Incidence and prognostic significance of ventricular arrhythmias in individuals without detectable heart disease

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Abstract
The spontaneous incidence of ventricular arrhythmias was documented in 170 individuals (age 18–70 years; mean age 42 years) without identifiable cardiovascular disease using 24 h continuous ambulatory electrocardiography. The study group consisted of 117 males and 53 females. In 104 individuals cardiac diseases were excluded clinically, all of them free of cardiac symptoms and with normal clinical findings including 12-lead ECG; all subjects of 40 years of age or older were included only after obtaining an exercise ECG without horizontal or down-sloping ST-segments and with a physical working capacity of at least 80%. A second subgroup of 66 individuals showed normal coronary angiograms, normal left ventriculography and having haemodynamics within the normal range. One hundred ‘normals’ (59%) showed no ectopic activity during 24 h electrocardiography. In contrast, 41 (24%) demonstrated ventricular extrasystoles (VES) at times (1–24 VES/24 h). 12 (7%) had a moderate incidence of 24–240 VES per 24 h, nine (5%) a high incidence of 241–2400 VES and eight (5%) an excessive incidence of > 2400 VES. With regard to qualitative criteria of VES, 45 out of 170 individuals (26%) had uniform VES whereas in 25 (15%) VES were of multiform configuration. Ventricular bigeminy was detected in three individuals and consecutive VES in 11 subjects (6%). However, only three of the latter demonstrated ventricular tachycardia consisting of three consecutive VES or more. In only two individuals were early VES interrupting the preceding T-wave (‘R on T-VES’) documented. Thus, VES are common findings in subjects without detectable cardiovascular diseases. Frequent and complex VES are however, rarely documented during ambulatory electrocardiography. Prevalence of VES in ‘normals’ was independent of sex, type of coronary vascular supply, and heart rate. However, there was a significant increase in ectopic activity with increasing age (P <0.01). After a mean follow-up period of 4.6 years (range: 23–91 months) we obtained information on 24 out of 28 individuals showing frequent and/or complex VES (multiform VES, bigeminy and/or consecutive VES) at entry into the study. All individuals of this group of interest survived having been without any cardiac medication during the follow-up period. Thus, frequent and complex VES do occur at times in subjects without identifiable cardiovascular disease. But our results suggest that they do not indicate a poor prognosis with regard to sudden cardiac death.

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