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Attachaipanich T, Thiravetyan B, Tribuddharat N, Jaroonpipatkul S, Navaravong L. Premature Ventricular Contraction-Induced Cardiomyopathy: Contemporary Evidence from Risk Stratification, Pathophysiology, and Management. J Clin Med 2024; 13:2635. [PMID: 38731164 PMCID: PMC11084868 DOI: 10.3390/jcm13092635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/16/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
Premature ventricular complexes (PVCs) are commonly encountered problems in clinical settings. The range of symptoms can be from asymptomatic to palpitations, fatigue, or heart failure symptoms. A higher burden of PVCs is a risk factor for development of PVC-induced cardiomyopathy (PIC). Rhythm evaluation by 12-lead ECG and an ambulatory monitoring device are essential. Currently, several imaging modalities, such as echocardiography and cardiac magnetic resonance imaging, are utilized to evaluate the underlying structure that may be related to PIC. Beta blockers and antiarrhythmic drugs are typically part of the initial management strategy. If these fail, catheter ablation of PVCs is typically the next step. The purpose of this article is to summarize the current evidence/knowledge about PIC.
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Affiliation(s)
- Tanawat Attachaipanich
- Cardiac Electrophysiology Research and Training Center, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Ben Thiravetyan
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
| | | | - Surachat Jaroonpipatkul
- Division of Cardiology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok 10400, Thailand;
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Shoureshi P, Kabadi R, James N, Torrado JF, Airapetov S, Hundley W, Kaszala K, Ellenbogen KA, Tan AY, Huizar JF. Left ventricular remodeling in premature ventricular contraction-induced cardiomyopathy: Effect of coupling intervals and atrioventricular dissociation. Heart Rhythm O2 2023; 4:556-564. [PMID: 37744937 PMCID: PMC10513922 DOI: 10.1016/j.hroo.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Background Left ventricular dyssynchrony (LVD) and postextrasystolic potentiation (PESP) associated with premature ventricular contractions (PVCs) may play a role in the development of premature ventricular contraction-induced cardiomyopathy (PVC-CM). Long-coupled (LC) PVCs have a greater LVD than short-coupled (SC) PVCs, whereas SC-PVCs have a stronger PESP than LC-PVCs. Objective The purpose of this study was to compare SC-PVCs and LC-PVCs to evaluate the roles of LVD, PESP, and atrioventricular dissociation (AVD) in the development of PVC-CM. Methods Thirty-six canines underwent pacemaker implantation to induce bigeminal right ventricular apical epicardial PVCs (50% burden) for 12 weeks. Telemetry assessed PVC burden and AVD. Animals were grouped as SC-PVC (coupling interval [CI] 200-220ms), LC-PVC (CI 330 ms), or sham (control). Echocardiographic changes, AVD, and hemodynamics were monitored for 12 weeks. Results PVC burden was similar between SC-PVC and LC-PVC groups but was statistically higher in the SC-PVC group (50% vs 47.5%; P = .028). After 12 weeks, left ventricular ejection fraction (LVEF) significantly decreased in both SC-PVC and LC-PVC groups (47.1% ± 1.4% and 45.5% ± 2%, respectively) compared to sham group (61% ± 1.6%; P <.001). Overall AVD was similar between SC-PVC and LC-PVC groups, and there was no significant correlation between AVD and reduction in LVEF at 12 weeks (r = 0.09, P = .5; and r = 0.06, P = .8, respectively). Additionally, both SC-PVC and LC-PVC groups experienced substantial declines in max and min dP/dt after 12 weeks compared to baseline. Conclusion Neither PVC CI nor AVD played an independent role in the development or severity of PVC-CM. LVD and PESP make equal relative contributions to the development of PVC-CM.
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Affiliation(s)
- Pouria Shoureshi
- Department of Internal Medicine, Cardiology Division, Central Virginia VA Health Care System/McGuire Veterans Affairs Medical Center, Richmond, Virginia
- Department of Internal Medicine, Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Rajiv Kabadi
- Department of Internal Medicine, Cardiology Division, Central Virginia VA Health Care System/McGuire Veterans Affairs Medical Center, Richmond, Virginia
| | - Nicholas James
- Department of Internal Medicine, Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Juan F. Torrado
- Department of Internal Medicine, Cardiology Division, Central Virginia VA Health Care System/McGuire Veterans Affairs Medical Center, Richmond, Virginia
| | - Sergei Airapetov
- Department of Internal Medicine, Cardiology Division, Central Virginia VA Health Care System/McGuire Veterans Affairs Medical Center, Richmond, Virginia
- Department of Internal Medicine, Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - William Hundley
- Department of Internal Medicine, Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Karoly Kaszala
- Department of Internal Medicine, Cardiology Division, Central Virginia VA Health Care System/McGuire Veterans Affairs Medical Center, Richmond, Virginia
- Department of Internal Medicine, Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Kenneth A. Ellenbogen
- Department of Internal Medicine, Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Alex Y. Tan
- Department of Internal Medicine, Cardiology Division, Central Virginia VA Health Care System/McGuire Veterans Affairs Medical Center, Richmond, Virginia
- Department of Internal Medicine, Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Jose F. Huizar
- Department of Internal Medicine, Cardiology Division, Central Virginia VA Health Care System/McGuire Veterans Affairs Medical Center, Richmond, Virginia
- Department of Internal Medicine, Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
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Lampert J, Vaid A, Whang W, Koruth J, Miller MA, Langan MN, Musikantow D, Turagam M, Maan A, Kawamura I, Dukkipati S, Nadkarni GN, Reddy VY. A Novel ECG-Based Deep Learning Algorithm to Predict Cardiomyopathy in Patients With Premature Ventricular Complexes. JACC Clin Electrophysiol 2023; 9:1437-1451. [PMID: 37480862 DOI: 10.1016/j.jacep.2023.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Premature ventricular complexes (PVCs) are prevalent and, although often benign, they may lead to PVC-induced cardiomyopathy. We created a deep-learning algorithm to predict left ventricular ejection fraction (LVEF) reduction in patients with PVCs from a 12-lead electrocardiogram (ECG). OBJECTIVES This study aims to assess a deep-learning model to predict cardiomyopathy among patients with PVCs. METHODS We used electronic medical records from 5 hospitals and identified ECGs from adults with documented PVCs. Internal training and testing were performed at one hospital. External validation was performed with the others. The primary outcome was first diagnosis of LVEF ≤40% within 6 months. The dataset included 383,514 ECGs, of which 14,241 remained for analysis. We analyzed area under the receiver operating curves and explainability plots for representative patients, algorithm prediction, PVC burden, and demographics in a multivariable Cox model to assess independent predictors for cardiomyopathy. RESULTS Among the 14,241-patient cohort (age 67.6 ± 14.8 years; female 43.8%; White 29.5%, Black 8.6%, Hispanic 6.5%, Asian 2.2%), 22.9% experienced reductions in LVEF to ≤40% within 6 months. The model predicted reductions in LVEF to ≤40% with area under the receiver operating curve of 0.79 (95% CI: 0.77-0.81). The gradient weighted class activation map explainability framework highlighted the sinus rhythm QRS complex-ST segment. In patients who underwent successful PVC ablation there was a post-ablation improvement in LVEF with resolution of cardiomyopathy in most (89%) patients. CONCLUSIONS Deep-learning on the 12-lead ECG alone can accurately predict new-onset cardiomyopathy in patients with PVCs independent of PVC burden. Model prediction performed well across sex and race, relying on the QRS complex/ST-segment in sinus rhythm, not PVC morphology.
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Affiliation(s)
- Joshua Lampert
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Akhil Vaid
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - William Whang
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jacob Koruth
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marc A Miller
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marie-Noelle Langan
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel Musikantow
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mohit Turagam
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Abhishek Maan
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Iwanari Kawamura
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Srinivas Dukkipati
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Girish N Nadkarni
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Division of Data Driven and Digital Medicine (D3M), The Charles Bronfman Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Keles N, Kahraman E, Parsova KE, Bastopcu M, Karatas M, Yelgec NS. May myocardial work predict the risk of cardiomyopathy in patients with premature ventricular complex? Acta Cardiol 2023:1-7. [PMID: 37171274 DOI: 10.1080/00015385.2023.2209407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND An increased premature ventricular complex (PVC) frequency is related to an increased risk of cardiomyopathy. Changes in myocardial work (MW) parameters in patients with PVC may be a predictor of the development of cardiomyopathy. METHODS The study included 56 patients with PVC and 50 healthy volunteers as a control group. A comprehensive echocardiographic examination was done. A speckle tracking echocardiography was used to obtain the left ventricle (LV) global longitudinal strain (GLS). A bull's eye plot of the global MW index and the global work efficiency of 17 left ventricle segments with MW component values were generated. RESULTS Global work index (GWI), global constructive work (GCW), and global work efficiency (GWE) were significantly lower in the patient group (2377.84 ± 216.52 vs.1818.30 ± 283.73, 2734.00 ± 208.90 vs. 2283.73 ± 321.65, 92.48 ± 2.85 vs. 87.75 ± 3.87, respectively, all p values <0.001). Global wasted work (GWW) was significantly higher in the patient group (216.80 ± 26.86 vs. 302.13 ± 41.81, p < 0.001) Patients were compared according to the origin of PVCs. GWI, GCW, GWE were significantly lower and GWW was significantly higher in patients with PVC originating from the right ventricle or the epicardial region (p < 0.001). CONCLUSIONS Compared to healthy individuals, patients with PVC had lower GCW, GWI, GWE values and a higher GWW value than healthy individuals, similar to cardiomyopathy patients. Therefore, the detoriation in MW parameter in patients with PVC may be a predictor of cardiomyopathy development.
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Affiliation(s)
- Nursen Keles
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Erkan Kahraman
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | | | - Murat Bastopcu
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mesut Karatas
- Department of Cardiology, Kartal Kosuyolu Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Nizamettin Selcuk Yelgec
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Keles N, Kahraman E, Parsova KE, Bastopcu M, Karatas M, Yelgec NS. Could premature ventricular contractions lead to atrial remodeling? Echocardiography 2022; 39:1548-1554. [PMID: 36447258 DOI: 10.1111/echo.15485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/07/2022] [Accepted: 10/19/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Premature ventricular contraction (PVC) is a frequent kind of arrhythmia that affects around 1% of the general population. While PVC most frequently impairs ventricular function in structurally normal heart, retrograde ventriculo-atrial conduction can occur in people with PVC. These retrograde atrial activations may mimic pulmonary vein-derived atrial ectopies. As a result, PVC may raise the risk of atrial fibrillation (AF) by retrograde ventriculo-atrial conduction. The Four-Dimensional Automated Left Atrial Quantification (4D Auto LAQ) tool is a left atrial analytical approach that utilizes three-dimensional volume data to quantify the volume, as well as LA longitudinal and circumferential strains. The purpose of this study was to determine if clinical diagnosis of PVC is connected with abnormal LA function as determined by LA strain evaluation utilizing a 4D Auto LAQ compared to the healthy population. METHODS The 58 patients with frequent PVCs and 53 healthy volunteers as a control group were enrolled in the study. Imaging was performed using the GE Vivid E95 echocardiography equipment (GE Healthcare; Vingmed Ultrasound, Horten, Norway) equipped with an M5S probe (frequency range: 1.5-4.6 MHz) and a 4V probe (frequency range: 1.5-4.0 MHz). Images were imported into and were selected for analysis using the EchoPAC203 software (GE Healthcare). The analysis mode was selected, followed by the volume and 4D Auto LAQ submodes. Following that, the sample point was positioned in the center of the mitral orifice in each of the three planes. The review function was used to acquire the LA parameters measured by 4D Auto LAQ, including volume and strain parameters. RESULTS The maximum left atrial volume (LAVmax) and minimal left atrial volume (LAVmin) were significantly higher in the patient group (38.91 ± 9.72 vs. 46.31 ± 10.22, 17.75 ± 4.52 vs. 23.10 ± 7.13, respectively, all p values <.001). On the other hand left atrial reservoir longitudinal strain (LASr), conduit longitudinal strain (LAScd), contraction longitudinal strain (LASct), reservoir circumferential strain (LASr-c), conduit circumferential strain (LAScd-c), and contraction circumferential strain (LASct-c) were significantly lower in patient group (26.64 ± 5.64 vs.19.16 ± 4.58, -19.53 ± 3.72 vs. -11.28 ± 3.47, -10.34 ± 1.56 vs. -4.59 ± 1.49, 30.72 ± 4.04 vs. 19.31 ± 2.60, -19.91 ± 1.78 vs. -13.38 ± 2.85, -15.89 ± 6.37 vs. -9.24 ± 1.63, respectively, all p values <.001). CONCLUSIONS The present study found that premature ventricular complexes can lead to atrial remodeling as well as ventricular remodeling in patients with PVC and 4D LAQ technology can quantitatively examine left atrial function and determine these alterations early.
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Affiliation(s)
- Nursen Keles
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Erkan Kahraman
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | | | - Murat Bastopcu
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiovascular Surgery, University of Health Sciences, Istanbul, Turkey
| | - Mesut Karatas
- Kartal Kosuyolu Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Nizamettin Selcuk Yelgec
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
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Cojocaru C, Penela D, Berruezo A, Vatasescu R. Mechanisms, time course and predictability of premature ventricular contractions cardiomyopathy-an update on its development and resolution. Heart Fail Rev 2022; 27:1639-1651. [PMID: 34510326 DOI: 10.1007/s10741-021-10167-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 01/05/2023]
Abstract
Frequent premature ventricular contractions (PVCs) associated left ventricular systolic dysfunction (LVSD) is a well-known clinical scenario and numerous predictors for cardiomyopathy (CMP) development have been already thoroughly described. It may present as a "pure" form of dissynchrony-induced cardiomyopathy or it may be an aggravating component of a multifactorial structural heart disease. However, the precise risk to develop PVC-induced CMP (which would allow for tailored-patient monitoring and/or early treatment) and the degree of CMP reversibility after PVC suppression/elimination (which may permit appropriate candidate selection for therapy) are unclear. Moreover, there is limited data regarding the time course of CMP development and resolution after arrhythmia suppression. Even less known are the other components of PVC-induced CMP, such as right ventricular (RV) and atrial myopathies. This review targets to synthetize the most recent information in this regard and bring a deeper understanding of this heart failure scenario. The mechanisms, time course (both in experimental models and clinical experiences) and predictors of reverse-remodelling after arrhythmia suppression are described. The novel experience hereby presented may aid everyday clinical practice, promoting a new paradigm involving more complex, multi-level and multi-modality evaluation and possible earlier intervention at least in some patient subsets.
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Affiliation(s)
- C Cojocaru
- Clinical Emergency Hospital, Bucharest, Romania
| | - D Penela
- Heart Institute, Teknon Medical Centre, Barcelona, Spain
| | - Antonio Berruezo
- Medical Centre Teknon, Grupo Quironsalud, Barcelona, Spain. .,Heart Institute, Teknon Medical Centre, Barcelona, Spain.
| | - R Vatasescu
- Clinical Emergency Hospital, Bucharest, Romania
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Kowlgi GN, Tan AY, Kaszala K, Kontos MC, Lozano P, Ellenbogen KA, Huizar JF. Left ventricular dyssynchrony as marker of early dysfunction in premature ventricular contraction-induced cardiomyopathy. Front Cardiovasc Med 2022; 9:978341. [PMID: 36148047 PMCID: PMC9485544 DOI: 10.3389/fcvm.2022.978341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 08/03/2022] [Indexed: 01/16/2023] Open
Abstract
Background Strain imaging has been suggested as a tool to detect early left ventricular (LV) dysfunction due to frequent premature ventricular contractions (PVCs) in patients with preserved LV ejection fraction (EF). However, the progression of intraventricular dyssynchrony (IVD), radial, and circumferential strain (RS, CS) in PVC-cardiomyopathy (CM) are unknown. The aim of this study was to elucidate the progression patterns of CS, IVD, and electro-mechanical latency (EML) in PVC-CM. Methods and results Pacemakers were implanted in 20 canines to reproduce ventricular bigeminy at 200ms (PVCs n = 11) for 12 weeks and compared to a sham group (n = 9). We obtained echocardiograms at baseline, 4-, 8- and 12-weeks. RS and CS were obtained at the LV mid-cavitary level. IVD was defined as the time between the earliest and latest peak RS. EML was defined as the time between the onset of QRS and the earliest peak RS. LVEF (62 ± 5 to 42 ± 7%, p < 0.01), CS (-18 ± 3 to -12 ± 3, p < 0.01), and EML (219 ± 37 to 283 ± 46ms, p = 0.02) changed significantly in the PVC group. Peak CS (-18 ± 3 to -14 ± 4, p = 0.02) and IVD (49 ± 31 to 122 ± 103, p = 0.05) had a significant change at 4-weeks despite preserved LVEF (51 ± 5%). IVD normalized while EML increased at weeks 8 and 12. Conclusion Our findings consolidate the existing theory that changes in strain precede changes in LVEF in PVC-CM. While IVD becomes abnormal early in the development of PVC-CM, it pseudo-normalizes at advanced stages due to further increases in EML suggestive of cardiac contractility remodeling. These findings are consistent with recent published data where abnormal LV mechanics could be part of a substrate that can predispose to worse outcome in PVC-Cardiomyopathy.
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Affiliation(s)
- Gurukripa N. Kowlgi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Alex Y. Tan
- Division of Cardiovascular Diseases, Department of Internal Medicine, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, United States
| | - Karoly Kaszala
- Division of Cardiovascular Diseases, Department of Internal Medicine, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, United States
| | - Michael C. Kontos
- Division of Cardiovascular Diseases, Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States
| | - Pedro Lozano
- Department of Cardiovascular Diseases, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Kenneth A. Ellenbogen
- Division of Cardiovascular Diseases, Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States
| | - Jose F. Huizar
- Division of Cardiovascular Diseases, Department of Internal Medicine, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, United States,Division of Cardiovascular Diseases, Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States,*Correspondence: Jose F. Huizar, ; ;
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Cicenia M, Silvetti MS, Drago F. When Should Premature Ventricular Contractions Be Considered as a Red Flag in Children with Cardiomyopathy? J Cardiovasc Dev Dis 2021; 8:jcdd8120176. [PMID: 34940531 PMCID: PMC8707971 DOI: 10.3390/jcdd8120176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/02/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
Premature ventricular contractions (PVCs) are common and generally benign in childhood and tend to resolve spontaneously in most cases. When PVCs occur frequently, an arrhythmia-induced cardiomyopathy may be present requiring medical or catheter ablation. PVCs are only rarely the manifestation of a cardiomyopathy. The purpose of this review is to provide some tips and tricks to raise the suspicion of a cardiac disease based on the presence and characteristics of PVCs in children.
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Hadjis A, Frontera A, Limite LR, Lipartiti F, Tsitsinakis G, Vlachos K, Becker G, Sturmer M, Jaïs P, Hsia H, Gerstenfeld E, Della Bella P. Landing on the spot: Approaches to outflow tract PVCs; from ECG to EGMs to intracardiac echocardiography. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1449-1463. [PMID: 34081333 DOI: 10.1111/pace.14290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 04/30/2021] [Accepted: 05/30/2021] [Indexed: 11/30/2022]
Abstract
Premature ventricular complexes (PVCs) are increasingly recognized, as the use of ECG wearables becomes more widespread. In particular, PVCs arising from both the right ventricular outflow tract (RVOT) and left ventricular outflow tract (LVOT) comprise the majority of these arrhythmias and form a significant component of an electrophysiology practice. A keen understanding of the correlative anatomy of the outflow tracts, in addition to recognizing key ECG indices illustrating PVC sites of origin, are fundamental in preparing for a successful ablation. Patient selection, incorporating symptomatology, structural disease, and PVC burden can pose a challenge, though tools such as the ABC-VT risk score may help identify those patients with a higher risk of clinical deterioration. Utilizing intracardiac echocardiography to highlight salient anatomic features not visible with fluoroscopy allows for a more precise and safer ablation. Interpretation of intracardiac EGMs, and the careful examination for low amplitude highly fractionated pre-potentials, enhanced by the advent of new developed mapping/ablation catheters, remains crucial. Utilizing these tools will guide the electrophysiologist to an efficient and effective outflow tract PVC ablation.
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Affiliation(s)
- Alexios Hadjis
- Arrhythmology Department, IRCCS San Raffaele Hospital, Milan, Italy.,Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Antonio Frontera
- Arrhythmology Department, IRCCS San Raffaele Hospital, Milan, Italy
| | | | | | | | - Konstantinos Vlachos
- Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux and IHU-LIRYC, Pessac, France
| | - Giuliano Becker
- Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Marcio Sturmer
- Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Pierre Jaïs
- Hôpital Cardiologique du Haut Lévêque, CHU de Bordeaux and IHU-LIRYC, Pessac, France
| | - Henry Hsia
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Edward Gerstenfeld
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Doctor P, Balakrishnan P, Sriram C, Aggarwal S. Does Premature Ventricular Contractions Affect Exercise Capacity in Teenagers with Normal Hearts? Pediatr Cardiol 2021; 42:606-613. [PMID: 33394114 DOI: 10.1007/s00246-020-02521-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/04/2020] [Indexed: 11/30/2022]
Abstract
Premature ventricular contractions (PVCs) are common in teenagers even in the absence of structural heart disease or channelopathy. The suppression of PVCs with exercise is a favorable prognostic indicator. There is a paucity of data regarding the relationship between exercise capacity and PVC burden in this population. Our objective was to evaluate the association between various exercise stress parameters and PVC burden ascertained with a 24 h Holter in children without structural heart disease and/or channelopathy. In this retrospective study, 447 patient's charts with a diagnosis of PVC were reviewed at a single tertiary center. The study cohort consisted of ninety one patients with no structural heart disease or channelopathy who underwent an echocardiogram, maximal stress test, and 24 h Holter monitor. The cohort was divided into two groups based on PVC burden by 24-h Holter monitoring: < 10% and ≥ 10%. Peak oxygen uptake (VO2 in ml/kg/min), an indicator of maximal aerobic capacity, was collected. Other exercise parameters included a) percentage of predicted VO2 (%VO2) based on age, weight, height, and gender b) percent oxygen pulse, c) Anaerobic threshold (AT), and d) Metabolic equivalents. Demographic and exercise stress test-derived parameters were compared between the two groups using student t test and a p value < 0.05 was considered significant. In our cohort of 91 patients, the mean (SD) age at exercise was 14.5 (3.2) years with 56 (62%) males. Left ventricle shortening fraction (LVFS) was ≥ 28% in all enrolled patients. PVCs were monomorphic in 72(80%) patients. The mean (SD) PVC burden was 14.43% (12.3) ranging from 0.1 to 49.8%. PVC burden was ≥ 10% in 48 (53%) patients. Eighty eight (97%) patients in the study cohort had suppression of PVCs with exercise. There were no significant differences between the two groups (< 10% vs. ≥ 10% PVC burden) with respect to demographic or exercise test-derived parameters. Univariate regression between PVC burden and %VO2 did not show significant correlation (r = - 0.04, p = 0.75). Children even with ≥ 10% PVC burden did not demonstrate any objective decrease in their exercise capacity. A plausible reason for no difference in exercise capacity in our cohort may be due to lower PVC load or shorter duration of PVCs compared to adults.
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Affiliation(s)
- Pezad Doctor
- Department of Pediatrics, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA.
| | - Preetha Balakrishnan
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, 48201, USA
| | - Chenni Sriram
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, 48201, USA
| | - Sanjeev Aggarwal
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, 48201, USA
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Speckle Tracking Echocardiography in Pediatric Patients with Premature Ventricular Contractions. Pediatr Cardiol 2020; 41:1587-1593. [PMID: 32683524 DOI: 10.1007/s00246-020-02415-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/11/2020] [Indexed: 01/25/2023]
Abstract
Premature ventricular contractions (PVCs) in pediatric patients without structural heart disease and normal left ventricular systolic function rarely require therapy, though it is unknown whether these patients have subclinical cardiac dysfunction. Speckle tracking echocardiography is an additional means of evaluating cardiac function in asymptomatic pediatric PVC patients with normal standard measures of left ventricular (LV) function. Asymptomatic pediatric patients (< 21 years) without congenital heart disease, LV ejection fraction (LVEF) ≥ 55% and PVC burden ≥ 5% on 24-h Holter monitor were included. Demographic information, exercise stress test results, standard echocardiographic measures of LV systolic function and PVC morphology by 12-lead ECG were collected. Peak global systolic longitudinal strain (GLS) from apical four-chamber view was analyzed offline. 29 patients were identified (mean age 11.7 ± 5.8 years, 49.2 ± 25.3 kg, 59% male). Mean PVC burden was 12.0 ± 7.0% (range 5-37.5%). 14/29 (48%) had exercise stress testing with evidence of PVCs; 9/14 (64%) had PVC suppression at a mean heart rate (HR) of 160 ± 23 bpm and 5/14 (36%) did not suppress at a mean maximum HR of 188 ± 9 bpm. All patients had normal strain values by speckle tracking echocardiography (mean LV GLS - 22.5 ± 2.0%, LV global circumferential strain - 25.3 ± 3.9 and RV GLS - 24.1 ± 3.0%). There was no correlation between PVC burden and cardiac function parameters. Asymptomatic pediatric patients without structural heart disease, preserved LVEF/shortening fraction and PVC burden ≥ 5% demonstrated normal cardiac function including strain patterns indicating no evidence of subclinical cardiac dysfunction. Larger scale studies and longitudinal evaluation of left ventricular function using speckle tracking echocardiography is warranted in this population.
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Norby FL, Alonso A, Rooney MR, Maheshwari A, Koene RJ, Zhang M, Soliman EZ, Loehr LR, Mosley T, Gottesman RF, Coresh J, Chen LY. Association of Ventricular Arrhythmias With Dementia: The Atherosclerosis Risk in Communities (ARIC) Study. Neurology 2020; 96:e926-e936. [PMID: 33106393 DOI: 10.1212/wnl.0000000000011122] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 10/12/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE We performed a cross-sectional analysis to determine whether nonsustained ventricular tachycardia (NSVT) and premature ventricular contractions (PVCs) were associated with dementia in a population-based study. METHODS We included 2,517 (mean age 79 years, 26% Black) participants who wore a 2-week ambulatory continuous ECG recording device in 2016 to 2017. NSVT was defined as a wide-complex tachycardia ≥4 beats with a rate >100 bpm. We calculated NSVT and PVC burden as the number of episodes per day. Dementia was adjudicated by experts. We used logistic regression to assess the associations of NSVT and PVCs with dementia. RESULTS The mean recording time of the Zio XT Patch was 12.6 ± 2.6 days. There were 768 (31%) participants with NSVT; prevalence was similar in White and Black participants. There were 134 (6.5%) dementia cases (5% in White, 10% in Black participants). After multivariable adjustment, there was no overall association between NSVT and dementia; however, there was a significant race interaction (p < 0.001). In Black participants, NSVT was associated with a 3.67 times higher adjusted odds of dementia (95% confidence interval [CI] 1.92-7.02) compared to those without NSVT, whereas in White participants NSVT was not associated with dementia (odds ratio [95% CI] 0.64 [0.37-1.10]). In Black participants only, a higher burden of PVCs was associated with dementia. CONCLUSIONS Presence of NSVT and a higher burden of NSVT and PVCs are associated with dementia in elderly Black people. Further research to confirm this novel finding and to elucidate the underlying mechanisms is warranted.
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Affiliation(s)
- Faye L Norby
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Alvaro Alonso
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Mary R Rooney
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Ankit Maheshwari
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Ryan J Koene
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Michael Zhang
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Elsayed Z Soliman
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Laura R Loehr
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Thomas Mosley
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Rebecca F Gottesman
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Josef Coresh
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
| | - Lin Y Chen
- From the Division of Epidemiology and Community Health (F.L.N.), School of Public Health, University of Minnesota, Minneapolis; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology (M.R.R., J.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Penn State Heart and Vascular Institute (A.M.), Penn State College of Medicine, Hershey, PA; Aultman Medical Group (R.J.K.), Aultman Hospital, Canton, OH; Cardiac Arrhythmia Center (M.Z., L.Y.C.), Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis; Department of Epidemiology (E.Z.S.), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (L.R.L.), School of Medicine, University of North Carolina at Chapel Hill; Department of Medicine (T.M.), University of Mississippi Medical Center, Jackson; and Departments of Neurology and Epidemiology (R.F.G.), Johns Hopkins University, Baltimore, MD
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Abstract
Premature ventricular contractions (PVCs) are a common arrhythmia that may cause symptoms of variable severity. PVCs have recently garnered interest in their ability to induce adverse structural heart remodeling in an entity known as PVC-induced cardiomyopathy. This entity is a retrospective diagnosis that likely remains under-recognized and may occur concurrently with other forms of cardiomyopathy. The appropriate identification and management of PVCs in the setting of associated cardiomyopathy may have a significant impact on cardiac function and the clinical course, including recovery of left ventricular ejection fraction and improvement in patient functional status. Treatment consists of catheter ablation and/or antiarrhythmic drug therapy, but continued monitoring and follow-up are required, as the recurrence of high PVC burden may lead to redevelopment of cardiomyopathy.
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14
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Kafantaris E, Piper I, Lo TYM, Escudero J. Application of Dispersion Entropy to Healthy and Pathological Heartbeat ECG Segments. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:2269-2272. [PMID: 31946352 DOI: 10.1109/embc.2019.8856554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Entropy quantification algorithms are a prominent tool for the quantification of irregularity in biological signal segments towards the characterization of the physiological state of individuals. This paper investigates the potential of Dispersion Entropy (DisEn) as a non-linear method to quantify the uncertainty of ECG signal segments for different types of heartbeats and the stratification of healthy heartbeats for the potential detection of developing pathologies in individuals. Our results indicate that the DisEn algorithm produces distributions with significant differences for the considered types of heartbeats, with higher DisEn values being more prominent in pathological heartbeats and normal heartbeats preceding them. This suggests that, with further research, DisEn algorithms can be integrated with heartbeat detection and classification algorithms for the improvement of medical prognosis through ECG signal processing.
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15
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Sharma N, Cortez D, Imundo JR. High burden of premature ventricular contractions in structurally normal hearts: To worry or not in pediatric patients? Ann Noninvasive Electrocardiol 2019; 24:e12663. [PMID: 31199031 DOI: 10.1111/anec.12663] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/22/2019] [Accepted: 05/04/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND There is paucity of data regarding the significance of high percentage of premature ventricular contractions (PVCs) in healthy children and their impact on left ventricular (LV) function and the risk of ventricular arrhythmias. The purpose of this study was to assess the prevalence of LV systolic dysfunction in children with frequent PVCs and determine whether PVC characteristics were predictive of LV dysfunction. METHODS We performed a single-center retrospective review to examine the prevalence of PVC-induced cardiomyopathy and natural history of PVC burden in children with frequent PVCs. Children aged 6 months-21 years with PVCs noted on 24-hr Holter monitoring studies were enrolled. The four categories included those with a PVC burden of >10%, 10%-20%, and those with more than 20% PVC burden. RESULTS A total of 134 children were included, 65 with more than 10% PVCs and 31 with more than 20% PVCs. Median age of the patients was 10.5 years (IQR 6.1-14.8 years), with 79 males (54.5%). Median PVC burden was 8.7% (IQR 4.2%-16.9%) with median follow-up of 2.8 years (IQR 1.2-4.6 years). During 2.8 years (1.3-4.3 years) of follow-up, the PVC burden decreased by 67% of baseline PVC burden in those who did not undergo any intervention. There were no deaths. CONCLUSION PVCs in children with structurally normal hearts are associated with a relatively benign course, with trend toward spontaneous resolution.
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Affiliation(s)
- Nandita Sharma
- Division of Pediatric Cardiology, Department of Pediatrics, Penn State Children's Hospital, Hershey, Pennsylvania.,Pediatric Cardiology, University of Minnesota/Masonic Children's Hospital, Minneapolis, Minnesota
| | - Daniel Cortez
- Pediatric Cardiology, University of Minnesota/Masonic Children's Hospital, Minneapolis, Minnesota.,Clinical Sciences, University of Lund, Lund, Sweden.,Penn State Milton S. Center, Heart and Vascular Institute, Hershey, Pennsylvania
| | - Jason R Imundo
- Division of Pediatric Cardiology, Department of Pediatrics, Penn State Children's Hospital, Hershey, Pennsylvania
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17
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Billet S, Rollin A, Mondoly P, Monteil B, Fournier P, Cariou E, Blaye-Felice MS, Galinier M, Carrié D, Lairez O, Delmas C, Maury P. Hemodynamic consequences of premature ventricular contractions: Association of mechanical bradycardia and postextrasystolic potentiation with premature ventricular contraction-induced cardiomyopathy. Heart Rhythm 2018; 16:853-860. [PMID: 30550835 DOI: 10.1016/j.hrthm.2018.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND The relationships between hemodynamic consequences of premature ventricular contractions (PVCs) and development of premature ventricular contraction-induced cardiomyopathy (PVC-CM) have not been investigated. OBJECTIVE The purpose of this study was to correlate concealed mechanical bradycardia and/or postextrasystolic potentiation (PEP) to PVC-CM. METHODS Invasive arterial pressure measurements from 17 patients with PVC-CM and 16 controls with frequent PVCs were retrospectively analyzed. PVCs were considered efficient (ejecting PVCs) when generating a measurable systolic arterial pressure. PEP was defined by a systolic arterial pressure of the post-PVC beat ≥5 mm Hg higher than the preceding sinus beat. Every PVC was analyzed for 10 minutes before ablation, and the electromechanical index (EMi = number of ejecting PVCs/total PVC) and postextrasystolic potentiation index (PEPi = number of PVCs with PEP/total PVC) were calculated. RESULTS EMi was 29% ± 31% in PVC-CM and 78% ± 20% in controls (P <.0001). PEPi was 41% ± 28% in PVC-CM and 14% ± 10% in controls (P = .001). There was no control in groups of low EMi or high PEPi. EMi and PEPi were not significantly correlated to left ventricular dimensions or function in PVC-CM patients. PVC coupling interval was related to both ejecting PVCs and PEP. CONCLUSION Patients with PVC-CM more often display nonejecting PVCs and PEP compared to controls.
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Affiliation(s)
- Sophie Billet
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Anne Rollin
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Pierre Mondoly
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Benjamin Monteil
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Pauline Fournier
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Eve Cariou
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | | | - Michel Galinier
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Clément Delmas
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France; Unité Inserm U 1048, Toulouse, France.
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Cardiac function in children with premature ventricular contractions: the effect of omega-3 polyunsaturated fatty acid supplementation. Cardiol Young 2018; 28:949-954. [PMID: 29759092 DOI: 10.1017/s1047951118000574] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Premature ventricular contractions are accepted as benign in structurally normal hearts. However, reversible cardiomyopathy can sometimes develop. Omega-3 polyunsaturated fatty acids have anti-arrhythmic properties in animals and humans.AimWe evaluated left ventricular function in children with premature ventricular contractions with normal cardiac anatomy and assessed the impact of omega-3 fatty acid supplementation on left ventricular function in a prospective trial. METHODS A total of 25 patients with premature ventricular contraction, with more than 2% premature ventricular contractions on 24-hour Holter electrocardiography, and 30 healthy patients were included into study. All patients underwent electrocardiography, left ventricular M-mode echocardiography, and myocardial performance index testing. Patients with premature ventricular contraction were given omega-3 fatty acids at a dose of 1 g/day for 3 months, and control echocardiography and 24-hour Holter electrocardiography were performed. Neither placebo nor omega-3 fatty acids were given to the control group. RESULTS Compared with the values of the control group, the patients with premature ventricular contraction had significantly lower fractional shortening. The myocardial performance index decreased markedly in the patient groups. The mean heart rate and mean premature ventricular contraction percentage of Group 2 significantly decreased in comparison with their baseline values after the omega-3 supplementation. CONCLUSION In conclusion, premature ventricular contractions can lead to systolic cardiac dysfunction in children. Omega-3 supplementation may improve cardiac function in children with premature ventricular contractions. This is the first study conducted in children to investigate the possible role of omega-3 fatty acid supplementation on treatment of premature ventricular contractions.
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Ip JE, Lerman BB. Idiopathic malignant premature ventricular contractions. Trends Cardiovasc Med 2018; 28:295-302. [DOI: 10.1016/j.tcm.2017.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/01/2017] [Accepted: 11/20/2017] [Indexed: 10/18/2022]
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Polymorphism, coupling interval and prematurity index in dogs with degenerative mitral valve disease and ventricular arrhythmias. Vet Res Commun 2018. [DOI: 10.1007/s11259-018-9718-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Panizo JG, Barra S, Mellor G, Heck P, Agarwal S. Premature Ventricular Complex-induced Cardiomyopathy. Arrhythm Electrophysiol Rev 2018; 7:128-134. [PMID: 29967685 DOI: 10.15420/aer.2018.23.2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Premature ventricular complex-induced cardiomyopathy is a potentially reversible condition in which left ventricular dysfunction is induced by the occurrence of frequent premature ventricular complexes (PVCs). Various cellular and extracellular mechanisms and risk factors for developing cardiomyopathy in this context have been suggested but the exact pathophysiological mechanism remains unclear. The suppression of PVCs is usually indicated in symptomatic patients with frequent PVCs and also those with left ventricular dysfunction. Antiarrhythmic drugs are a useful non-invasive treatment to eliminate PVCs, but the side effect profile, including the risk of pro-arrhythmia, along with suboptimal clinical effectiveness, should be weighed against the usually more effective but not risk-free treatment with catheter ablation. The latter has progressively become first line therapy in many patients with PVC-induced cardiomyopathy and should be particularly considered in specific scenarios.
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Affiliation(s)
- Jorge G Panizo
- Royal Papworth Hospital NHS Foundation Trust, Cambridge University Health Partners Cambridge, UK
| | - Sergio Barra
- Royal Papworth Hospital NHS Foundation Trust, Cambridge University Health Partners Cambridge, UK
| | - Greg Mellor
- Royal Papworth Hospital NHS Foundation Trust, Cambridge University Health Partners Cambridge, UK
| | - Patrick Heck
- Royal Papworth Hospital NHS Foundation Trust, Cambridge University Health Partners Cambridge, UK
| | - Sharad Agarwal
- Royal Papworth Hospital NHS Foundation Trust, Cambridge University Health Partners Cambridge, UK
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Risk factor algorithm used to predict frequent premature ventricular contraction-induced cardiomyopathy. Int J Cardiol 2017; 233:37-42. [DOI: 10.1016/j.ijcard.2017.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 12/21/2016] [Accepted: 02/01/2017] [Indexed: 11/17/2022]
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Bertels RA, Harteveld LM, Filippini LH, Clur SA, Blom NA. Left ventricular dysfunction is associated with frequent premature ventricular complexes and asymptomatic ventricular tachycardia in children. Europace 2017; 19:617-621. [PMID: 28431063 DOI: 10.1093/europace/euw075] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 03/05/2016] [Indexed: 01/08/2023] Open
Abstract
AIMS To assess the risk factors for left ventricular (LV) dysfunction in a paediatric population with idiopathic frequent premature ventricular contractions (PVCs) and asymptomatic ventricular tachycardias (VTs). METHODS AND RESULTS Paediatric patients with the diagnosis of idiopathic frequent PVCs and asymptomatic VTs were retrospectively evaluated. Frequent PVCs were defined as ≥5% on 24 h Holter recording. Left ventricular dysfunction was defined as a shortening fraction of ≤28%. Seventy-two children were identified. Six patients showed LV dysfunction at diagnosis [age 10 ± 7 years, 2 (33%) had symptoms such as syncope, palpitations, fatigue, and dizziness], and 66 showed normal LV function [age 8 ± 6 years, 22 (33%) with symptoms]. Patients with LV dysfunction had a higher percentage of PVCs on Holter recordings (47 ± 16 vs. 16 ± 11%, P = 0.006), higher prevalence of VT [5 (83%) vs. 27 (41%), P = 0.045] and sustained ventricular tachycardia (sVT) [3 (50%) vs. 4 (6%), P = 0.001], and a higher number of couplets [6 (100%) vs. 34 (52%), P = 0.030]. In patients with LV dysfunction, two responded to medication (Classes Ic and II) and five underwent ablation, of which one was unsuccessful. During follow-up, LV function normalized in five of six patients. In patients with a normal function, none developed LV dysfunction during the follow-up. CONCLUSION In children with idiopathic PVCs and asymptomatic VTs, development of LV dysfunction is associated with a higher burden of PVCs, the presence of sVTs, and couplets. Left ventricular dysfunction appears to be reversible if the burden of PVCs is decreased by medication or ablation.
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Affiliation(s)
- R A Bertels
- The Center for Congenital Heart Disease Amsterdam-Leiden, Leiden, The Netherlands
- Department of Pediatric Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
| | - L M Harteveld
- The Center for Congenital Heart Disease Amsterdam-Leiden, Leiden, The Netherlands
- Department of Pediatric Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
| | - L H Filippini
- The Center for Congenital Heart Disease Amsterdam-Leiden, Leiden, The Netherlands
- Department of Pediatric Cardiology, Juliana Children's Hospital, The Hague, The Netherlands
| | - S A Clur
- The Center for Congenital Heart Disease Amsterdam-Leiden, Leiden, The Netherlands
- Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - N A Blom
- The Center for Congenital Heart Disease Amsterdam-Leiden, Leiden, The Netherlands
- Department of Pediatric Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
- Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, The Netherlands
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Abadir S, Blanchet C, Fournier A, Mawad W, Shohoudi A, Dahdah N, Khairy P. Characteristics of premature ventricular contractions in healthy children and their impact on left ventricular function. Heart Rhythm 2016; 13:2144-2148. [DOI: 10.1016/j.hrthm.2016.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Indexed: 11/25/2022]
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Zavadovsky KV, Saushkin VV, Khlynin MS, Popov SV, Lishmanov YB. Radionuclide Assessment of Cardiac Function and Dyssynchrony in Children with Idiopathic Ventricular Tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:1213-1224. [PMID: 27662633 DOI: 10.1111/pace.12948] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 06/15/2016] [Accepted: 08/23/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of the study was to evaluate the impact of idiopathic ventricular tachycardia and premature ventricular beats on cardiac function and dyssynchrony and to elucidate relationships between data of scintigraphic and intracardiac electrophysiology studies (EPSs). METHODS The study comprised 64 patients with idiopathic ventricular arrhythmias (VAs; median age of 14 years ranging from 8 to 18 years). The control group comprised 20 patients (median age of 12 ranging from 7 to 16 years) without cardiac arrhythmias. EPS and radiofrequency ablation (RFA) procedure for VA were performed in 21 children according to indications. The functional state of both ventricles was assessed by gated blood pool single photon emission computer tomography (GBP-SPECT) before and after RFA in all patients. RESULTS Patients with VA had local areas of asynchronous myocardial contraction (AMC). Compared with the control group, VA patients had significantly higher values of end-diastolic volume, end-systolic volume, and lower contractility indices. Negative association was found between total numbers of AMC areas and cardiac contractility indices. Ectopic foci localization, determined based on EPS data, was associated with AMC areas topography based on GBP-SPECT. RFA procedure significantly improved cardiac contractility indices; AMC areas completely disappeared or decreased compared with the preoperative conditions. CONCLUSION In VA patients, AMC areas were localized mostly in the right ventricle. Comparison of the results of GBP-SPECT and EPS studies showed a relationship between AMC localizations and ectopic foci topography. The fact that AMC areas disappeared after RFA supports the hypothesis stating that the presence of AMC areas is a scintigraphic symptom of ectopic focus.
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Affiliation(s)
- Konstantin V Zavadovsky
- Nuclear Medicine Department, Federal State Budgetary Scientific Institution "Research Institute for Cardiology", Tomsk, Russia.,National Research Tomsk Polytechnic University, Russian Federation, Tomsk, Russia
| | - Victor V Saushkin
- Nuclear Medicine Department, Federal State Budgetary Scientific Institution "Research Institute for Cardiology", Tomsk, Russia
| | - Mikhail S Khlynin
- Department of Surgical Treatment of Cardiac Rhythm Disorders and Pacing, Federal State Budgetary Scientific Institution "Research Institute for Cardiology", Tomsk, Russia
| | - Sergey V Popov
- Department of Surgical Treatment of Cardiac Rhythm Disorders and Pacing, Federal State Budgetary Scientific Institution "Research Institute for Cardiology", Tomsk, Russia
| | - Yuri B Lishmanov
- Nuclear Medicine Department, Federal State Budgetary Scientific Institution "Research Institute for Cardiology", Tomsk, Russia.,National Research Tomsk Polytechnic University, Russian Federation, Tomsk, Russia
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Martin AP, Skinner JR. Ventricular extrasystoles and ventricular dysfunction: Too close for comfort? Heart Rhythm 2016; 13:2149-2150. [PMID: 27496585 DOI: 10.1016/j.hrthm.2016.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Andrew P Martin
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Jonathan R Skinner
- Cardiac Inherited Disease Group, Auckland City Hospital, Auckland, New Zealand; Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand; Department of Child Health, University of Auckland, Auckland, New Zealand.
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Tran CT, Calkins H. Premature ventricular contraction-induced cardiomyopathy: an emerging entity. Expert Rev Cardiovasc Ther 2016; 14:1227-1234. [PMID: 27531417 DOI: 10.1080/14779072.2016.1222901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Over the past 10-15 years, there has been an increasing amount of evidence that frequent premature ventricular contractions (PVCs) are associated with the development of a reversible cardiomyopathy. Areas covered: This review considers current evidence of the association between PVCs and the development of cardiomyopathy, risk factors, and available treatment modalities based on available published literature. Expert commentary: The field is rapidly evolving, although evidence is based primarily on observational studies. Pharmacological therapy may suppress PVCs and lead to resolution of cardiomyopathy in many patients. In addition, catheter ablation has emerged as an effective treatment modality that has compared favorably to pharmacological antiarrhythmic therapy. The excellent outcome in successfully treated patients should prompt physicians to consider whether frequent PVCs may be a contributing factor in patients with heart failure.
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Affiliation(s)
- Cao Thach Tran
- a Division of Cardiology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Hugh Calkins
- a Division of Cardiology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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28
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Chantepie A, Soulé N, Poinsot J, Labarthe F, Lefort B. Myocardiopathie rythmique induite par des extrasystoles ventriculaires chez un enfant. Arch Pediatr 2016; 23:742-6. [DOI: 10.1016/j.arcped.2016.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/26/2016] [Accepted: 04/21/2016] [Indexed: 10/21/2022]
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Abstract
BACKGROUND Adults with high premature ventricular contraction burden can develop left ventricular dilation, dysfunction, and strain, consistent with a cardiomyopathy, which is reversible with radiofrequency ablation of the premature ventricular contractions. Evidence in children with similar ectopy burden is limited. We performed a single-centre retrospective review to examine the prevalence of premature ventricular contraction-induced cardiomyopathy, natural history of ventricular ectopy, and progression to ventricular tachycardia in children with frequent premature ventricular contractions. METHODS Children aged between 6 months and 18 years, with premature ventricular contractions comprising at least 20% of rhythm on 24-hour Holter monitor, were included in our study. Those with significant structural heart disease, ventricular tachycardia greater than 1% of rhythm at the time of premature ventricular contraction diagnosis, or family history of cardiomyopathy - except tachycardia-induced - were excluded. Cardiomyopathy was defined by echocardiographic assessment. RESULTS A total of 36 children met the study criteria; seven patients (19.4%, 95% CI 6.2-32.6%) met the criteria for cardiomyopathy, mostly at initial presentation. Ectopy decreased to <10% of beats without intervention in 16.7% (95% CI 4.3-29.1%) of the patients. No patient progressed to having ventricular tachycardia as more than 1% of beats on follow-up Holter. Radiofrequency ablation was performed in three patients without cardiomyopathy. CONCLUSIONS Our study demonstrates a higher prevalence of cardiomyopathy among children with high premature ventricular contraction burden than that previously shown. Ectopy tended to persist throughout follow-up. These trends suggest the need for a multi-centre study on frequent premature ventricular contractions in children. In the interim, regular follow-up with imaging to evaluate for cardiomyopathy is warranted.
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Contijoch F, Rogers K, Rears H, Shahid M, Kellman P, Gorman J, Gorman RC, Yushkevich P, Zado ES, Supple GE, Marchlinski FE, Witschey WRT, Han Y. Quantification of Left Ventricular Function With Premature Ventricular Complexes Reveals Variable Hemodynamics. Circ Arrhythm Electrophysiol 2016; 9:e003520. [PMID: 27009416 PMCID: PMC4807630 DOI: 10.1161/circep.115.003520] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 02/19/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Premature ventricular complexes (PVCs) are prevalent in the general population and are sometimes associated with reduced ventricular function. Current echocardiographic and cardiovascular magnetic resonance imaging techniques do not adequately address the effect of PVCs on left ventricular function. METHODS AND RESULTS Fifteen subjects with a history of frequent PVCs undergoing cardiovascular magnetic resonance imaging had real-time slice volume quantification performed using a 2-dimensional (2D) real-time cardiovascular magnetic resonance imaging technique. Synchronization of 2D real-time imaging with patient ECG allowed for different beats to be categorized by the loading beat RR duration and beat RR duration. For each beat type, global volumes were quantified via summation over all slices covering the entire ventricle. Different patterns of ectopy, including isolated PVCs, bigeminy, trigeminy, and interpolated PVCs, were observed. Global functional measurement of the different beat types based on timing demonstrated differences in preload, stroke volume, and ejection fraction. An average of hemodynamic function was quantified for each subject depending on the frequency of each observed beat type. CONCLUSIONS Application of real-time cardiovascular magnetic resonance imaging in patients with PVCs revealed differential contribution of PVCs to hemodynamics.
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Affiliation(s)
- Francisco Contijoch
- From the Department of Bioengineering (F.C.), Cardiovascular Division, Department of Medicine (K.R., E.S.Z., G.E.S., F.E.M., Y.H.), Department of Radiology (H.R., M.S., P.Y., W.R.T.W.), and Department of Surgery (J.G., R.C.G.), University of Pennsylvania, Philadelphia; and Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.).
| | - Kelly Rogers
- From the Department of Bioengineering (F.C.), Cardiovascular Division, Department of Medicine (K.R., E.S.Z., G.E.S., F.E.M., Y.H.), Department of Radiology (H.R., M.S., P.Y., W.R.T.W.), and Department of Surgery (J.G., R.C.G.), University of Pennsylvania, Philadelphia; and Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.)
| | - Hannah Rears
- From the Department of Bioengineering (F.C.), Cardiovascular Division, Department of Medicine (K.R., E.S.Z., G.E.S., F.E.M., Y.H.), Department of Radiology (H.R., M.S., P.Y., W.R.T.W.), and Department of Surgery (J.G., R.C.G.), University of Pennsylvania, Philadelphia; and Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.)
| | - Mohammed Shahid
- From the Department of Bioengineering (F.C.), Cardiovascular Division, Department of Medicine (K.R., E.S.Z., G.E.S., F.E.M., Y.H.), Department of Radiology (H.R., M.S., P.Y., W.R.T.W.), and Department of Surgery (J.G., R.C.G.), University of Pennsylvania, Philadelphia; and Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.)
| | - Peter Kellman
- From the Department of Bioengineering (F.C.), Cardiovascular Division, Department of Medicine (K.R., E.S.Z., G.E.S., F.E.M., Y.H.), Department of Radiology (H.R., M.S., P.Y., W.R.T.W.), and Department of Surgery (J.G., R.C.G.), University of Pennsylvania, Philadelphia; and Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.)
| | - Joseph Gorman
- From the Department of Bioengineering (F.C.), Cardiovascular Division, Department of Medicine (K.R., E.S.Z., G.E.S., F.E.M., Y.H.), Department of Radiology (H.R., M.S., P.Y., W.R.T.W.), and Department of Surgery (J.G., R.C.G.), University of Pennsylvania, Philadelphia; and Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.)
| | - Robert C Gorman
- From the Department of Bioengineering (F.C.), Cardiovascular Division, Department of Medicine (K.R., E.S.Z., G.E.S., F.E.M., Y.H.), Department of Radiology (H.R., M.S., P.Y., W.R.T.W.), and Department of Surgery (J.G., R.C.G.), University of Pennsylvania, Philadelphia; and Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.)
| | - Paul Yushkevich
- From the Department of Bioengineering (F.C.), Cardiovascular Division, Department of Medicine (K.R., E.S.Z., G.E.S., F.E.M., Y.H.), Department of Radiology (H.R., M.S., P.Y., W.R.T.W.), and Department of Surgery (J.G., R.C.G.), University of Pennsylvania, Philadelphia; and Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.)
| | - Erica S Zado
- From the Department of Bioengineering (F.C.), Cardiovascular Division, Department of Medicine (K.R., E.S.Z., G.E.S., F.E.M., Y.H.), Department of Radiology (H.R., M.S., P.Y., W.R.T.W.), and Department of Surgery (J.G., R.C.G.), University of Pennsylvania, Philadelphia; and Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.)
| | - Gregory E Supple
- From the Department of Bioengineering (F.C.), Cardiovascular Division, Department of Medicine (K.R., E.S.Z., G.E.S., F.E.M., Y.H.), Department of Radiology (H.R., M.S., P.Y., W.R.T.W.), and Department of Surgery (J.G., R.C.G.), University of Pennsylvania, Philadelphia; and Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.)
| | - Francis E Marchlinski
- From the Department of Bioengineering (F.C.), Cardiovascular Division, Department of Medicine (K.R., E.S.Z., G.E.S., F.E.M., Y.H.), Department of Radiology (H.R., M.S., P.Y., W.R.T.W.), and Department of Surgery (J.G., R.C.G.), University of Pennsylvania, Philadelphia; and Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.)
| | - Walter R T Witschey
- From the Department of Bioengineering (F.C.), Cardiovascular Division, Department of Medicine (K.R., E.S.Z., G.E.S., F.E.M., Y.H.), Department of Radiology (H.R., M.S., P.Y., W.R.T.W.), and Department of Surgery (J.G., R.C.G.), University of Pennsylvania, Philadelphia; and Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.)
| | - Yuchi Han
- From the Department of Bioengineering (F.C.), Cardiovascular Division, Department of Medicine (K.R., E.S.Z., G.E.S., F.E.M., Y.H.), Department of Radiology (H.R., M.S., P.Y., W.R.T.W.), and Department of Surgery (J.G., R.C.G.), University of Pennsylvania, Philadelphia; and Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.)
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Abstract
Long-standing tachycardia is a well-recognised cause of heart failure and left ventricular dysfunction, and has led to the nomenclature, tachycardia-induced cardiomyopathy (TIC). TIC is generally a reversible cardiomyopathy if the causative tachycardia can be treated effectively, either with medications, surgery or catheter ablation. The diagnosis is usually made after demonstrating recovery of left ventricular function with normalisation of heart rate in the absence of other identifiable aetiologies. One hundred years after the first reported case of TIC, our understanding of the pathophysiology of TIC in humans remains limited despite extensive work in animal models of TIC. In this review we will discuss the proposed mechanisms of TIC, the causative tachyarrhythmias and their treatment, outcomes for patients diagnosed with TIC, and future directions for research and clinical care.
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Affiliation(s)
- Ethan R Ellis
- Clinical Fellow, Harvard Medical School, Beth Israel Deaconess Medical Center
| | - Mark E Josephson
- Herman C. Dana Professor of Medicine, Harvard Medical School, Chief of the Cardiovascular Division, Beth Israel Deaconess Medical Center and Director, Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Beth Israel Deaconess Medical Center, Boston, US
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Xu W, Li M, Chen M, Yang B, Wang D, Kong X, Chen H, Ju W, Gu K, Cao K, Liu H, Jiang Q, Shi J, Cui Y, Wang H. Effect of burden and origin sites of premature ventricular contractions on left ventricular function by 7-day Holter monitor. J Biomed Res 2015; 29:465-74. [PMID: 26668581 PMCID: PMC4662208 DOI: 10.7555/jbr.29.20150032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/10/2015] [Accepted: 06/10/2015] [Indexed: 11/10/2022] Open
Abstract
Recent studies have shown that premature ventricular contractions (PVCs) could enlarge the heart, but its risk factors are incompletely understood as a single 24-hour recording cannot reflect the true PVC burden due to day-to-day variability. Our purpose was to investigate the effect of burden and origin sites on left ventricular (LV) function in patients with PVCs by 7-day Holter electrocardiography (ECG). From May 2012 to August 2013, 112 consecutive patients with PVCs were recruited from the authors' affiliated hospital. All patients received 2-dimensional transthoracic echocardiography, 12-lead routing ECG and 7-days Holter ECG. Serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were measured. A total of 102 participants with PVCs were included in the final analysis. Origin of PVCs from the tricuspid annulus had the highest burden and NT-proBNP level. LV papillary muscle had a higher LV ejection fraction (EF) level and a lower LV end-systolic dimension (ESD) than other PVC foci (P<0.05). The high burden group had a higher LV end-diastolic dimension (EDD) and LVESD but lower LVEF than the other two groups (P<0.05). Female, older age, physical work, and history of PVCs had a significantly positive correlation with symptoms. Male, older age, physical work, and high burden were positive predictors of enlarged LVEDD, LVESD and higher serum NT-proBNP level, but lower LVEF. Seven-day dynamic ECG Holter monitor showed the true PVC burden on patients with PVCs. PVCs with a lower burden or origin from the LV papillary muscle and the fascicle were relatively benign, while PVCs with a higher burden or origin from the tricuspid annulus may lead to cardiac dysfunction.
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Affiliation(s)
- Wenhua Xu
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Mingfang Li
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Minglong Chen
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Bing Yang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Daowu Wang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Xiangqing Kong
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Hongwu Chen
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Weizhu Ju
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Kai Gu
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Kejiang Cao
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Hailei Liu
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Qi Jiang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Jiaojiao Shi
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Yan Cui
- Nursing College of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Hong Wang
- Department of Respiratory, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
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Tan AY, Hu YL, Potfay J, Kaszala K, Howren M, Sima AP, Shultz M, Koneru JN, Ellenbogen KA, Huizar JF. Impact of ventricular ectopic burden in a premature ventricular contraction-induced cardiomyopathy animal model. Heart Rhythm 2015; 13:755-61. [PMID: 26586453 DOI: 10.1016/j.hrthm.2015.11.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Frequent premature ventricular contractions (PVCs) have been associated with PVC-induced cardiomyopathy (CM) in some patients. OBJECTIVE The purpose of this study was to understand the cardiac consequences of different PVC burdens and the minimum burden required to induce left ventricular (LV) dysfunction. METHODS Right ventricular apical PVCs at a coupling interval of 240 ms were introduced at different PVC burdens in 9 mongrel canines. A stepwise increase in PVC burden was implemented every 8 weeks from 0% (baseline), 7%, 14%, 25%, 33% to 50% using our premature pacing algorithm. Echocardiogram and 24-hour Holter were obtained at 4- and 8-week period for each PVC burden with a single blinded reader assessing all echocardiographic parameters including those assessed by speckle tracking imaging (EchoPAC workstation, General Electric). CM was defined as left ventricular ejection fraction (LVEF) <50% or LVEF drop >10% points. Interleukin-6 and pro-brain natriuretic peptide levels were obtained at the end of each PVC burden. RESULTS The mean LVEF (mean heart rate) at 8 weeks for each PVC burden (0%, 7%, 14%, 33%, and 50%) were 57% ± 2.9% (85 ± 13 beats/min), 54.4% ± 3% (81 ± 10 beats/min), 53.3% ± 5% (77 ± 12 beats/min), 51.1% ± 4.2% (79 ± 14 beats/min), 47.7% ± 3.8% (80 ± 14 beats/min), and 44.7% ± 1.9% (157 ± 43 beats/min). PVC-induced CM was present in 11.1%, 44.4%, and 100% of animals with 25%, 33%, and 50% PVC burden, respectively. E/A ratio and radial strain decreased while left atrial size increased beyond 33% PVC burden. No changes in pro-brain natriuretic peptide and interleukin-6 levels were noted at any PVC burden. CONCLUSION LV systolic function (LVEF and radial strain) declined linearly as PVC burden increased. PVC-induced CM developed in some canines with 25% and 33% PVC burden, but developed in all animals with 50% PVC burden.
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Affiliation(s)
- Alex Y Tan
- Cardiology Division, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia; Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Yuhning L Hu
- Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Jonathan Potfay
- Cardiology Division, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia; Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Karoly Kaszala
- Cardiology Division, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia; Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Maureen Howren
- Cardiology Division, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Adam P Sima
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Michael Shultz
- Cardiology Division, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Jayanthi N Koneru
- Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Kenneth A Ellenbogen
- Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Jose F Huizar
- Cardiology Division, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia; Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.
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Potfay J, Kaszala K, Tan AY, Sima AP, Gorcsan J, Ellenbogen KA, Huizar JF. Abnormal Left Ventricular Mechanics of Ventricular Ectopic Beats: Insights Into Origin and Coupling Interval in Premature Ventricular Contraction-Induced Cardiomyopathy. Circ Arrhythm Electrophysiol 2015; 8:1194-200. [PMID: 26297787 DOI: 10.1161/circep.115.003047] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 08/03/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left ventricular (LV) dyssynchrony caused by premature ventricular contractions (PVCs) has been proposed as a mechanism of PVC-induced cardiomyopathy. We sought to understand the impact of different PVC locations and coupling intervals (prematurity) on LV regional mechanics and global function of the PVC beat itself. METHODS AND RESULTS Using our premature pacing algorithm, pentageminal PVCs at coupling intervals of 200 to 375 ms were delivered from the epicardial right ventricular apex, RV outflow tract, and LV free wall, as well as premature atrial contractions, from the left atrial appendage at a coupling interval of 200 ms in 7 healthy canines. LV short-axis echocardiographic images, LV stroke volume, and dP/dtmax were obtained during all ectopic beats and ventricular pacing. LV dyssynchrony was assessed by dispersion of QRS-to-peak strain (earliest-last QRS-to-peak strain) between 6 different LV segments during each of the aforementioned beats (GE, EchoPac). LV dyssynchrony was greater during long-coupled rather than short-coupled PVCs and PVCs at 375 ms compared with rapid ventricular pacing at 400 ms (P<0.0001), whereas no difference was found between PVC locations. Longer PVC coupling intervals were associated with greater stroke volume and dP/dtmax despite more pronounced dyssynchrony (P<0.001). CONCLUSIONS PVCs with longer coupling intervals demonstrate more pronounced LV dyssynchrony, whereas PVC location has minimal impact. LV dyssynchrony cannot be attributed to prematurity or abnormal ventricular activation alone, but rather to a combination of both. This study suggests that late-coupled PVCs may cause a more severe cardiomyopathy if dyssynchrony is the leading mechanism responsible for PVC-induced cardiomyopathy.
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Affiliation(s)
- Jonathan Potfay
- From the Cardiology Division, Hunter Holmes McGuire VA Medical Center, Richmond, VA (J.P., K.K., A.Y.T., J.F.H.); Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond (J.P., K.K., A.Y.T., K.A.E., J.F.H.); School of Biostatistics, Virginia Commonwealth University, Richmond (A.P.S.); and Cardiology Division, University of Pittsburgh Medical Center, PA (J.G. III)
| | - Karoly Kaszala
- From the Cardiology Division, Hunter Holmes McGuire VA Medical Center, Richmond, VA (J.P., K.K., A.Y.T., J.F.H.); Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond (J.P., K.K., A.Y.T., K.A.E., J.F.H.); School of Biostatistics, Virginia Commonwealth University, Richmond (A.P.S.); and Cardiology Division, University of Pittsburgh Medical Center, PA (J.G. III)
| | - Alex Y Tan
- From the Cardiology Division, Hunter Holmes McGuire VA Medical Center, Richmond, VA (J.P., K.K., A.Y.T., J.F.H.); Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond (J.P., K.K., A.Y.T., K.A.E., J.F.H.); School of Biostatistics, Virginia Commonwealth University, Richmond (A.P.S.); and Cardiology Division, University of Pittsburgh Medical Center, PA (J.G. III)
| | - Adam P Sima
- From the Cardiology Division, Hunter Holmes McGuire VA Medical Center, Richmond, VA (J.P., K.K., A.Y.T., J.F.H.); Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond (J.P., K.K., A.Y.T., K.A.E., J.F.H.); School of Biostatistics, Virginia Commonwealth University, Richmond (A.P.S.); and Cardiology Division, University of Pittsburgh Medical Center, PA (J.G. III)
| | - John Gorcsan
- From the Cardiology Division, Hunter Holmes McGuire VA Medical Center, Richmond, VA (J.P., K.K., A.Y.T., J.F.H.); Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond (J.P., K.K., A.Y.T., K.A.E., J.F.H.); School of Biostatistics, Virginia Commonwealth University, Richmond (A.P.S.); and Cardiology Division, University of Pittsburgh Medical Center, PA (J.G. III)
| | - Kenneth A Ellenbogen
- From the Cardiology Division, Hunter Holmes McGuire VA Medical Center, Richmond, VA (J.P., K.K., A.Y.T., J.F.H.); Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond (J.P., K.K., A.Y.T., K.A.E., J.F.H.); School of Biostatistics, Virginia Commonwealth University, Richmond (A.P.S.); and Cardiology Division, University of Pittsburgh Medical Center, PA (J.G. III)
| | - Jose F Huizar
- From the Cardiology Division, Hunter Holmes McGuire VA Medical Center, Richmond, VA (J.P., K.K., A.Y.T., J.F.H.); Cardiology Division/Pauley Heart Center, Virginia Commonwealth University, Richmond (J.P., K.K., A.Y.T., K.A.E., J.F.H.); School of Biostatistics, Virginia Commonwealth University, Richmond (A.P.S.); and Cardiology Division, University of Pittsburgh Medical Center, PA (J.G. III).
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Park KM, Im SI, Chun KJ, Hwang JK, Park SJ, Kim JS, On YK. Coupling Interval Ratio Is Associated with Ventricular Premature Complex-Related Symptoms. Korean Circ J 2015; 45:294-300. [PMID: 26240583 PMCID: PMC4521107 DOI: 10.4070/kcj.2015.45.4.294] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 02/11/2015] [Accepted: 03/17/2015] [Indexed: 11/29/2022] Open
Abstract
Background and Objectives Frequent ventricular premature complex (VPC) is one of the most common arrhythmia syndromes. Symptoms observed frequently with this arrhythmia syndrome remain limited. We sought to identify predictors of VPC-related symptoms by analyzing demographic information, VPC burden, and VPC surface electrocardiogram characteristics. Subjects and Methods We prospectively enrolled 109 patients with idiopathic outflow tract VPCs (63 males, 49±16 years old). They were divided into Group A (n=30, without VPC-related symptoms of palpitations or "dropped beats") and Group B (n=79, with VPC-related symptoms). Measured parameters were sinus and VPC QRS width, coupling interval (CI) between the previous sinus beat and VPC, CI ratio (%, CI/sinus cycle length), post-VPC CI and CI ratio, and VPC amplitude. Results Both groups had similar age (p=0.22), daily VPC burden (p=0.15), and VPC site of origin (p=0.36). The VPC CI ratio was higher in Group B (60±15%) than in Group A (49±22%) (p=0.01). Conclusion VPC-related symptoms are associated with a higher VPC CI ratio (>50%). The physiologic basis for these results deserves further study.
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Affiliation(s)
- Kyoung-Min Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Il Im
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Jin Chun
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Kyung Hwang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Jung Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - June Soo Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Keun On
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Cha MJ, Oh S. The Theory of Relativity in E (ectopy) and C (coupling): Who Will Prove It? Korean Circ J 2015; 45:273-4. [PMID: 26240580 PMCID: PMC4521104 DOI: 10.4070/kcj.2015.45.4.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 07/09/2015] [Accepted: 07/14/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Myung-Jin Cha
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Kumar S, Stevenson WG, John RM. Catheter ablation for premature ventricular contractions and ventricular tachycardia in patients with heart failure. Curr Cardiol Rep 2014; 16:522. [PMID: 25059465 DOI: 10.1007/s11886-014-0522-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ventricular arrhythmias (VA) are a significant contributor to morbidity and mortality in patients with heart failure (HF). Implantable cardioverter defibrillators are effective in reducing mortality, but do not prevent arrhythmia recurrence. There is increasing recognition that frequent premature ventricular contractions or repetitive ventricular tachycardia may also lead to new onset ventricular dysfunction or deterioration of ventricular function in patients with pre-existing HF. Suppression of the arrhythmia may lead to recovery of ventricular function. Catheter ablation has emerged as a safe and effective treatment option for reducing arrhythmia recurrence and for suppression of PVCs but its efficacy is governed by the nature of the arrhythmias, the underlying HF substrate and the accessibility of the arrhythmia substrates to ablation.
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Affiliation(s)
- Saurabh Kumar
- Cardiac Arrhythmia Service, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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Kawamura M, Badhwar N, Vedantham V, Tseng ZH, Lee BK, Lee RJ, Marcus GM, Olgin JE, Gerstenfeld EP, Scheinman MM. Coupling interval dispersion and body mass index are independent predictors of idiopathic premature ventricular complex-induced cardiomyopathy. J Cardiovasc Electrophysiol 2014; 25:756-62. [PMID: 24612052 DOI: 10.1111/jce.12391] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 02/04/2014] [Accepted: 02/11/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Patients with frequent premature ventricular complexes (PVCs) might be at risk for the developing or exacerbation of left ventricular (LV) dysfunction. However, some patients with a high-PVC burden do not develop cardiomyopathy, while other patients with low-PVC burden can develop cardiomyopathy. The purpose of this study was to evaluate the positive predictors of idiopathic PVCs-induced cardiomyopathy. METHODS AND RESULTS We investigated 214 patients undergoing successful ablation of PVCs who had no other causes of cardiomyopathy. We divided the study cohort into 2 groups: ejection fraction (EF) ≥ 50% (normal LV) and EF < 50% (LV dysfunction). We analyzed the clinical characteristics, including the electrocardiogram and findings at electrophysiology study. Among these patients, 51 (24%) had reduced LVEF and 163 (76%) had normal LV function. Patients with LV dysfunction had significantly longer coupling interval (CI) dispersion (maximum-CI-minimum-CI) and had significantly higher PVC burden compared to those with normal LV function (CI-dispersion: 115 ± 25 milliseconds vs. 94 ± 19 milliseconds; P < 0.001; PVC burden: 19% vs. 15%; P = 0.04). Furthermore, patients with LV dysfunction had significantly higher body mass index (BMI) compared to those with normal LV function (BMI > 30 kg/m(2) ; 37% vs. 13%; P = 0.001). Logistic regression analysis showed that CI-dispersion, PVC burden, and BMI (>30 kg/m(2) ) are independent predictors of PVC-induced cardiomyopathy. CONCLUSIONS In addition to the PVC burden, the CI-dispersion and BMI are associated with PVC-induced cardiomyopathy.
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Affiliation(s)
- Mitsuharu Kawamura
- Division of Cardiology, University of California, San Francisco, California, USA
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40
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Zhong L, Lee YH, Huang XM, Asirvatham SJ, Shen WK, Friedman PA, Hodge DO, Slusser JP, Song ZY, Packer DL, Cha YM. Relative efficacy of catheter ablation vs antiarrhythmic drugs in treating premature ventricular contractions: a single-center retrospective study. Heart Rhythm 2013; 11:187-93. [PMID: 24157533 DOI: 10.1016/j.hrthm.2013.10.033] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND It is unknown whether radiofrequency ablation (RFA) or antiarrhythmic therapy is superior when treating patients with symptomatic premature ventricular contractions (PVCs). OBJECTIVE To determine the relative efficacy of RFA and antiarrhythmic drugs (AADs) on PVC burden reduction and increasing left ventricular systolic function. METHODS Patients with frequent PVCs (>1000/24 h) were treated either by RFA or with AADs from January 2005 through December 2010. Data from 24-hour Holter monitoring and echocardiography before and 6-12 months after treatment were compared between the 2 groups. RESULTS Of 510 patients identified, 215 (40%) underwent RFA and 295 (60%) received AADs. The reduction in PVC frequency was greater by RFA than with AADs (-21,799/24 h vs -8,376/24 h; P < .001). The left ventricular ejection fraction (LVEF) was increased significantly after RFA (53%-56%; P < .001) but not after AAD (52%- 52%; P = .6) therapy. Of 121 (24%) patients with reduced LVEF, 39 (32%) had LVEF normalization to 50% or greater. LVEF was restored in 25 of 53 (47%) patients in the RFA group compared with 14 of 68 (21%) patients in the AAD group (P = .003). PVC coupling interval less than 450 ms, less impaired left ventricular function, and RFA were independent predictors of LVEF normalization performed by using multivariate analysis. CONCLUSION RFA appears to be more effective than AADs in PVC reduction and LVEF normalization.
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Affiliation(s)
- Li Zhong
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Ying-Hsiang Lee
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Cardiovascular Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Xin-Miao Huang
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Department of Cardiovascular Diseases, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | | | - Win-Kuang Shen
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Paul A Friedman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - David O Hodge
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester
| | - Joshua P Slusser
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester
| | - Zhi-Yuan Song
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China.
| | - Douglas L Packer
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Yong-Mei Cha
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
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Chen T, Koene R, Benditt DG, Lü F. Ventricular Ectopy in Patients With Left Ventricular Dysfunction: Should It Be Treated? J Card Fail 2013; 19:40-9. [DOI: 10.1016/j.cardfail.2012.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 09/18/2012] [Accepted: 11/12/2012] [Indexed: 02/07/2023]
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Cha YM, Lee GK, Klarich KW, Grogan M. Premature Ventricular Contraction-Induced Cardiomyopathy. Circ Arrhythm Electrophysiol 2012; 5:229-36. [DOI: 10.1161/circep.111.963348] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Yong-Mei Cha
- From the Division of Cardiovascular Diseases (Y.-M.C., K.W.K., M.G.), Mayo Clinic, Rochester, MN; and the Department of Medicine (G.K.L.), National University Health System, Singapore
| | - Glenn K. Lee
- From the Division of Cardiovascular Diseases (Y.-M.C., K.W.K., M.G.), Mayo Clinic, Rochester, MN; and the Department of Medicine (G.K.L.), National University Health System, Singapore
| | - Kyle W. Klarich
- From the Division of Cardiovascular Diseases (Y.-M.C., K.W.K., M.G.), Mayo Clinic, Rochester, MN; and the Department of Medicine (G.K.L.), National University Health System, Singapore
| | - Martha Grogan
- From the Division of Cardiovascular Diseases (Y.-M.C., K.W.K., M.G.), Mayo Clinic, Rochester, MN; and the Department of Medicine (G.K.L.), National University Health System, Singapore
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Agarwal SK, Simpson RJ, Rautaharju P, Alonso A, Shahar E, Massing M, Saba S, Heiss G. Relation of ventricular premature complexes to heart failure (from the Atherosclerosis Risk In Communities [ARIC] Study). Am J Cardiol 2012; 109:105-9. [PMID: 21945138 DOI: 10.1016/j.amjcard.2011.08.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 08/08/2011] [Accepted: 08/08/2011] [Indexed: 11/25/2022]
Abstract
Analogous to rapid ventricular pacing, frequent ventricular premature complexes (VPCs) can predispose over time to cardiomyopathy and subsequent heart failure (HF). We examined the association of frequent VPCs with HF incidence in a population-based cohort, free of HF and coronary heart disease at baseline. At study baseline (1987 to 1989), ≥1 VPC on a 2-minute rhythm electrocardiographic strip was seen in 5.5% (739 of 13,486) of the middle-age (45 to 64 years old at baseline) white and black, men and women of the Atherosclerosis Risk In Communities cohort. Incident HF was defined as the first appearance of International Classification of Diseases code 428.x in the hospital discharge record or death certificate through 2005. During an average follow-up of 15.6 years, incident HF was seen in 10% the participants (19.4% of those with VPCs vs 9.4% of those without). The age-, race-, and gender-adjusted hazard ratio of HF for VPCs was 1.89 (95% confidence interval 1.59 to 2.24). After multivariable adjustment for potential confounders, the hazard ratio of HF for those with any VPC versus no VPC was 1.63 (95% confidence interval 1.36 to 1.96). After additional adjustment for incident coronary heart disease as a time-varying covariate, the hazard ratio was 1.71 (95% confidence interval 1.42 to 2.08). Those with a greater frequency of VPCs or complex VPCs had similar rates of HF compared to those with a single VPC and all had rates greater than those with no VPC. In conclusion, in this large population-based cohort, the presence of VPCs was associated with incident HF, independent of incident coronary heart disease.
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DEL CARPIO MUNOZ FREDDY, SYED FAISALF, NOHERIA AMIT, CHA YONGMEI, FRIEDMAN PAULA, HAMMILL STEPHENC, MUNGER THOMASM, VENKATACHALAM K, SHEN WINKUANG, PACKER DOUGLASL, ASIRVATHAM SAMUELJ. Characteristics of Premature Ventricular Complexes as Correlates of Reduced Left Ventricular Systolic Function: Study of the Burden, Duration, Coupling Interval, Morphology and Site of Origin of PVCs. J Cardiovasc Electrophysiol 2011; 22:791-8. [DOI: 10.1111/j.1540-8167.2011.02021.x] [Citation(s) in RCA: 156] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kakavand B, Ballard HO, Disessa TG. Frequent ventricular premature beats in children with a structurally normal heart: a cause for reversible left ventricular dysfunction? Pediatr Cardiol 2010; 31:986-90. [PMID: 20512569 DOI: 10.1007/s00246-010-9740-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Accepted: 05/11/2010] [Indexed: 11/24/2022]
Abstract
Ventricular premature beats (VPBs) in a structurally normal heart generally are a benign condition. Rarely, however, reversible cardiomyopathy may develop. This study aimed to evaluate the incidence of cardiomyopathy among pediatric patients in a cohort with frequent VPBs and to examine the characteristics of the ventricular ectopic beats as well as therapeutic options. This study reviewed the charts of all pediatric patients between the ages of 1 day and 18 years seen at the University of Kentucky with the diagnosis of VPBs between 2003 and 2007. Frequent VPBs were defined as an ectopy burden of 5% or more in 24 h. Electrocardiograms, Holter monitors, and echocardiograms were reviewed. The review identified 28 patients (17 boys, age 13.3 ± 5.9 years, and 11 girls, age 13 ± 5.2 years) with frequent VPBs. The echocardiograms of four patients (2 boys, 14%) showed cardiomyopathy. Cardiac function normalized in all four patients, with spontaneous resolution of the VPBs (2 patients) or with antiarrhythmic therapy (2 patients). During a follow-up period of 2.7 ± 2.3 years, 32% of the patients without cardiomyopathy showed a marked spontaneous improvement in arrhythmia burden. Most of the patients showed VPBs with a left bundle branch block (LBBB) and inferior axis morphology. The most commonly associated symptoms were chest pain (17.8%) and dizziness and syncope (21.4%). Generally, VPBs in structurally normal hearts are considered benign. Rarely, a reversible cardiomyopathy can develop, requiring therapeutic intervention.
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Affiliation(s)
- Bahram Kakavand
- Department of Pediatrics, Division of Cardiology, University of Kentucky, Lexington, KY 40536-0298, USA.
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46
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Wiwanitkit V. PVC and LVF. Heart Rhythm 2010; 7:e1; author reply e1. [PMID: 20417312 DOI: 10.1016/j.hrthm.2010.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Indexed: 10/19/2022]
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Agarwal SK, Heiss G, Rautaharju PM, Shahar E, Massing MW, Simpson RJ. Premature ventricular complexes and the risk of incident stroke: the Atherosclerosis Risk In Communities (ARIC) Study. Stroke 2010; 41:588-93. [PMID: 20167922 DOI: 10.1161/strokeaha.109.567800] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND PURPOSE Premature ventricular complexes (PVCs) on a 2-minute electrocardiogram are a common, largely asymptomatic finding associated with increased risk of coronary heart disease and death. They may reflect atherosclerosis or other pathogenic pathways that predispose to arrhythmias and stroke. METHODS We conducted a prospective evaluation of the Atherosclerosis Risk In Communities Study cohort (n=14,783) of middle-aged men and women to assess whether the presence of PVCs at study baseline (1987 to 1989) influenced the risk of incident stroke through December 31, 2004. RESULTS PVCs were seen in 6.1% of the participants at baseline, and 729 (4.9%) had incident stroke. The unadjusted cumulative proportion of incident stroke in individuals with any PVC was 6.6% compared with 4.1% in those without PVC. The unadjusted hazard ratio of incident stroke in individuals with any PVC compared with those without any PVCs was 1.71 (95% CI, 1.33 to 2.20). Among individuals without hypertension and diabetes at baseline, PVCs were independently associated with incident stroke (hazard ratio: 1.72; 95% CI: 1.14 to 2.59). Among those with either diabetes or hypertension, the presence of any PVCs did not increase the risk of stroke. The association was stronger for noncarotid embolic stroke than for thrombotic stroke and its magnitude increased with higher frequency of PVCs. CONCLUSIONS Frequent PVCs are associated with risk of incident stroke in participants free of hypertension and diabetes. This suggests that PVCs may contribute to atrioventricular remodeling or may be a risk marker for incident stroke, particularly embolic stroke.
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Affiliation(s)
- Sunil K Agarwal
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7075, USA
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Mazurek B, Szydłowski L, Giec-Fuglewicz G, Markiewicz-Łoskot G. N-terminal prohormone brain natriuretic peptide-proBNP levels in ventricular arrhythmias in children. Clin Cardiol 2009; 32:690-4. [PMID: 20027660 PMCID: PMC6653564 DOI: 10.1002/clc.20611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Accepted: 04/04/2009] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Ventricular arrhythmias are the most common consequences of structural and functional heart diseases, but cases with no evident pathology are also observed. A parameter indicating asymptomatic circulatory failure could support decisions related to possible treatment of ventricular arrhythmias. HYPOTHESIS The study objective was the evaluation of N-terminal prohormone brain natriuretic peptide (NT-proBNP) levels in children with ventricular arrhythmias and an attempt to determine if this parameter may be used for diagnosis and prognosis of ventricular arrhythmias. MATERIAL AND METHODS The study population was comprised of 36 children age 5 to 17.5 years old with idiopathic ventricular arrhythmias (Group B) graded mild or potentially malignant; 29 patients with mild ventricular arrhythmias were included into Group B1; and 7 patients with potentially malignant cases into Group B2. In all the patients, NT-proBNP assays were performed. RESULTS The NT-proBNP levels in Groups B, B1, B2 and the control group (Group K) were as follows: 41.5 +/- 15.1 pg/mL, 35.5 +/- 18.5 pg/mL, 66.3 +/- 24.9 pg/mL and 31.5 +/- 15.1 pg/mL, respectively. Between the groups with and without arrhythmias (Group B vs Group K), no statistically significant differences in NT-proBNP levels were found. However, markedly higher NT-proBNP levels were shown in the children with potentially malignant arrhythmias (Group B2) compared to the patients with mild arrhythmias (B1) and the control group (Group K). CONCLUSIONS The level of NT-proBNP increases with the severity of ventricular arrhythmia. NT-proBNP assays can be helpful for diagnosing and grading the severity of ventricular arrhythmias.
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Affiliation(s)
- Bogusław Mazurek
- Department of Pediatric Cardiology, Medical University of Silesia, Katowice, Poland.
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Sestito A, Pardeo M, Sgueglia GA, Natale L, Delogu A, Infusino F, De Rosa G, Bellocci F, Crea F, Lanza GA. Cardiac magnetic resonance of healthy children and young adults with frequent premature ventricular complexes. J Cardiovasc Med (Hagerstown) 2007; 8:692-8. [PMID: 17700398 DOI: 10.2459/jcm.0b013e3280103948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess whether magnetic resonance imaging could detect any cardiac morphological or functional myocardial alterations in healthy children and young adults with ventricular arrhythmias. METHODS Twenty-three subjects (14 male, mean age 15.6 +/- 6.5 years) with frequent (> or =30/h) premature ventricular complexes (PVCs) on Holter monitoring and normal echocardiographic and electrocardiographic findings underwent cardiac magnetic resonance (CMR) on a 1.5T scanner and an exercise stress test. Subjects were also followed up for a period of 71 +/- 24 months. RESULTS CMR showed no evidence of structural cardiac abnormalities, but functional assessment revealed significant impairment in 17 subjects (74%): mild to moderate right ventricular enlargement was found in all of these subjects associated with a mild reduction of ventricular function in five cases (22%) and mild free wall and/or apex contraction abnormalities in eight subjects (35%). PVCs persisted during stress test in three subjects (13%) and disappeared in 19 (83%). No serious cardiac event was observed during the follow-up. CONCLUSIONS Our study shows that subjects with PVCs without detectable electrocardiographic and echocardiographic abnormalities frequently exhibit functional impairment of the right ventricle at CMR, potentially responsible for ventricular arrhythmias. Although the causes of these abnormalities remain to be elucidated, the long-term outcome of these subjects is excellent.
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Affiliation(s)
- Alfonso Sestito
- Institute of Cardiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
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TAN HW, LI L, WANG ZH, XING SS, BI XP, ZHONG M, ZHANG W. Impaired Left Ventricular Systolic Synchronicity in Hypertensive Patients with Ventricular Arrhythmias. Hypertens Res 2007; 30:759-66. [DOI: 10.1291/hypres.30.759] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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