PURPOSE: The most common causes of chronic cough include asthma, nonasthmatic eosinophilic bronchitis (NAEB), gastroesophageal reflux (GER) and upper airway cough syndrome in combination or alone. Nevertheless, its cause may remain unexplained in up to 33% of cases. There are some case reports on arrhythmia related chronic cough, however, prospective evaluation of large cohort of patients with premature ventricular complexes (PVC) has not been reported.The study evaluated incidence and management of PVC-induced chronic cough in pts with idiopathic ventricular arrhythmias.
METHODS: 120 consecutive pts referred for management of symptomatic PVC have prospectively been evaluated. The organic heart disease was excluded by medical history, ECHO and exercise test. A history of chronic cough was reported by 10 patients. In 6 relationship between PVC and cough was established. The PVC induced cough was recognized if cough episodes have occurred just after spontaneous or induced PVC, observed in ECG record. The association of PVCs and cough was shown also by multi-channel recording system with simultaneous ECG and cough recording (Hypno PTT). After confirmation of PVC-induced cough electrophysiologist-guided therapy was conducted to achieve complete disappearance of PVC. Pulmonologically oriented, differential diagnostics was performed including spirometry, methacholine provocation challenge, sputum induction for cytological analyses, sinus CT, videolaryngoscopy, 24 hours oesophageal pH monitoring.
RESULTS: 6 (5%) (6/6 women, mean age: 45±15) out of 120 patients with idiopathic PVC were diagnosed as PVC-induced cough. The symptoms lasted for 1.5±0.9 year. Intensity of cough decreased significantly during administration of effective antiarrhythmic treatment in 5/6 cases. Four patients were referred for invasive treatment due to drug intolerance or preference of curative treatment. The disappearance of PVC-induced cough was achieved immediately after successful percutaneous endocardial radiofrequency ablation of arrhythmogenic focus. During additional investigations proximal GER was found in 4/5 pts, reflux laryngitis in 4/4, NAEB in 5/6 and rhinitis in 3/6 pts.
CONCLUSION: PVC-induced cough should be considered in differential diagnosis of chronic cough.
CLINICAL IMPLICATIONS: Coexistence of other pathologies causing chronic cough make diagnostics and management of such patients difficult.
DISCLOSURE: Elzbieta Grabczak, No Product/Research Disclosure Information; No Financial Disclosure Information