judged were 192 males and 9 females, with ages ranging from significant at p<0.05. 19 to 56 yr (mean of 44.4 yr). All subjects underwent a clinical examination for heart diseases in medical facilities Results and their medical history was reviewed. Subjects with Individual classifications are shown in Table 1. The atrial fibrillation (valvular heart disease, lone atrial heart disease diagnoses were as follows: 20 had fibrillation, ischemic heart disease, cardiomyopathy), hypertensive cardiovascular disease, 11 had ischemic conduction disturbance (atrioventricular block, left bundle heart disease, 5 had cardiomyopathy and 4 had valvular branch block, right bundle branch block, Wolff- heart disease. In excluded subjects, one at Lown’s grade Parkinson-White syndrome), who were taking 3 had neither symptoms nor heart disease and another at antiarrhythmics drugs or who showed poorly recorded Lown’s grade 4A had symptoms and ischemic heart ECG tracing were excluded from the study population. disease. Subjects corresponding to Lown’s grades14) 2–5 were also 135 subjects had the LBBB pattern without axis excluded. The QRS complexes were diagnosed as PVCs deviation, 29 had the LBBB pattern with left axis not by automatic data processing, but by physicians deviation, 22 had the RBBB pattern without axis deviation according to the following criteria: (1) premature, (2) not and 15 had the RBBB pattern with left axis deviation. preceded by a premature P wave, (3) with a duration of Of the 201 subjects, 25 had symptoms associated with 0.12 s or greater and (4) with a different morphology PVCs and 176 were asymptomatic. Of the 25 subjects from the dominant rhythm13). The RBBB pattern was with symptoms, 11 had heart disease and 29 did not. Of diagnosed when there was a QRS duration of 0.12 s or the 176 asymptomatic subjects, 29 had heart disease and greater with a QR, RSR’ or RR’ pattern in the V1 lead15). 147 did not (Table 2). The asymptomatic subjects had a The LBBB pattern was diagnosed when there was a QRS lower incidence of heart disease than the symptomatic duration of 0.12 s or greater and a predominantly negative subjects (p<0.05). QRS complex with a terminal S wave in the V1 lead16). Of the 135 subjects with the LBBB pattern without The mean electrical axis deviation was measured in the axis deviation, 16 had symptoms related to PVCs and QRS complex, and the QRS frontal-plane vector, between 119 had no symptoms. Of the 29 subjects with the LBBB –30° and –90°, was defined as left axis deviation17, 18). pattern with left axis deviation, 4 had symptoms and 25 Subjects were placed into the following four categories, had no symptoms. Of the 22 subjects with the RBBB based on their PVC patterns and electrical axis deviation: pattern without axis deviation, 3 were symptomatic and (1) LBBB pattern without axis deviation, (2) LBBB 19 were asymptomatic. Of the 15 subjects with the RBBB pattern with left axis deviation, (3) RBBB pattern without pattern with left axis deviation, 2 were symptomatic and axis deviation, (4) RBBB pattern with left axis deviation. 13 were asymptomatic. There was no significant The presence or absence of heart disease was also difference between the categories regarding the presence Kazuhito HATANAKA, et al.: Association between PVC Patterns and Heart Disease 345 Table 2. Association between symptoms and heart diseases Subjects Symptomatic (%) Asymptomatic (%) Total Heart diseases 11 (44.0) 29 (16.5) 40 No heart diseases 14 (56.0) 147 (83.5) 161 Total 25 176 201 χ2=13.1 (p<0.05) Table 3. Association between PVC patterns and symptoms Pattern of PVCs Subjects LBBB without LBBB with RBBB without RBBB with Total AD (%) LAD (%) AD (%) LAD (%) Symptomatic 16 (11.9) 4 (13.8) 3 (13.6) 2 (13.3) 25 Asymptomatic 119 (88.1) 25 (86.2) 19 (86.4) 13 (86.7) 176 Total 135 29 22 15 201 χ2=0.168 (N.S.) Abbreviations: PVCs=premature ventricular contractions; LBBB=left bundle branch block; RBBB=right bundle branch block; AD=axis deviation; LAD=left axis deviation.
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