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Penela D, Jáuregui B, Fernández-Armenta J, Aguinaga L, Tercedor L, Ordóñez A, Acosta J, Bisbal F, Vassanelli F, Teres C, Aceña M, Martí-Almor J, De Sensi F, Vatasescu R, Borràs R, Sánchez Millán P, Soto-Iglesias D, Oller Martínez G, Carballo J, Berruezo A. Influence of baseline QRS on the left ventricular ejection fraction recovery after frequent premature ventricular complex ablation. Europace 2020; 22:274-280. [DOI: 10.1093/europace/euz330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 12/05/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Frequent premature ventricular complexes (PVCs) can induce or worsen left ventricular systolic dysfunction. We aimed to investigate the influence of the baseline QRS in the response after PVC ablation in patients with depressed left ventricular ejection fraction (LVEF).
Methods and results
Two hundred and fifteen [59 ± 13 years old, 152 (71%) men] consecutive patients with left ventricular (LV) systolic dysfunction and frequent PVCs referred for ablation were included and followed-up for 12 months. Echocardiographic response was defined as an improvement of at least five absolute points in LVEF. Clinical, electrocardiogram, and electrophysiological characteristics were analysed. Mean baseline QRS duration was 110 ms [97–140]. Premature ventricular complex burden significantly decreased after ablation from 23% [16–33] at baseline to 1% [0–8] at 12 months, P < 0.001. Mean PVC burden reduction was 18 [8–30] points. There was a significant improvement of LVEF from 35% [29–40] at baseline to 44% [35–55] at 12 months, P < 0.001. One hundred and thirty (61%) patients were considered as echocardiographic responders. Baseline QRS duration (ms) [odds ratio (OR) 0.98 (0.97–0.99), P = 0.01] was an independent predictor of echocardiographic response. Mean LVEF improvement was 16 [10–21] points when the baseline QRS duration was <90 ms; 12 [4–20] when it was 90–110 ms; 5 [0–15] when it was 110 ± 130 ms; and 0 [0–6] points when it was >130 ms.
Conclusions
In patients with LV systolic dysfunction, intrinsic QRS duration is inversely related to the probability and the degree of echocardiographic response after frequent PVC ablation. Patients with a QRS duration >130 ms at baseline have the poorer response after ablation.
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Affiliation(s)
- Diego Penela
- Heart Institute, Teknon Medical Center, Barcelona, Spain
| | | | | | | | | | | | - Juan Acosta
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Felipe Bisbal
- Institut del Cor (iCor), Hospital Universitari Germans Trias i Pujol, Badalona, Spain, and Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Cheryl Teres
- Heart Institute, Teknon Medical Center, Barcelona, Spain
| | | | | | | | | | | | | | | | | | - Julio Carballo
- Heart Institute, Teknon Medical Center, Barcelona, Spain
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Yoon SS, Bang JH, Jeong SS, Jeong JH, Woo JS. Risk Factors of On-Pump Conversion during Off-Pump Coronary Artery Bypass Graft. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 50:355-362. [PMID: 29124027 PMCID: PMC5628963 DOI: 10.5090/kjtcs.2017.50.5.355] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/30/2016] [Accepted: 12/30/2016] [Indexed: 11/30/2022]
Abstract
Background Off-pump coronary artery bypass grafting (OPCABG) procedures can avoid the complications of an on-pump bypass. However, some cases unexpectedly require conversion to cardiopulmonary bypass during OPCABG. The risk factors associated with a sudden need for cardiopulmonary bypass were analyzed. Methods This retrospective study included 283 subjects scheduled for OPCABG from 2001 to 2010. These were divided into an OPCABG group and an on-pump conversion group. Preoperative, operative, and postoperative variables were compared between the 2 groups. Results Of the 283 patients scheduled for OPCABG, 47 (16%) were switched to on-pump coronary artery bypass grafting (CABG). The mortality of the both the OPCABG and on-pump conversion groups was not significantly different. The major risk factors for conversion to on-pump CABG were congestive heart failure (CHF) (odds ratio [OR], 3.5; p=0.029), ejection fraction (EF) <35% (OR, 4.4; p=0.012), and preoperative beta-blocker (BB) administration (OR, 0.3; p=0.007). The use of intraoperative (p=0.007) and postoperative (p=0.021) inotropics was significantly higher in the conversion group. The amount of postoperative drainage (p<0.001) and transfusion (p<0.001) also was significantly higher in the conversion group. There were no significant differences in stroke or cardiovascular complications between the groups over the course of short-term and long-term follow-up. Conclusion Patients who undergo OPCABG and have CHF or a lower EF (<35%) are more likely to undergo on-pump conversion, while preoperative BB administration could help prevent conversions from OPCABG to on-pump CABG.
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Affiliation(s)
- Sung Sil Yoon
- Department of Thoracic and Cardiovascular Surgery, Dong-A University College of Medicine
| | - Jung Hee Bang
- Department of Thoracic and Cardiovascular Surgery, Dong-A University College of Medicine
| | - Sang Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Dong-A University College of Medicine
| | - Jae Hwa Jeong
- Department of Thoracic and Cardiovascular Surgery, Dong-A University College of Medicine
| | - Jong Soo Woo
- Department of Thoracic and Cardiovascular Surgery, BHS Hanseo Hospital
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