The role of heart rate variability in predicting the response to beta blocker in patients with frequent premature ventricular contractions

Abstract Background Frequent premature ventricular contractions (PVCs) in patients with structurally normal heart are not uncommon. Beta blocker is generally used to reduce symptom and burden of PVCs, but the response to beta blockers vary from patient to patient. Purpose This study aimed to investigate whether the heart rate variability (HRV) values could predict the response to beta blockers in patients with frequent PVCs. Methods We analyzed the patients who underwent 24-hour Holter monitoring and had PVC burden >3% in baseline 24-hour Holter monitoring. Bisoprolol and nebivolol was used to reduce symptom and burden of PVCs. The response to beta blocker was defined as the reduction of PVCs burden more than 50% in follow-up Holter monitoring. Baseline HRV was measured by time domain and frequency domain methods using 24-hour Holter monitoring. Results A total of 125 patients (mean age, 52.1 ± 14.7 years; male, 38.3%) underwent repeated 24-hour Holter monitoring were finally analyzed. Mean follow-up duration between the Holter monitoring was 205 ± 200 days. Among 125 patients with frequent PVCs, 45 patients had response to beta blockers. The ratio of low-frequency (LF) and high-frequency (HF) was higher in response group than those with non-response to beta blocker (P=0.016). LF, HF, and other variables measured by time-domain method were not associated with response to beta blocker. Conclusion The HRV value, especially LF/HF ratio, could predict the response to beta blockers in patients with idiopathic frequent PVCs.