15 December 1992

Prognostic Implications of Asymptomatic Ventricular Arrhythmias: The Framingham Heart Study

Publication: Annals of Internal Medicine
Volume 117, Number 12


Objective: To evaluate the prevalence and prognostic significance of asymptomatic complex or frequent ventricular premature beats detected during ambulatory electrocardiographic (ECG) monitoring.
Design: Cohort study with a follow-up period of 4 to 6 years.
Setting: Population-based.
Participants: Surviving patients of the original Framingham Heart Study cohort and offspring of original cohort members (2727 men and 3306 women).
Measurements: One-hour ambulatory electrocardiography.
Results: The age-adjusted prevalence of complex or frequent arrhythmia (more than 30 ventricular premature complexes per hour or multiform premature complexes, ventricular couplets, ventricular tachycardia, or R-on-T ventricular premature complexes) was 12% (95% Cl, 11 % to 13%) in the 2425 men without clinically evident coronary heart disease and 33% (Cl, 24% to 42%) in the 302 men with coronary heart disease. The corresponding values in women (3064 without disease and 242 with disease) were 12% (Cl, 11% to 13%) and 26% (Cl, 9% to 43%). After adjusting for age and traditional risk factors for coronary heart disease in a Cox proportional hazards model, men without coronary heart disease who had complex or frequent ventricular arrhythmias were at increased risk for both all-cause mortality (relative risk, 2.30; Cl, 1.65 to 3.20) and the occurrence of myocardial infarction or death from coronary heart disease (relative risk, 2.12; Cl, 1.33 to 3.38). In men with coronary heart disease and in women with and without coronary heart disease, complex or frequent arrhythmias were not associated with an increased risk for either outcome.
Conclusions: In men who do not have clinically apparent coronary heart disease, the incidental detection of ventricular arrhythmias is associated with a twofold increase in the risk for all-cause mortality and myocardial infarction or death due to coronary heart disease. The preventive and therapeutic implications of these findings await further investigation.

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Kotler MTabatznik BMower M, and Tominaga S. Prognostic significance of ventricular ectopic beats with respect to sudden death in the late post infarction period. Circulation. 1973;47:959-66.
Prognostic importance of premature beats following myocardial infarction. Experience in the coronary drug project. JAMA. 1973;223:1116-24.
Ruberman WWernblatt MGoldberg JFrank C, and Shapiro S. Ventricular premature beats and mortality after myocardial infarction. N Engl J Med. 1977;297:750-7.
Moss ADeCamilla JEngstrom FHoffman WOdoroff C, and Davis H. The posthospital phase of myocardial infarction: identification of patients with increased mortality risk. Circulation 1974;49:460-6.
Bigger JDresdale RHeissenbuttel RWeld F, and Wit A. Ventricular arrhythmias in ischemic heart disease: mechanism, prevalence, significance, and management. Prog Cardiovasc Dis. 1977;19:255-300.
Lie KWellens HDownar E, and Durrer D. Observations on patients with primary ventricular fibrillation complicating acute myocardial infarction. Circulation. 1975;52:755-9.
Conolly S and Carins J. Comparison of one-, six- and 24-hour ambulatory electrocardiographic monitoring for ventricular arrhythmia as a predictor of mortality in survivors of acute myocardial infarction. CAMIAT Pilot Study Group. Canadian Amiodarone Myocardial Arrhythmia Trial. Am J Cardiol. 1992;69:308-13.
Moss A. Clinical significance of ventricular arrhythmias in patients with and without coronary artery disease. Prog Cardiovasc Dis. 1980;23:33-52.
Horan M and Kennedy H. Ventricular ectopy. History, epidemiology, and clinical implications. JAMA. 1984;251:380-6.
Chiang RPerlman LOstrander L, and Epstein F. Relationship of premature systoles to coronary heart disease and sudden death in the Tecumseh epidemiologic study. Ann Intern Med. 1969;70:1159-69.
Hinkle LCarver S, and Stevens M. The frequency of asymptomatic disturbances of cardiac rhythm and conduction in middle-aged men. Am J Cardiol. 1969;24:629-50.
Pell S and D'Alonzo C. A three year study of myocardial infraction in a large employed population. JAMA. 1961;175:463-70.
Rabkin SMathewson F, and Tate R. Relationship of ventricular ectopy in men without apparent heart disease to occurrence of ischemic heart disease and sudden death. Am Heart J. 1981;101:135-42.
Rodstein MWolloch L, and Gubner R. Mortality study of the significance of extrasystoles in an insured population. Circulation. 1971;44:617-25.
Fisher F and Tyroler H. Relationship between ventricular premature contractions on routine electrocardiography and subsequent sudden death from coronary heart disease. Circulation. 1973;47:712-9.
Elkon KSwerdlow T, and Myburgh D. Persistent ventricular ectopic beats: a long-term study. S Afr Med J. 1977;52:564-6.
Dawber TMeadors G, and Moore F. Epidemiologic approaches to heart disease: the Framingham study. Am J Public Health. 1951;41:279-86.
Dawber TKannel W, and Lyell L. An approach to longitudinal studies in a community: the Framingham Study. Ann NY Acad Sci. 1963;107:539-56.
Gordon TMoore TShurtleff D, and Dawber T. Some methodologic problems in the long-term study of cardiovascular disease: observations on the Framingham study. J Chronic Dis. 1959;10:186-206.
Kannel WFeinleib MMcNamara PGarrison R, and Castelli W. An investigation of coronary heart disease in families. The Framingham Offspring Study. Am J Epidemiol. 1979;110:281-90.
Shurtleff D. Some characteristics related to the incidence of cardiovascular disease and death: Framingham Heart Study 18 follow-up. In: Kannel WB, Gordon T, eds. The Framingham Study. Section 30. Washington, DC: U.S. Government Printing Office; 1974 (DHEW publication No. [NIH] 74-599): 17-25.
Lown B and Wolf M. Approaches to sudden death from coronary heart disease. Circulation 1971;44:130-42.
Levy DSavage DGarrison RAnderson KKannel W, and Castelli W. Echocardiographic criteria for left ventricular hypertrophy: The Framingham Heart Study. Am J Cardiol. 1987;59:956-60.
Feigenbaum H. Echocardiography. Third edition. Philadelphia: Lea & Febiger, 1981:51-118.
Devereux R and Reichek N. Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation. 1977;55:613-8.
. SAS/STAT User's Guide, Version 6, Fourth Edition, Volume 1. Cary, North Carolina: SAS Institute Inc.; 1989.
. SAS/STAT User's Guide, Version 6, Fourth Edition, Volume 2. Cary, North Carolina. SAS Institute Inc.; 1989.
Kalbfleisch J and Prentice R. The Statistical Analysis of Failure Time Data. New York: John Wiley & Sons.; 1980.
. SAS Technical Report P-217, SAS/STAT Software: The PHREG Procedure, Version 6. Cary, North Carolina: SAS Institute Inc.; 1991.
Kennedy H and Underhill S. Frequent and complex ventricular ectopy in apparently healthy subjects: a clinical study of 25 cases Am J Cardiol. 1976;38:141-8.
Kennedy HPescarmona JBouchard R, and Goldberg R. Coronary artery status of apparently healthy subjects with frequent or complex ventricular ectopy. Ann Intern Med. 1980;92:179-85.
Kennedy HWhitlock JSprague MKennedy LBucklingham T, and Goldberg R. Long-term follow-up of asymptomatic healthy subjects with frequent and complex ventricular ectopy. N Engl J Med. 1985;312:193-7.
de Soyza NBennett FMurphy MBissett J, and Kane J. The relationship of paroxysmal ventricular tachycardia complicating the acute phase of ventricular arrhythmia during the late hospital phase of myocardial infarction to long-term survival. Am J Med. 1978;64:377-81.
Cats VLie KVan Capelle F, and Durrer O. Limitations of 24 hour ambulatory electrocardiographic recording in predicting coronary events after acute myocardial infarction. Am J Cardiol. 1979;44:1257-62.
Multiple Risk Factor Intervention Trial: risk factor changes and mortality results. Multiple Risk Factor Intervention Trial Research Group. JAMA. 1982;248:1465-77.
MRC trial of treatment of mild hypertension: principal results. Br Med J (Clin Res Ed). Medical Research Council Working Party. 1985;291:97-104.
Levy DAnderson KChristiansen JCampanile G, and Stokes J. Antihypertensive drug therapy and arrhythmia risk. Am J Cardiol. 1988;62:147-9.
Ventricular extrasystoles during thiazide treatment: sub-study of MRC mild hypertension trial. The Medical Research Council Working Party on Mild to Moderate Hypertension. Br Med J. 1983;287:1249-53.
Koppes GBeckmann C, and Jones F. Propranolol therapy for ventricular arrhythmias two months after acute myocardial infarction. Am J Cardiol. 1980;46:322-8.
Lichstein EMorganroth J, and Harrist Hubble E. Effect of propranolol on ventricular arrhythmia. The betablocker heart attack trial experience. Circulation. 1983;67(Suppl 1):5-10.
Olsson G and Rehnquist N. Ventricular arrhythmias during the first year after myocardial infraction: influence of long-term treatment with metaprolol. Circulation. 1984;69:1129-34.
Preliminary report: Effect of encanide and flecanide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. The Cardiac Arrhythmia Suppression Trial (CAST) Investigators. N Engl J Med. 1989; 321:406-17.
Talajic M. Long term management of ventricular arrhythmias—to treat or not to treat? Can J Cardiol. 1991;7:96-7.
Swerdlow CWinkle R, and Mason W. Determinants of survival in patients with ventricular tachyarrhythmias. N Engl J Med. 1983;308:1436-42.
Levy DAnderson KSavage DBalkus SKannel W, and Castelli W. Risk of ventricular arrhythmias in left ventricular hypertrophy: The Framingham Heart Study. Am J Cardiol. 1987;60:560-5.
Levy DAnderson KPlehn JSavage DChristiansen J, and Castelli W. Echocardiographically determined left ventricular structural and functional correlates of complex or frequent ventricular arrhythmias on one-hour ambulatory electrocardiographic monitoring. Am J Cardiol. 1987;59:836-40.
Messerili FVentura HElizardi DDunn F, and Frohlich E. Hypertension and sudden death. Increased ventricular ectopic activity in left ventricular hypertrophy. Am J Med. 1984;77:18-22.
Kannel WGordon TCastelli W, and Margolis J. Electrocardiographic left ventricular hypertrophy and risk of coronary heart disease. The Framingham Study. Ann Intern Med. 1970;72:813-22.
Levy DGarrison RSavage DKannel W, and Castelli W. Left ventricular mass and incidence of coronary heart disease in elderly cohort. The Framingham Heart Study. Ann Intern Med. 1989;110:101-7.
Casale PDevereux RMilner MZullo GHarshfield G, and Pickering T. Value of echocardiographic left ventricular mass in predicting cardiovascular morbidity events in hypertensive men. Ann Intern Med. 1986;105:173-8.
Risk stratification and survival after myocardial infarction. N Engl J Med. 1983;309:331-6.

Information & Authors


Published In

cover image Annals of Internal Medicine
Annals of Internal Medicine
Volume 117Number 1215 December 1992
Pages: 990 - 996


Published in issue: 15 December 1992
Published online: 1 December 2008




Mahesh Bikkina, MD, MPH
Martin G. Larson, ScD
From the Framingham Heart Study, Framingham, Massachusetts; the National Heart, Lung, and Blood Institute, Bethesda, Maryland; and Boston University School of Medicine and Beth Israel Hospital, Boston, Massachusetts. For current author addresses, see end of text.

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