Abdel Salam R. Kaleel M.D, MSc

Agarwal SK, Chao J, Peace F, Judd SE, Kissela B, Kleindorfer D, et al. Premature Ventricular Complexes on Screening Electrocardiogram and Risk of Ischemic Stroke. Stroke. 2015

Previously, the Atherosclerosis Risk in Communities (ARIC) study found an association of higher ischemic stroke in patients with PVCs on a 2 minute ECG rhythm strip. This study sought to determine if Premature Ventricular Contractions (PVC) seen on routine ECG were also associated with an increased risk of ischemic stroke. This analysis included 24,460 participants from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Exclusions were made for patients with prevalent stroke or transient ischemic stroke, poor quality ECG, and missing covariates. 

Participants in the REGARDS study were followed every 6 months by telephone for possible stroke events and PVCS were ascertained from baseline ECG between 2003-2007. Further, incident strokes were logged through 2011. Cox proportional hazard models were then used to examine the association between PVCs and ischemic stroke.

During an average follow up of approximately six years, incident rate of ischemic stroke was higher in those with versus without PVCs (6.7 vs 4.2 per 1000 patients, p< 0.01) – PVCs were associated with a 38% increased risk of ischemic stroke.

The authors concluded that the underlying mechanism of increased risk is not very clear, but indicated that PVCs may represent an underlying cardiac arrhythmia or cardiac disease. Finally, the authors concluded that the presence of PVCs on routine ECG is associated with an increased risk of stroke, independent of other traditional risk factors.