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Shoureshi P, Tan AY, Koneru J, Ellenbogen KA, Kaszala K, Huizar JF. Arrhythmia-Induced Cardiomyopathy: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 83:2214-2232. [PMID: 38811098 DOI: 10.1016/j.jacc.2024.03.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 05/31/2024]
Abstract
Arrhythmias frequently accompany heart failure and left ventricular dysfunction. Tachycardias, atrial fibrillation, and premature ventricular contractions can induce a reversible form of dilated cardiomyopathy (CM) known as arrhythmia-induced CM (AiCM). The intriguing question is why certain individuals are more susceptible to AiCM, despite similar arrhythmia burdens. The primary challenge is determining the extent of arrhythmias' contribution to left ventricular systolic dysfunction. AiCM should be considered in patients with a mean heart rate of >100 beats/min, atrial fibrillation, or a PVC burden of >10%. Confirmation of AiCM occurs when CM reverses upon eliminating the responsible arrhythmia. Therapy choice depends on the specific arrhythmia, patient comorbidities, and preferences. After left ventricular function is restored, ongoing follow-up is essential if an abnormal myocardial substrate persists. Accurate diagnosis and treatment of AiCM have the potential to enhance patients' quality of life, improve clinical outcomes, and reduce hospital admissions and overall health care costs.
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Affiliation(s)
- Pouria Shoureshi
- Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA; Central Virginia Veterans Affair Health Care System, Richmond, Virginia, USA
| | - Alex Y Tan
- Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA; Central Virginia Veterans Affair Health Care System, Richmond, Virginia, USA
| | - Jayanthi Koneru
- Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA
| | | | - Karoly Kaszala
- Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA; Central Virginia Veterans Affair Health Care System, Richmond, Virginia, USA
| | - Jose F Huizar
- Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA; Central Virginia Veterans Affair Health Care System, Richmond, Virginia, USA.
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2
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Yen KC, Chan YH, Wang CL. Number of Premature Ventricular Complexes Predicts Long-Term Outcomes in Patients with Persistent Atrial Fibrillation. Biomedicines 2024; 12:1149. [PMID: 38927356 PMCID: PMC11200947 DOI: 10.3390/biomedicines12061149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/14/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Premature ventricular complexes (PVCs) are common electrocardiographic abnormalities and may be a prognosticator in predicting mortality in patients with structurally normal hearts or chronic heart diseases. Whether PVC burden was associated with mortality in patients with chronic atrial fibrillation (AF) remained unknown. We investigated the prognostic value of PVC burden in patients with persistent AF. METHODS A retrospective analysis of 24 h Holter recordings of 1767 patients with persistent AF was conducted. Clinical characteristics, 24 h average heart rate (HR), and PVC measures, including 24 h PVC burden and the presence of consecutive PVCs (including any PVC couplet, triplet, or non-sustained ventricular tachycardia) were examined for the prediction of all-cause and cardiovascular mortality using the Cox proportional hazards model. RESULTS After a median follow-up time of 30 months, 286 (16%) patients died and 1481 (84%) patients survived. Multivariate analysis revealed that age, heart failure, stroke, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta-blocker, digoxin, oral anticoagulant use, and estimated glomerular filtration rate were significant baseline predictors of all-cause mortality and cardiovascular mortality. Twenty-four-hour PVC burden and the presence of consecutive PVCs were significantly associated with all-cause and cardiovascular mortality after adjusting for significant clinical factors. When compared to the first quartile of PVC burden (<0.003%/day), the highest quartile (>0.3%/day) was significantly associated with an increased risk of all-cause mortality (hazard ratio, 2.46; 95% CI, 1.77-3.42) and cardiovascular mortality (hazard ratio: 2.67; 95% CI, 1.76-4.06). CONCLUSIONS Twenty-four-hour PVC burden is independently associated with all-cause and cardiovascular mortality in patients with persistent AF.
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Affiliation(s)
- Kun-Chi Yen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (K.-C.Y.); (C.-L.W.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yi-Hsin Chan
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (K.-C.Y.); (C.-L.W.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Microscopy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taoyuan 33305, Taiwan
| | - Chun-Li Wang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (K.-C.Y.); (C.-L.W.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
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3
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Pundi K, Marcus GM. Predictors and possible mechanisms of premature ventricular contraction induced cardiomyopathy. J Cardiovasc Electrophysiol 2024; 35:569-573. [PMID: 37724798 DOI: 10.1111/jce.16070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/30/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023]
Abstract
Premature ventricular complexes (PVCs) are encountered frequently in clinical practice. While PVCs may have various causes, a small number of individuals with PVCs develop cardiomyopathy in the absence of other potential etiologies. When correctly identified, patients with PVC-incuded cardiomyopathy can have dramatic improvement of their cardiomyopathy with treatment of their PVCs. In this focused review, we discuss potential predictors of PVC-induced cardiomyopathy, including PVC frequency, PVC characteristics, and modifiable patient risk factors. We also review some proposed mechanisms of PVC-induced cardiomyopathy and conclude with future directions for research and clinical practice.
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Affiliation(s)
- Krishna Pundi
- Division of Cardiology, University of California, San Francisco, San Francisco, California, USA
| | - Gregory M Marcus
- Division of Cardiology, University of California, San Francisco, San Francisco, California, USA
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Doğan Z, Erden EÇ, Erden İ, Bektaşoğlu G. Assessment of subtle cardiac dysfunction induced by premature ventricular contraction using two-dimensional strain echocardiography and the effects of successful ablation. Rev Port Cardiol 2024; 43:25-32. [PMID: 37473913 DOI: 10.1016/j.repc.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/30/2023] [Accepted: 04/25/2023] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES We aimed to assess the effects of successful ablation on impaired left ventricular global longitudinal strain (LV-GLS) in patients with frequent premature ventricular contractions (PVCs). We also evaluated the potential risk factors of impaired LV-GLS. METHODS Thirty-six consecutive patients without any structural heart disease, who were treated with radiofrequency (RF) ablation due to frequent PVCs, were included in the study. All patients were evaluated with standard transthoracic and two-dimensional speckle tracking echocardiography. RESULTS Mean LV-GLS before ablation was 17.3±3.7 and 20.5±2.6 after ablation; the difference was statistically significant (p<0.01). Patients were categorized into two groups: those with LV-GLS value >-16% and those ≤16%. Low PVC E flow/post-PVC E flow and PVC SV/post-PVC SV ratios were associated with impaired LV-GLS. CONCLUSION In symptomatic patients with frequent PVCs and normal left ventricular ejection fraction, we observed significant improvement in LV-GLS value following successful RF ablation. Patients with impaired LV-GLS more often display non-ejecting PVCs and post-extrasystolic potentiation (PEP) compared to patients with normal LV-GLS.
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Affiliation(s)
- Zeki Doğan
- Department of Cardiology, Atlas University Medical Faculty Medicine Hospital, Istanbul, Turkey
| | - Emine Çakcak Erden
- Department of Cardiology, Atlas University Medical Faculty Medicine Hospital, Istanbul, Turkey
| | - İsmail Erden
- Department of Cardiology, Atlas University Medical Faculty Medicine Hospital, Istanbul, Turkey.
| | - Gökhan Bektaşoğlu
- Department of Cardiology, Atlas University Medical Faculty Medicine Hospital, Istanbul, Turkey
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Bury TM, Diagne K, Olshan D, Glass L, Shrier A, Lerman BB, Bub G. The inverse problem for cardiac arrhythmias. CHAOS (WOODBURY, N.Y.) 2023; 33:123130. [PMID: 38149994 DOI: 10.1063/5.0161210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/20/2023] [Indexed: 12/28/2023]
Abstract
A cardiac arrhythmia is an abnormality in the rate or rhythm of the heart beat. We study a type of arrhythmia called a premature ventricular complex (PVC), which is typically benign, but in rare cases can lead to more serious arrhythmias or heart failure. There are three known mechanisms for PVCs: reentry, an ectopic focus, and triggered activity. We develop minimal models for each mechanism and attempt the inverse problem of determining which model (and therefore which mechanism) best describes the beat dynamics observed in an ambulatory electrocardiogram. We demonstrate our approach on a patient who exhibits frequent PVCs and find that their PVC dynamics are best described by a model of triggered activity. Better identification of the PVC mechanism from wearable device data could improve risk stratification for the development of more serious arrhythmias.
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Affiliation(s)
- T M Bury
- Department of Physiology, McGill University, 3655 Promenade Sir William Osler, Montreal, Quebec H3G 1Y6, Canada
| | - K Diagne
- Department of Physiology, McGill University, 3655 Promenade Sir William Osler, Montreal, Quebec H3G 1Y6, Canada
| | - D Olshan
- Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, New York 10065, USA
| | - L Glass
- Department of Physiology, McGill University, 3655 Promenade Sir William Osler, Montreal, Quebec H3G 1Y6, Canada
| | - A Shrier
- Department of Physiology, McGill University, 3655 Promenade Sir William Osler, Montreal, Quebec H3G 1Y6, Canada
| | - B B Lerman
- Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, New York 10065, USA
| | - G Bub
- Department of Physiology, McGill University, 3655 Promenade Sir William Osler, Montreal, Quebec H3G 1Y6, Canada
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6
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Prisco AR, Castro JR, Roukoz H, Tholakanahalli VN. Premature Ventricular Complexes: Benign versus Malignant - How to approach? Indian Pacing Electrophysiol J 2023; 23:189-195. [PMID: 37714513 PMCID: PMC10685167 DOI: 10.1016/j.ipej.2023.09.004] [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: 04/06/2023] [Revised: 08/22/2023] [Accepted: 09/12/2023] [Indexed: 09/17/2023] Open
Abstract
Premature Ventricular Complexes (PVCs) refer to electrical activity arising from ventricles resulting in ventricular contraction independent of the native rhythm. PVCs by themselves are common in the general population but based on the origin of the PVCs, either related to anatomical or electrical substrate, the disease process has a widely varied presentation and prognosis. The clinical presentation of symptoms may vary from being extremely benign, or very severe (malignant). Benign PVCs include those that are asymptomatic or induce very mild symptoms including palpitations, lightheadedness, chest discomfort, or the sensation of skipped beats. The middle range of PVCs present as heart failure or heart failure complicated by PVCs. The malignant variety may present as syncope, or sudden cardiac death. In this review we describe the multiple facets of PVC presentation and strategies of clinical management.
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Affiliation(s)
- Anthony R Prisco
- University of Minnesota, Department of Medicine, Division of Cardiology, USA
| | - Jorge Reyes Castro
- University of Minnesota, Department of Medicine, Division of Cardiology, USA
| | - Henri Roukoz
- University of Minnesota, Department of Medicine, Division of Cardiology, USA
| | - Venkatakrishna N Tholakanahalli
- University of Minnesota, Department of Medicine, Division of Cardiology, USA; Minneapolis VA Health Care System, Department of Medicine, Division of Cardiology, USA.
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Echocardiographic changes and heart failure hospitalizations following rhythm control for arrhythmia-induced cardiomyopathy: results from a multicenter, retrospective study. J Interv Card Electrophysiol 2023; 66:455-462. [PMID: 36008502 DOI: 10.1007/s10840-022-01354-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/16/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND The incidence and prevalence of arrhythmia-induced cardiomyopathy (AIC) are unclear but likely underrecognized. LV dysfunction is common among patients with atrial fibrillation (AF), atrial flutter (AFL), and frequent premature ventricular contractions (PVC). The hallmark of AIC is the improvement of left ventricular ejection fraction (LVEF) following arrhythmia treatment. Changes in echocardiographic parameters and their effect on outcomes after rhythm control for AIC are not well understood. We aimed to study echocardiographic parameters and outcomes following rhythm control for AIC. METHODS A multicenter, retrospective study was conducted at 4 different medical centers involving patients with AIC. Clinical, echocardiographic, and outcome (mortality and heart failure hospitalizations [HFH]) parameters were extracted from the medical record. RESULTS Two hundred fifty-five patients (age 66 ± 11 years, 73% male) with AIC caused by AF (51%), atrial tachycardia/AFL (20%), and PVCs (29%) were included and followed for a median period of 6 months after successful rhythm control. Significant improvements in left ventricular (LV) ejection fraction (P < 0.0001), LV end-systolic volume (ml) (90 ± 48 to 58 ± 30; P < 0.0001), LV internal diameter end diastole (cm) (5.5 ± 0.78 to 5.3 ± 0.64; P = 0.0001) and end systole (4.7 ± 0.95 to 4.3 ± 1.02; P < 0.0001), right atrial pressure (mmHg) (11.3 ± 5.0 to 7.4 ± 3.2; P = 0.0001), and right ventricular function (n (%)) (42 (44) to 9 (11); P < 0.0001) were noted following arrhythmia treatment. No deaths occurred during follow-up. HFH occurred in 7 patients. Arrhythmia recurrence rate was 50.5%. Neither echocardiographic parameters nor recurrence of arrhythmia correlated with HFH. CONCLUSION Arrhythmia treatment significantly improved echocardiographic LV dimensions, LVEF, and RAP in this multicenter AIC cohort, underscoring the need for early recognition and aggressive rhythm control in suspected AIC patients. The event rate was too low to assess for outcome predictors.
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Chung WH, Hayase J, Do DH, Dixit N, Ajijola O, Buch E, Boyle N, Shivkumar K, Bradfield JS. Clinical predictors and implications of cardiac inflammation detected on positron emission tomography (PET) in patients referred for premature ventricular complex (PVC) ablation. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01446-z. [PMID: 36510109 DOI: 10.1007/s10840-022-01446-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Positron emission tomography computed tomography (PET-CT) is not routinely used for premature ventricular complexes (PVCs). Whether specific clinical factors are associated with abnormal PET-CT results is not clear. METHODS The treatment courses and baseline characteristics of consecutive patients in a single center between 2012 and 2021, age > 18 years old, and who received 18F-fluorodeoxyglucose (FDG) PET-CT imaging for evaluation of PVCs were retrospectively analyzed. RESULTS A total of 102 patients was included. Of these, 27 patients (26.4%) had abnormal PET-CT and 61 (59.8%) had normal imaging. Abnormal PET-CT findings were associated with non-sustained ventricular tachycardia (NSVT) (95.2% vs. 52.6%, p = 0.001), higher number of PVC morphologies (2.29 ± 0.7 vs. 1.31 ± 0.6, p < 0.001), greater PVC coupling interval dispersion (72.47 ± 66.4 ms vs. 13.42 ± 17.9 ms, p < 0.001), and greater likelihood of fast heart rate dependent PVCs (78.5% vs. 38.2%, p = 0.017). Fourteen (51.8%) patients had an abnormal PET-CT and abnormal late gadolinium enhancement (LGE). Patients with abnormal PET-CT were more frequently treated with immunosuppression (81.4% vs. 3.2%, p < .0001) than with catheter ablation (11.1% vs. 45.9%, p = 0.002) compared to the normal PET-CT group. Over a median follow-up of 862 days (IQR 134, 1407), PVC burden decreased in both groups [from 23 ± 16% to 9 ± 10% (p < 0.001) in abnormal PET-CT group and from 21 ± 15% to 7 ± 10% (p < 0.001) in normal PET-CT group]. CONCLUSIONS Abnormal PET-CT findings were more commonly associated with NSVT, multiform PVCs, greater PVC coupling interval dispersion, and fast heart rate dependent PVCs. LGE was not sensitive for detecting inflammation. Immunosuppression was effective in managing PVCs with abnormal PET-CT.
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Affiliation(s)
- Wei-Hsin Chung
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA.
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung, Taiwan.
| | - Justin Hayase
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
| | - Duc H Do
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
| | - Neal Dixit
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
| | - Olujimi Ajijola
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
| | - Eric Buch
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
| | - Noel Boyle
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
| | - Jason S Bradfield
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA
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de Lavallaz JDF, Mézier J, Mertz L, Mannhart D, Serban T, Knecht S, Abid QUA, Nguyen TT, Kühne M, Sticherling C, Huang H, Gold MR, Badertscher P. Risk factors for the development of premature ventricular complex-induced cardiomyopathy: a systematic review and meta-analysis. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01421-8. [DOI: 10.1007/s10840-022-01421-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/08/2022] [Indexed: 11/23/2022]
Abstract
Abstract
Background
Premature ventricular complexes (PVCs) are a potentially reversible cause of heart failure. However, the characteristics of patients most likely to develop impaired left ventricular function are unclear. Hence, the objective of this study is to systematically assess risk factors for the development of PVC-induced cardiomyopathy.
Methods
We performed a structured database search of the scientific literature for studies investigating risk factors for the development of PVC-induced cardiomyopathy (PVC-CM). We investigated the reporting of PVC-CM risk factors (RF) and assessed the comparative association of the different RF using random-effect meta-analysis.
Results
A total of 26 studies (9 prospective and 17 retrospective studies) involving 16,764,641 patients were analyzed (mean age 55 years, 58% women, mean PVC burden 17%). Eleven RF were suitable for quantitative analysis (≥ 3 occurrences in multivariable model assessing a binary change in left ventricular (LV) function). Among these, age (OR 1.02 per increase in the year of age, 95% CI [1.01, 1.02]), the presence of symptoms (OR 0.18, 95% CI [0.05, 0.64]), non-sustained ventricular tachycardias (VT) (OR 3.01, 95% CI [1.39, 6.50]), LV origin (OR 2.20, 95% CI [1.14, 4.23]), epicardial origin (OR 4.72, 95% CI [1.81, 12.34]), the presence of interpolation (OR 4.93, 95% CI [1.66, 14.69]), PVC duration (OR 1.05 per ms increase in QRS-PVC duration [1.004; 1.096]), and PVC burden (OR 1.06, 95% CI [1.04, 1.08]) were all significantly associated with PVC-CM.
Conclusions
In this meta-analysis, the most consistent risk factors for PVC-CM were age, non-sustained VT, LV, epicardial origin, interpolation, and PVC burden, whereas the presence of symptoms significantly reduced the risk. These findings help tailor stringent follow-up of patients presenting with frequent PVCs and normal LV function.
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10
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Alhede C, Higuchi S, Hadjis A, Bibby D, Abraham T, Schiller NB, Gerstenfeld EP. Premature Ventricular Contractions Are Presaged by a Mechanically Abnormal Sinus Beat. JACC Clin Electrophysiol 2022; 8:943-953. [PMID: 35843863 DOI: 10.1016/j.jacep.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/22/2022] [Accepted: 05/12/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Frequent premature ventricular contractions (PVCs) can lead to cardiomyopathy; it is unclear if there are abnormal myocardial mechanics operative in the PVC and non-PVC beats. OBJECTIVES The aim of this study was to investigate regional and global myocardial mechanics, including dyssynchrony, in patients with frequent PVCs. METHODS Fifty-six consecutive patients referred for PVC ablation were prospectively studied. During sinus rhythm (SR) and PVC beats, left ventricular (LV) global longitudinal strain (GLS), LV dyssynchrony (measured as the SD of time to peak GLS), and dyssynergy (measured as maximum regional strain minus minimum regional strain at aortic valve closure) were quantified using 2-dimensional strain echocardiography. GLS, dyssynchrony, and dyssynergy were compared in remote SR, pre-PVC SR, PVC, and post-PVC SR beats. RESULTS In SR beats remote from the PVC, GLS was -17.3% ± 4%, dyssynchrony was 49 ± 14 ms, and dyssynergy was 22% ± 9%. Myocardial mechanics were significantly abnormal during PVCs compared with remote SR beats (GLS -7.7% ± 3% [P < 0.001], dyssynchrony 115 ± 37 milliseconds [P < 0.001], and dyssynergy 26% ± 10% [P < 0.001]). There were significant mechanical abnormalities in the SR beat preceding the PVC, which demonstrated significantly lower LV strain (pre-PVC SR, -13% ± 4%; P < 0.001) and more dyssynchrony (pre-PVC SR, 63 ± 19 milliseconds; P < 0.001) compared with remote SR beats. Dyssynergy was significantly higher for pre-PVC SR and PVC beats compared with remote SR (pre-PVC SR, 25% ± 8% [P < 0.001]; PVC, 26% ± 10% [P < 0.001]). CONCLUSIONS In patients with frequent PVCs, the SR beat preceding the PVC demonstrates significant mechanical abnormalities. This finding suggests that perturbations in cellular physiological processes such as excitation-contraction coupling may underlie the generation of frequent PVCs.
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Affiliation(s)
- Christina Alhede
- Section of Electrophysiology, University of California-San Francisco, San Francisco, California, USA
| | - Satoshi Higuchi
- Section of Electrophysiology, University of California-San Francisco, San Francisco, California, USA
| | - Alexios Hadjis
- Section of Electrophysiology, University of California-San Francisco, San Francisco, California, USA
| | - Dwight Bibby
- Section of Echocardiography, University of California-San Francisco, San Francisco, California, USA
| | - Theodore Abraham
- Section of Echocardiography, University of California-San Francisco, San Francisco, California, USA
| | - Nelson B Schiller
- Section of Echocardiography, University of California-San Francisco, San Francisco, California, USA
| | - Edward P Gerstenfeld
- Section of Electrophysiology, University of California-San Francisco, San Francisco, California, USA.
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Ono K, Iwasaki YK, Akao M, Ikeda T, Ishii K, Inden Y, Kusano K, Kobayashi Y, Koretsune Y, Sasano T, Sumitomo N, Takahashi N, Niwano S, Hagiwara N, Hisatome I, Furukawa T, Honjo H, Maruyama T, Murakawa Y, Yasaka M, Watanabe E, Aiba T, Amino M, Itoh H, Ogawa H, Okumura Y, Aoki-Kamiya C, Kishihara J, Kodani E, Komatsu T, Sakamoto Y, Satomi K, Shiga T, Shinohara T, Suzuki A, Suzuki S, Sekiguchi Y, Nagase S, Hayami N, Harada M, Fujino T, Makiyama T, Maruyama M, Miake J, Muraji S, Murata H, Morita N, Yokoshiki H, Yoshioka K, Yodogawa K, Inoue H, Okumura K, Kimura T, Tsutsui H, Shimizu W. JCS/JHRS 2020 Guideline on Pharmacotherapy of Cardiac Arrhythmias. Circ J 2022; 86:1790-1924. [DOI: 10.1253/circj.cj-20-1212] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Yu-ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Masaharu Akao
- Department of Cardiovascular Medicine, National Hospital Organization Kyoto Medical Center
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine
| | - Kuniaki Ishii
- Department of Pharmacology, Yamagata University Faculty of Medicine
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshinori Kobayashi
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital
| | | | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | | | - Tetsushi Furukawa
- Department of Bio-information Pharmacology, Medical Research Institute, Tokyo Medical and Dental University
| | - Haruo Honjo
- Research Institute of Environmental Medicine, Nagoya University
| | - Toru Maruyama
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital
| | - Yuji Murakawa
- The 4th Department of Internal Medicine, Teikyo University School of Medicine, Mizonokuchi Hospital
| | - Masahiro Yasaka
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center
| | - Eiichi Watanabe
- Department of Cardiology, Fujita Health University School of Medicine
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Mari Amino
- Department of Cardiovascular Medicine, Tokai University School of Medicine
| | - Hideki Itoh
- Division of Patient Safety, Hiroshima University Hospital
| | - Hisashi Ogawa
- Department of Cardiology, National Hospital Organisation Kyoto Medical Center
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Chizuko Aoki-Kamiya
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center
| | - Jun Kishihara
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Eitaro Kodani
- Department of Cardiovascular Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Takashi Komatsu
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University School of Medicine
| | | | | | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University
| | - Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Yukio Sekiguchi
- Department of Cardiology, National Hospital Organization Kasumigaura Medical Center
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Noriyuki Hayami
- Department of Fourth Internal Medicine, Teikyo University Mizonokuchi Hospital
| | | | - Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University, Faculty of Medicine
| | - Takeru Makiyama
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Mitsunori Maruyama
- Department of Cardiovascular Medicine, Nippon Medical School Musashi Kosugi Hospital
| | - Junichiro Miake
- Department of Pharmacology, Tottori University Faculty of Medicine
| | - Shota Muraji
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | | | - Norishige Morita
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital
| | - Hisashi Yokoshiki
- Department of Cardiovascular Medicine, Sapporo City General Hospital
| | - Koichiro Yoshioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School
| | | | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
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12
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Limpitikul WB, Dewland TA, Vittinghoff E, Soliman E, Nah G, Fang C, Siscovick DS, Psaty BM, Sotoodehnia N, Heckbert S, Stein PK, Gottdiener J, Hu X, Hempfling R, Marcus GM. Premature ventricular complexes and development of heart failure in a community-based population. Heart 2022; 108:105-110. [PMID: 34493549 PMCID: PMC8702448 DOI: 10.1136/heartjnl-2021-319473] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/09/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE A higher premature ventricular complex (PVC) frequency is associated with incident congestive heart failure (CHF) and death. While certain PVC characteristics may contribute to that risk, the current literature stems from patients in medical settings and is therefore prone to referral bias. This study aims to identify PVC characteristics associated with incident CHF in a community-based setting. METHODS The Cardiovascular Health Study is a cohort of community-dwelling individuals who underwent prospective evaluation and follow-up. We analysed 24-hour Holter data to assess PVC characteristics and used multivariable logistic and Cox proportional hazards models to identify predictors of a left ventricular ejection fraction (LVEF) decline and incident CHF, respectively. RESULTS Of 871 analysed participants, 316 participants exhibited at least 10 PVCs during the 24-hour recording. For participants with PVCs, the average age was 72±5 years, 41% were women and 93% were white. Over a median follow-up of 11 years, 34% developed CHF. After adjusting for demographics, cardiovascular comorbidities, antiarrhythmic drug use and PVC frequency, a greater heterogeneity of the PVC coupling interval was associated with an increased risk of LVEF decline and incident CHF. Of note, neither PVC duration nor coupling interval duration exhibited a statistically significant relationship with either outcome. CONCLUSIONS In this first community-based study to identify Holter-based features of PVCs that are associated with LVEF reduction and incident CHF, the fact that coupling interval heterogeneity was an independent risk factor suggests that the mechanism of PVC generation may influence the risk of heart failure.
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Affiliation(s)
- Worawan B Limpitikul
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Thomas A Dewland
- Division of Cardiology, Electrophysiology Section, University of California San Francisco, San Francisco, California, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Elsayed Soliman
- Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Gregory Nah
- Division of Cardiology, Electrophysiology Section, University of California San Francisco, San Francisco, California, USA
| | - Christina Fang
- Division of Cardiology, Electrophysiology Section, University of California San Francisco, San Francisco, California, USA
| | | | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington, USA
| | - Nona Sotoodehnia
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Susan Heckbert
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington, USA
| | - Phyllis K Stein
- Cardiovascular Division, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - John Gottdiener
- Cardiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Xiao Hu
- Duke University School of Nursing, Durham, North Carolina, USA
| | | | - Gregory M Marcus
- Division of Cardiology, Electrophysiology Section, University of California San Francisco, San Francisco, California, USA
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13
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Elbey MA, Kanuri SH, Shaikh N, Gopinathannair R, Lakkireddy D. Localization of Right Ventricular Outflow Tract Premature Ventricular Complexes Using a Novel Mapping System. J Atr Fibrillation 2021; 13:20200471. [PMID: 34950353 DOI: 10.4022/jafib.20200471] [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: 06/01/2020] [Revised: 06/03/2020] [Accepted: 07/09/2020] [Indexed: 11/10/2022]
Abstract
Premature ventricular complexes (PVCs) are common in the general population, usuallyasymptomatic, and deemed to be benign in structurally normal hearts. The spectrum of "benign" outflow tract PVCs ranges from single PVCs to recurrent non-sustained ventricular tachycardia (NSVT). Short-coupled right ventricular outflow tract (RVOT) PVCs may trigger polymorphic ventricular tachycardia (VT) in some patients and can be high risk. In many patients, PVCs can be morefrequent and cause symptoms ofpalpitations, shortness of breath, dizziness, and heart failure.In the presence of underlying heart disease, they may indicate an increasedrisk of adverse cardiovascular outcomes. A high PVC burdenmay lead to ventricular dysfunction and worsen underlying cardiomyopathy.PVCs may also be a marker of underlying pathophysiologic processes such as myocarditisand other acquired and inherited infiltrative cardiomyopathies. In this unique case report, we describe the use of a novel non-contact mapping array for mapping RVOT PVCs.
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Affiliation(s)
- Mehmet Ali Elbey
- Kansas City Heart Rhythm Institute (KCHRI), Overland Park, Kansas
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14
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 2021; 37:709-870. [PMID: 34386109 PMCID: PMC8339126 DOI: 10.1002/joa3.12491] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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15
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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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16
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Han FT. Empiric ablation of asymptomatic PVCs when there is greater than 20% burden but normal left ventricular function-An argument in support of catheter ablation. Heart Rhythm O2 2021; 2:205-209. [PMID: 34113923 PMCID: PMC8183869 DOI: 10.1016/j.hroo.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Frederick T Han
- Section of Cardiac Electrophysiology University of California, San Diego Cardiovascular Institute, La Jolla, California
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17
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Empiric catheter ablation of premature ventricular contractions when there is a >20% burden in an asymptomatic patient with normal left ventricular size and function-An argument for a conservative, do-less approach. Heart Rhythm O2 2021; 2:210-214. [PMID: 34113924 PMCID: PMC8183866 DOI: 10.1016/j.hroo.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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18
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto SI, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2021; 85:1104-1244. [PMID: 34078838 DOI: 10.1253/circj.cj-20-0637] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Kure Medical Center and Chugoku Cancer Center
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kaoru Okishige
- Department of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Yuji Nakazato
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi
| | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Takeshi Aiba
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Inoue
- Division of Arrhythmia, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kikuya Uno
- Arrhythmia Center, Chiba Nishi General Hospital
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | | | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | | | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | - Tsugutoshi Suzuki
- Departments of Pediatric Electrophysiology, Osaka City General Hospital
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Department of Internal Medicine II, Kansai Medical University
| | - Masaomi Chinushi
- School of Health Sciences, Faculty of Medicine, Niigata University
| | - Nobuhiro Nishi
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Hachiya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | | | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Congenital Heart Disease Center, Tenri Hospital
| | - Tomoshige Morimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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19
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Huizar JF, Tan AY, Kaszala K, Ellenbogen KA. Clinical and translational insights on premature ventricular contractions and PVC-induced cardiomyopathy. Prog Cardiovasc Dis 2021; 66:17-27. [PMID: 33857575 PMCID: PMC9192164 DOI: 10.1016/j.pcad.2021.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 12/29/2022]
Abstract
The medical community's understanding of the consequences of premature ventricular contractions (PVCs) and PVC-induced cardiomyopathy has been derived mostly from observational and large population-based studies. Due to the difficulty of predicting the development of PVC-cardiomyopathy, the acute and chronic cardiac effects of PVCs and the mechanism of PVC-cardiomyopathy have been derived from pre-clinical studies with large animal models. Recently, these studies have described myocardial substrates that could potentially increase morbidity and mortality in patients with frequent PVCs and PVC-cardiomyopathy. In this paper, we provide an up-to-date comprehensive review of these pre-clinical and clinical studies.
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Affiliation(s)
- Jose F Huizar
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States of America; Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, United States of America.
| | - Alex Y Tan
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States of America; Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, United States of America
| | - Karoly Kaszala
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States of America; Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, United States of America
| | - Kenneth A Ellenbogen
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States of America
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20
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Hsia BC, Greige N, Patel SK, Clark RM, Ferrick KJ, Fisher JD, Gross J, Di Biase L, Krumerman A. Determining the optimal duration for premature ventricular contraction monitoring. Heart Rhythm 2020; 17:2119-2125. [PMID: 32679267 DOI: 10.1016/j.hrthm.2020.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Premature ventricular contractions (VPC) have hour-to-hour and day-to-day variation. High VPC burden correlates with cardiomyopathy. OBJECTIVE To determine the optimal duration for ambulatory electrocardiogram monitoring for accurate assessment of VPC burden. METHODS Our group performed a retrospective analysis on patch monitors used for any indication with overall VPC burden ≥5.0% between February 1, 2016, and February 1, 2020. We generated cumulative daily VPC averages for each day of wear and performed linear regression analysis between each cumulative daily average and overall burden. Patients were divided into groups based on low or high VPC frequency, and the analysis was repeated. Split-sample validation was used to internally validate the overall prediction model. RESULTS A total of 116 patches representing 107 patients (mean age: 64.5; female: 48%) were analyzed. Mean overall VPC burden was 13.4% ± 7.5% (range: 5.0%-42.0%). Day 1 R2 was 60%, P < .001, and continued to increase to R2 88%, P < .001 at day 14. Median percent and absolute error decreased from 22.70% (interquartile range [IQR]: 9.73-34.39) and 2.58% (IQR: 1.24-4.59) at day 1 to 5.62% (IQR: 2.82-8.39) and 0.55% (IQR: 0.28-1.05) at day 14. Patients with higher overall VPC frequencies achieved a more rapid rise in R2 relative to those with lower frequencies. Split-sample validation supported the internal validity of our linear regression prediction model. CONCLUSION Mobile telemetry for a period of ∼7 days accurately reflects overall VPC burden. Measurement of VPC burden for only 24-48 hours may not accurately reflect total burden. Monitoring for 2 weeks or longer adds little additional VPC information.
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Affiliation(s)
- Brian C Hsia
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York
| | - Nicolas Greige
- Harold and Muriel Block Institute for Clinical and Translational Research, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York
| | - Shreyans K Patel
- Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York
| | - Rachel M Clark
- Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York
| | - Kevin J Ferrick
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York
| | - John D Fisher
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York
| | - Jay Gross
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York
| | - Luigi Di Biase
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York
| | - Andrew Krumerman
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York.
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21
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Di Biase L, Romero J, Briceño DF. The ABC-VT risk score: Not as simple as it seems. Heart Rhythm 2020; 17:1075-1076. [DOI: 10.1016/j.hrthm.2020.03.017] [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: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 10/24/2022]
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22
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Voskoboinik A, Hadjis A, Alhede C, Im SI, Park H, Moss J, Marcus GM, Hsia H, Lee B, Tseng Z, Lee R, Scheinman M, Vedantham V, Vittinghoff E, Park KM, Gerstenfeld EP. Predictors of adverse outcome in patients with frequent premature ventricular complexes: The ABC-VT risk score. Heart Rhythm 2020; 17:1066-1074. [DOI: 10.1016/j.hrthm.2020.02.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 02/14/2020] [Indexed: 12/21/2022]
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Abstract
Premature ventricular complexes (PVCs) are extremely common, found in the majority of individuals undergoing long-term ambulatory monitoring. Increasing age, a taller height, a higher blood pressure, a history of heart disease, performance of less physical activity, and smoking each predict a greater PVC frequency. Although the fundamental causes of PVCs remain largely unknown, potential mechanisms for any given PVC include triggered activity, automaticity, and reentry. PVCs are commonly asymptomatic but can also result in palpitations, dyspnea, presyncope, and fatigue. The history, physical examination, and 12-lead ECG are each critical to the diagnosis and evaluation of a PVC. An echocardiogram is indicated in the presence of symptoms or particularly frequent PVCs, and cardiac magnetic resonance imaging is helpful when the evaluation suggests the presence of associated structural heart disease. Ambulatory monitoring is required to assess PVC frequency. The prognosis of those with PVCs is variable, with ongoing uncertainty regarding the most informative predictors of adverse outcomes. An increased PVC frequency may be a risk factor for heart failure and death, and the resolution of systolic dysfunction after successful catheter ablation of PVCs demonstrates that a causal relationship can be present. Patients with no or mild symptoms, a low PVC burden, and normal ventricular function may be best served with simple reassurance. Either medical treatment or catheter ablation are considered first-line therapies in most patients with PVCs associated with symptoms or a reduced left ventricular ejection fraction, and patient preference plays a role in determining which to try first. If medical treatment is selected, either β-blockers or nondihydropyridine calcium channel blockers are reasonable drugs in patients with normal ventricular systolic function. Other antiarrhythmic drugs should be considered if those initial drugs fail and ablation has been declined, has been unsuccessful, or has been deemed inappropriate. Catheter ablation is the most efficacious approach to eradicate PVCs but may confer increased upfront risks. Original research remains necessary to identify individuals at risk for PVC-induced cardiomyopathy and to identify preventative and therapeutic approaches targeting the root causes of PVCs to maximize effectiveness while minimizing risk.
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Affiliation(s)
- Gregory M. Marcus
- Electrophysiology Section, Division of Cardiology, University of California, San Francisco
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24
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Arrhythmia-Induced Cardiomyopathy: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 73:2328-2344. [PMID: 31072578 DOI: 10.1016/j.jacc.2019.02.045] [Citation(s) in RCA: 170] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/13/2019] [Accepted: 02/18/2019] [Indexed: 12/26/2022]
Abstract
Arrhythmias coexist in patients with heart failure (HF) and left ventricular (LV) dysfunction. Tachycardias, atrial fibrillation, and premature ventricular contractions are known to trigger a reversible dilated cardiomyopathy referred as arrhythmia-induced cardiomyopathy (AiCM). It remains unclear why some patients are more prone to develop AiCM despite similar arrhythmia burdens. The challenge is to determine whether arrhythmias are fully, partially, or at all responsible for an observed LV dysfunction. AiCM should be suspected in patients with mean heart rate >100 beats/min, atrial fibrillation, and/or premature ventricular contractions burden ≥10%. Reversal of cardiomyopathy by elimination of the arrhythmia confirms AiCM. Therapeutic choice depends on the culprit arrhythmia, patient comorbidities, and preferences. Following recovery of LV function, patients require continued follow-up if an abnormal myocardial substrate is present. Appropriate diagnosis and treatment of AiCM is likely to improve quality of life and clinical outcomes and to reduce hospital admission and health care spending.
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25
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Premature ventricular complexes: diagnostic and therapeutic considerations in clinical practice : A state-of-the-art review by the American College of Cardiology Electrophysiology Council. J Interv Card Electrophysiol 2019; 57:5-26. [PMID: 31828560 DOI: 10.1007/s10840-019-00655-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/27/2019] [Indexed: 12/16/2022]
Abstract
Premature ventricular complexes (PVCs) are common arrhythmias in the clinical setting. PVCs in the structurally normal heart are usually benign, but in the presence of structural heart disease (SHD), they may indicate increased risk of sudden death. High PVC burden may induce cardiomyopathy and left ventricular (LV) dysfunction or worsen underlying cardiomyopathy. Sometimes PVCs may be a marker of underlying pathophysiologic process such as myocarditis. Identification of PVC burden is important, since cardiomyopathy and LV dysfunction can reverse after catheter ablation or pharmacological suppression. This state-of-the-art review discusses pathophysiology, clinical manifestations, how to differentiate benign and malignant PVCs, PVCs in the structurally normal heart, underlying SHD, diagnostic procedures (physical examination, electrocardiogram, ambulatory monitoring, exercise testing, echocardiography, cardiac magnetic resonance imaging, coronary angiography, electrophysiology study), and treatment (lifestyle modification, electrolyte imbalance, medical, and catheter ablation).
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Walters TE, Rahmutula D, Szilagyi J, Alhede C, Sievers R, Fang Q, Olgin J, Gerstenfeld EP. Left Ventricular Dyssynchrony Predicts the Cardiomyopathy Associated With Premature Ventricular Contractions. J Am Coll Cardiol 2019; 72:2870-2882. [PMID: 30522650 DOI: 10.1016/j.jacc.2018.09.059] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 08/23/2018] [Accepted: 09/10/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The pathophysiology of cardiomyopathy associated with premature ventricular contractions (PVCs) remains unclear. OBJECTIVES This study prospectively explored cardiomyopathy development in a swine model of paced ectopic beats. METHODS A total of 35 swine underwent pacemaker implantation. A group exposed to paced bigeminy from the right ventricular apex (RVA) for 14 weeks (RVA PVC) (n = 10) were compared with a group exposed to regular pacing from the RVA at 140 beats/min (RV-140) (n = 5) and a control group (n = 5). To test the role of ectopic beat dyssynchrony, further groups were exposed for 12 weeks to bigeminy from the right ventricular free wall (RVFW PVC) (n = 5), the left ventricular epicardium (LV Epi PVC) (n = 5) or the right atrium (premature atrial complex) (n = 5). RESULTS After 14 weeks, the mean left ventricular ejection fraction (LVEF) was significantly lower in the RVA PVC group than in the RV-140 or control groups (p < 0.05). LVEF declined significantly in the LV Epi PVC (65.2 ± 2.4% to 39.7 ± 3.0%; p < 0.01) and RVFW PVC (66.1 ± 2.6% to 48.6 ± 2.7%; p < 0.01) groups, with final LVEF significantly lower and ventricular fibrosis significantly higher in the LV Epi PVC group compared with all others (p < 0.05). Protein levels of pRyR2, NCX-1, CaMKII-α, and PLN were up-regulated and levels of SERCA2a were down-regulated in the LV Epi PVC group compared with the control group (p < 0.05). Longer ectopic beat QRS duration and greater LV dyssynchrony were significantly associated with larger declines in LV systolic function. CONCLUSIONS In a swine model of paced ectopic beats, PVC-induced cardiomyopathy is phenotypically distinct from a tachycardia-induced cardiomyopathy. Cardiomyopathy severity is strongly associated with severity of the hemodynamic derangement associated with the paced ectopic beats, particularly the extent of LV dyssynchrony.
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Affiliation(s)
- Tomos E Walters
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, San Francisco, California
| | - Dolkun Rahmutula
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, San Francisco, California
| | - Judit Szilagyi
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, San Francisco, California
| | - Christina Alhede
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, San Francisco, California
| | - Richard Sievers
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, San Francisco, California
| | - Qizhi Fang
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, San Francisco, California
| | - Jeffrey Olgin
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, San Francisco, California
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, San Francisco, California.
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Kawamura M, Arai S, Gokan T, Yoshikawa K, Ogawa K, Ochi A, Chiba Y, Onishi Y, Munetsugu Y, Ito H, Onuki T, Kobayashi Y, Shinke T. Idiopathic basal crux ventricular arrhythmias with left bundle branch block and superior axis: A comparison with inferior-septal valvular arrhythmias. J Cardiovasc Electrophysiol 2019; 30:1914-1922. [PMID: 31392788 DOI: 10.1111/jce.14103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/05/2019] [Accepted: 08/05/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Left bundle branch block (LBBB) with superior axis is common in patients with idiopathic-ventricular arrhythmia (VA) originating from the tricuspid annulus (TA) and rarely from the cardiac basal crux and mitral annulus (MA). We described the electrocardiography and electrophysiological findings of idiopathic-VA presenting with LBBB and superior axis. METHODS AND RESULTS We described 42 idiopathic-VA patients who had an LBBB and superior axis; 15 basal crux-VA, 17 TA-VA, and 10 MA-VA. No patient had a structural heart disease. Among patients with idiopathic-VA referred for ablation, we investigated the electrocardiogram and clinical characteristics of basal crux-VA as compared with other LBBB and superior axis-VA. The left ventricular ejection fraction with MA-VA was significantly lower in comparison with basal crux-VA (P = .01). All patients had a positive R wave in lead I and aVL. The maximum deflection index with basal crux-VA was significantly higher in comparison with TA-VA or MA-VA (P = .01). Patients with basal crux-VA presented with QS wave in lead II more frequently as compared with TA-VA or MA-VA (P = .001). All MA-VA patients had Rs wave in V6, and basal crux-VA, and TA-VA patients had a monophasic R wave or Rs wave in V6. Basal crux-VA patients underwent ablation in the middle cardiac vein (MCV) or coronary sinus (success rate: 94%, recurrence rate: 6%). CONCLUSIONS We could distinguish basal crux-VA, TA-VA, and MA-VA, using a combination of clinical and electrocardiographic findings. These findings might be useful for counseling patients about an ablation strategy. Ablation via the MCV is effective for eliminating basal crux-VA.
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Affiliation(s)
- Mitsuharu Kawamura
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Shuhei Arai
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Toshihiko Gokan
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Kosuke Yoshikawa
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Ko Ogawa
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Akinori Ochi
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Yuta Chiba
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Yoshimi Onishi
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Yumi Munetsugu
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Hiroyuki Ito
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Tatsuya Onuki
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Youichi Kobayashi
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Toshiro Shinke
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
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Kanat S, Mutluer FO, Tütüncü A, Karaduman BD, Bozkaya VO, Keskin M, Uslu A, Çay S, Tenekecioglu E. Left Atrial Function Is Improved in Short-Term Follow-Up after Catheter Ablation of Outflow Tract Premature Ventricular Complexes. ACTA ACUST UNITED AC 2019; 55:medicina55060241. [PMID: 31163695 PMCID: PMC6630603 DOI: 10.3390/medicina55060241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/04/2019] [Accepted: 05/27/2019] [Indexed: 12/13/2022]
Abstract
Background: Association of premature ventricular complexes (PVC) with left ventricular systolic dysfunction (LVSD) and efficacy of catheter ablation treatment have been demonstrated in studies. The role of left atrial (LA) mechanics in the etiopathogenesis of PVC-induced cardiomyopathy (PVC-CMP) as well as changes in LA mechanics with catheter ablation have not been studied before. Methods: A total number of 61 patients (Mean Age 43 ± 3) with idiopathic outflow tract (OT) PVCs undergoing radiofrequency catheter ablation (RFCA) were enrolled. ECG, 24 h Holter, and echocardiographic evaluation with left ventricular (LV) diastolic functions and LA volumetric assessments were performed before and three months after RFCA. Results: Along with a marginal increase in left ventricle ejection fraction (LVEF), improvement in diastolic functions and left atrial mechanics were observed in the study (LVEF 53 ± 7 versus 57 ± 6, p < 0.01) in short-term follow-up. The frequency of LV diastolic dysfunction (LVDD) decreased with catheter ablation (n = 5 to 0, p = 0.02). The overall LA function improved. Left atrium passive and overall emptying fraction (LAEF) increased significantly (0.32 ± 0.04 to 0.41 ± 0.04, p < 0.05 and 0.62 ± 0.04 to 0.65 ± 0.004, p < 0.05, respectively). Active LAEF decreased significantly (0.29 ± 0.005 to 0.24 ± 0.006, p < 0.05). Conclusions: The results of this study are indicative of “PVC-induced atriomyopathy” which responds to RFCA in short-term follow-up. Atrial dysfunction might play a role in symptoms and etiopathogenesis of LVSD.
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Affiliation(s)
- Selçuk Kanat
- Department of Cardiology, Bursa Education and Research Hospital, Health Sciences University Bursa, 16310 Bursa, Turkey.
| | - Ferit Onur Mutluer
- Department of Cardiology, Erasmus MC, Erasmus University, 3000 CA Rotterdam, The Netherlands.
| | - Ahmet Tütüncü
- Department of Cardiology, Bursa Education and Research Hospital, Health Sciences University Bursa, 16310 Bursa, Turkey.
| | - Bilge Duran Karaduman
- Department of Cardiology, Atatürk Education and Research Hospital, Yildirim Bayezit University, 06760 Ankara, Turkey.
| | - Veciha Ozlem Bozkaya
- Department of Cardiology, Zekai Tahir Burak Education and Research Hospital, 06230 Ankara, Turkey.
| | - Muhammed Keskin
- Department of Cardiology, Istanbul Sultan Abdulhamid Han Education and Research Hospital, 34668 Istanbul, Turkey.
| | - Abdulkadir Uslu
- Department of Cardiology, Kosuyolu Education and Research Hospital, 34865 Istanbul, Turkey.
| | - Serkan Çay
- Department of Cardiology, Ankara Yüksek İhtisas Education and Research Hospital, 06100 Ankara, Turkey.
| | - Erhan Tenekecioglu
- Department of Cardiology, Bursa Education and Research Hospital, Health Sciences University Bursa, 16310 Bursa, Turkey.
- Department of Cardiology, Erasmus MC, Erasmus University, 3000 CA Rotterdam, The Netherlands.
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Hamon D, Swid MA, Rajendran PS, Liu A, Boyle NG, Shivkumar K, Bradfield JS. Premature ventricular contraction diurnal profiles predict distinct clinical characteristics and beta‐blocker responses. J Cardiovasc Electrophysiol 2019; 30:836-843. [DOI: 10.1111/jce.13944] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 02/15/2019] [Indexed: 11/28/2022]
Affiliation(s)
- David Hamon
- UCLA Cardiac Arrhythmia CenterDavid Geffen School of Medicine at UCLALos Angeles California
- Department of CardiologyUniversity Hospital Henri MondorCreteil France
| | - Mohammed Amer Swid
- UCLA Cardiac Arrhythmia CenterDavid Geffen School of Medicine at UCLALos Angeles California
| | - Pradeep S. Rajendran
- UCLA Cardiac Arrhythmia CenterDavid Geffen School of Medicine at UCLALos Angeles California
| | - Albert Liu
- UCLA Cardiac Arrhythmia CenterDavid Geffen School of Medicine at UCLALos Angeles California
| | - Noel G. Boyle
- UCLA Cardiac Arrhythmia CenterDavid Geffen School of Medicine at UCLALos Angeles California
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia CenterDavid Geffen School of Medicine at UCLALos Angeles California
| | - Jason S. Bradfield
- UCLA Cardiac Arrhythmia CenterDavid Geffen School of Medicine at UCLALos Angeles California
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Lee A, Denman R, Haqqani HM. Ventricular Ectopy in the Context of Left Ventricular Systolic Dysfunction: Risk Factors and Outcomes Following Catheter Ablation. Heart Lung Circ 2019; 28:379-388. [DOI: 10.1016/j.hlc.2018.01.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/23/2017] [Accepted: 01/29/2018] [Indexed: 10/18/2022]
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Mariani MV, Gatto MC, Piro A, Fedele F, Lavalle C. Delayed efficacy of radiofrequency catheter ablation on arrhythmias originating in the interventricular basal septum. Clin Case Rep 2019; 7:322-327. [PMID: 30847198 PMCID: PMC6389468 DOI: 10.1002/ccr3.1883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 09/18/2018] [Accepted: 10/02/2018] [Indexed: 11/20/2022] Open
Abstract
Delayed efficacy of radiofrequency energy can suppress ventricular arrhythmias after a failed ablation procedure. The implant of cardiac defibrillator for arrhythmia-induced cardiomyopathy should be procrastinated after a period of follow-up. Waiting for delayed efficacy is a reasonable choice to reduce the risk of complications associated with aggressive ablative approaches.
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Affiliation(s)
- Marco V. Mariani
- Department of Cardiovascular, Respiratory, Nephrology, Anaesthesiology and Geriatric Sciences of “Sapienza”University of RomeRomeItaly
| | - Maria C. Gatto
- Department of Cardiovascular, Respiratory, Nephrology, Anaesthesiology and Geriatric Sciences of “Sapienza”University of RomeRomeItaly
| | - Agostino Piro
- Department of Cardiovascular, Respiratory, Nephrology, Anaesthesiology and Geriatric Sciences of “Sapienza”University of RomeRomeItaly
| | - Francesco Fedele
- Department of Cardiovascular, Respiratory, Nephrology, Anaesthesiology and Geriatric Sciences of “Sapienza”University of RomeRomeItaly
| | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrology, Anaesthesiology and Geriatric Sciences of “Sapienza”University of RomeRomeItaly
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Lee A, Walters TE, Gerstenfeld EP, Haqqani HM. Frequent Ventricular Ectopy: Implications and Outcomes. Heart Lung Circ 2019; 28:178-190. [DOI: 10.1016/j.hlc.2018.09.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 11/29/2022]
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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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2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Heart Rhythm 2018; 15:e73-e189. [DOI: 10.1016/j.hrthm.2017.10.036] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Indexed: 02/07/2023]
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2018; 138:e272-e391. [PMID: 29084731 DOI: 10.1161/cir.0000000000000549] [Citation(s) in RCA: 249] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | - William G Stevenson
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael J Ackerman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - William J Bryant
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - David J Callans
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne B Curtis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Barbara J Deal
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Timm Dickfeld
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael E Field
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Gregg C Fonarow
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne M Gillis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Christopher B Granger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Stephen C Hammill
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Mark A Hlatky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - José A Joglar
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - G Neal Kay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Daniel D Matlock
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Robert J Myerburg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Richard L Page
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2018; 72:e91-e220. [PMID: 29097296 DOI: 10.1016/j.jacc.2017.10.054] [Citation(s) in RCA: 692] [Impact Index Per Article: 115.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Yamada S, Chung FP, Lin YJ, Chang SL, Lo LW, Hu YF, Chao TF, Liao JN, Lin CH, Lin CY, Chang YT, Te ALD, Liao YC, Chi PC, Chen SA. Electrocardiographic characteristics for predicting idiopathic right ventricular outflow tract premature ventricular complex-induced cardiomyopathy. J Interv Card Electrophysiol 2018; 53:175-185. [PMID: 29948583 DOI: 10.1007/s10840-018-0384-5] [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] [Received: 02/14/2018] [Accepted: 05/15/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE In spite of several proposed predictors for premature ventricular complex (PVC)-induced cardiomyopathy (PVC-CMP), the specific ECG features of idiopathic right ventricular outflow tract (RVOT) PVC-CMP remain unknown. METHODS A total of 130 patients (49 males, mean age 44 years) with symptomatic and drug-refractory idiopathic RVOT PVCs undergoing radiofrequency catheter ablation (RFCA) were enrolled. The patients were categorized into two groups, including those with and without RVOT PVC-CMP (left ventricular ejection fraction (LVEF) < 50%, n = 25 and LVEF ≥ 50%, n = 105, respectively). The 12-lead PVC morphologies were assessed. RESULTS Patients with RVOT PVC-CMP had a lower LVEF (42 ± 5% vs. 60 ± 7%, P < 0.01) and higher PVC burden (24 ± 14% vs. 15 ± 11%, P = 0.02) when compared to patients without RVOT PVC-CMP. The PVC features in those with PVC-CMP displayed a significantly wider QRS duration (143 ± 14 ms vs. 132 ± 17 ms, P < 0.01) and higher peak deflection index (PDI; 0.60 ± 0.07 vs. 0.55 ± 0.08, P < 0.01). A multivariate analysis demonstrated that the QRS duration (odds ratio (OR) 1.130, 95% confidence interval (CI) 1.020-1.253, P = 0.02) and PDI (OR 1.240, 95% CI 1.004-1.532, P = 0.04) were independently associated with RVOT PVC-CMP. Based on the receiver-operating characteristic analysis, a QRS duration > 139 ms and PDI > 0.57 could predict RVOT PVC-CMP (area under the curve (AUC) 0.710 and AUC 0.690, respectively). The elimination and suppression of PVCs by RFCA resulted in the recovery of the LVEF in RVOT PVC-CMP. CONCLUSIONS The ECG parameters, including a wider QRS duration and higher PDI, could predict the development of RVOT PVC-CMP, which could be effectively treated by RFCA.
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Affiliation(s)
- Shinya Yamada
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Fa-Po Chung
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shih-Lin Chang
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Li-Wei Lo
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yu-Feng Hu
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Tze-Fan Chao
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Jo-Nan Liao
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chung-Hsing Lin
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Internal Medicine, Division of Cardiology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chin-Yu Lin
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan
| | - Yao-Ting Chang
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan
| | - Abigail Louise D Te
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan
| | - Ying-Chieh Liao
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Po-Ching Chi
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shih-Ann Chen
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan. .,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
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Mulpuru SK, Witt CM. Post-Extrasystolic Potentiation for Individualizing Care of Premature Ventricular Contraction-Induced Cardiomyopathy. JACC Clin Electrophysiol 2018; 3:1292-1295. [PMID: 29759626 DOI: 10.1016/j.jacep.2017.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 07/13/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Siva K Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, Arizona; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Chance M Witt
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, Arizona; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Predicting value of coupling interval variability in determining the origin of ventricular premature contractions with V3 transition. J Interv Card Electrophysiol 2018; 53:169-174. [PMID: 29737447 DOI: 10.1007/s10840-018-0381-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE We aimed to investigate the predictive value of coupling interval variability (ΔCI) in determining the origin of idiopathic outflow tract ventricular tachycardia (OTVT) with V3 transition. METHODS We reviewed data from 126 patients who underwent catheter ablation of OTVT between 2015 and 2018 at our institution. We identified 32 patients of successful OTVT ablation with a precordial transition at V3 derivation. The ΔCI (maximum - minimum CI) was measured. RESULTS CI variability was significantly smaller for right ventricular (RV) OT than left ventricular (LV) OT premature ventricular contractions (PVCs) (p = 0.004). In multivariate analysis, including QRS duration, R-wave duration in lead V1, R-wave amplitude in V1, PVC burden, and ΔCI, ΔCI was the only independent predictor of PVC origin (OR 0.963, 95% CI, 0.939-0.988, p < 0.001). A CI variability ≥ 30 predicted a PVC from LVOT origin with a sensitivity of 83% and specificity of 89%. ΔCI was compared with other previously proposed ECG criteria used to differentiate LVOT from RVOT PVCs. ΔCI exhibited a greater area under the curve (AUC) (0.867) than the other ECG criteria. A ΔCI ≥ 30 ms exhibited a high sensitivity of 89% and a specificity of 83%. CONCLUSIONS ΔCI is outperformed other ECG criteria to differentiate LVOT from RVOT PVCs, and this parameter may be useful for planning the ablation strategy.
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40
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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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Affiliation(s)
- Claire A Martin
- Department of Cardiology, Barts Health NHS Trust, London, UK
| | - Pier D Lambiase
- Department of Cardiology, Barts Health NHS Trust, London, UK
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Hamon D, Rajendran PS, Chui RW, Ajijola OA, Irie T, Talebi R, Salavatian S, Vaseghi M, Bradfield JS, Armour JA, Ardell JL, Shivkumar K. Premature Ventricular Contraction Coupling Interval Variability Destabilizes Cardiac Neuronal and Electrophysiological Control: Insights From Simultaneous Cardioneural Mapping. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004937. [PMID: 28408652 DOI: 10.1161/circep.116.004937] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 02/15/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Variability in premature ventricular contraction (PVC) coupling interval (CI) increases the risk of cardiomyopathy and sudden death. The autonomic nervous system regulates cardiac electrical and mechanical indices, and its dysregulation plays an important role in cardiac disease pathogenesis. The impact of PVCs on the intrinsic cardiac nervous system, a neural network on the heart, remains unknown. The objective was to determine the effect of PVCs and CI on intrinsic cardiac nervous system function in generating cardiac neuronal and electric instability using a novel cardioneural mapping approach. METHODS AND RESULTS In a porcine model (n=8), neuronal activity was recorded from a ventricular ganglion using a microelectrode array, and cardiac electrophysiological mapping was performed. Neurons were functionally classified based on their response to afferent and efferent cardiovascular stimuli, with neurons that responded to both defined as convergent (local reflex processors). Dynamic changes in neuronal activity were then evaluated in response to right ventricular outflow tract PVCs with fixed short, fixed long, and variable CI. PVC delivery elicited a greater neuronal response than all other stimuli (P<0.001). Compared with fixed short and long CI, PVCs with variable CI had a greater impact on neuronal response (P<0.05 versus short CI), particularly on convergent neurons (P<0.05), as well as neurons receiving sympathetic (P<0.05) and parasympathetic input (P<0.05). The greatest cardiac electric instability was also observed after variable (short) CI PVCs. CONCLUSIONS Variable CI PVCs affect critical populations of intrinsic cardiac nervous system neurons and alter cardiac repolarization. These changes may be critical for arrhythmogenesis and remodeling, leading to cardiomyopathy.
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Affiliation(s)
- David Hamon
- From the Cardiac Arrhythmia Center (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.S.B., J.A.A., J.L.A., K.S.), Neurocardiology Research Center of Excellence (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.A.A., J.L.A., K.S.), and Molecular, Cellular & Integrative Physiology Program (P.S.R., R.W.C., M.V., J.L.A., K.S.), David Geffen School of Medicine, University of California-Los Angeles
| | - Pradeep S Rajendran
- From the Cardiac Arrhythmia Center (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.S.B., J.A.A., J.L.A., K.S.), Neurocardiology Research Center of Excellence (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.A.A., J.L.A., K.S.), and Molecular, Cellular & Integrative Physiology Program (P.S.R., R.W.C., M.V., J.L.A., K.S.), David Geffen School of Medicine, University of California-Los Angeles
| | - Ray W Chui
- From the Cardiac Arrhythmia Center (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.S.B., J.A.A., J.L.A., K.S.), Neurocardiology Research Center of Excellence (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.A.A., J.L.A., K.S.), and Molecular, Cellular & Integrative Physiology Program (P.S.R., R.W.C., M.V., J.L.A., K.S.), David Geffen School of Medicine, University of California-Los Angeles
| | - Olujimi A Ajijola
- From the Cardiac Arrhythmia Center (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.S.B., J.A.A., J.L.A., K.S.), Neurocardiology Research Center of Excellence (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.A.A., J.L.A., K.S.), and Molecular, Cellular & Integrative Physiology Program (P.S.R., R.W.C., M.V., J.L.A., K.S.), David Geffen School of Medicine, University of California-Los Angeles
| | - Tadanobu Irie
- From the Cardiac Arrhythmia Center (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.S.B., J.A.A., J.L.A., K.S.), Neurocardiology Research Center of Excellence (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.A.A., J.L.A., K.S.), and Molecular, Cellular & Integrative Physiology Program (P.S.R., R.W.C., M.V., J.L.A., K.S.), David Geffen School of Medicine, University of California-Los Angeles
| | - Ramin Talebi
- From the Cardiac Arrhythmia Center (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.S.B., J.A.A., J.L.A., K.S.), Neurocardiology Research Center of Excellence (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.A.A., J.L.A., K.S.), and Molecular, Cellular & Integrative Physiology Program (P.S.R., R.W.C., M.V., J.L.A., K.S.), David Geffen School of Medicine, University of California-Los Angeles
| | - Siamak Salavatian
- From the Cardiac Arrhythmia Center (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.S.B., J.A.A., J.L.A., K.S.), Neurocardiology Research Center of Excellence (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.A.A., J.L.A., K.S.), and Molecular, Cellular & Integrative Physiology Program (P.S.R., R.W.C., M.V., J.L.A., K.S.), David Geffen School of Medicine, University of California-Los Angeles
| | - Marmar Vaseghi
- From the Cardiac Arrhythmia Center (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.S.B., J.A.A., J.L.A., K.S.), Neurocardiology Research Center of Excellence (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.A.A., J.L.A., K.S.), and Molecular, Cellular & Integrative Physiology Program (P.S.R., R.W.C., M.V., J.L.A., K.S.), David Geffen School of Medicine, University of California-Los Angeles
| | - Jason S Bradfield
- From the Cardiac Arrhythmia Center (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.S.B., J.A.A., J.L.A., K.S.), Neurocardiology Research Center of Excellence (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.A.A., J.L.A., K.S.), and Molecular, Cellular & Integrative Physiology Program (P.S.R., R.W.C., M.V., J.L.A., K.S.), David Geffen School of Medicine, University of California-Los Angeles
| | - J Andrew Armour
- From the Cardiac Arrhythmia Center (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.S.B., J.A.A., J.L.A., K.S.), Neurocardiology Research Center of Excellence (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.A.A., J.L.A., K.S.), and Molecular, Cellular & Integrative Physiology Program (P.S.R., R.W.C., M.V., J.L.A., K.S.), David Geffen School of Medicine, University of California-Los Angeles
| | - Jeffrey L Ardell
- From the Cardiac Arrhythmia Center (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.S.B., J.A.A., J.L.A., K.S.), Neurocardiology Research Center of Excellence (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.A.A., J.L.A., K.S.), and Molecular, Cellular & Integrative Physiology Program (P.S.R., R.W.C., M.V., J.L.A., K.S.), David Geffen School of Medicine, University of California-Los Angeles
| | - Kalyanam Shivkumar
- From the Cardiac Arrhythmia Center (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.S.B., J.A.A., J.L.A., K.S.), Neurocardiology Research Center of Excellence (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.A.A., J.L.A., K.S.), and Molecular, Cellular & Integrative Physiology Program (P.S.R., R.W.C., M.V., J.L.A., K.S.), David Geffen School of Medicine, University of California-Los Angeles.
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Noheria A, Deshmukh A, Asirvatham SJ. Ablating Premature Ventricular Complexes: Justification, Techniques, and Outcomes. Methodist Debakey Cardiovasc J 2016; 11:109-20. [PMID: 26306129 DOI: 10.14797/mdcj-11-2-109] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We reviewed the underlying principles that allow for safe and effective ablation for premature ventricular complexes. Clinical scenarios that necessitate consideration for ablation, the underlying anatomy, and the unique consideration to maximize energy delivery without compromising safety are sequentially examined.
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LAPLANTE LAURENCE, BENZAQUEN BRUNOS. A Review of the Potential Pathogenicity and Management of Frequent Premature Ventricular Contractions. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:723-30. [DOI: 10.1111/pace.12870] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 04/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- LAURENCE LAPLANTE
- Cardiology Department, Maisonneuve-Rosemont Hospital; University of Montreal; Montreal Quebec Canada
| | - BRUNO S. BENZAQUEN
- Cardiology Department, Maisonneuve-Rosemont Hospital; University of Montreal; Montreal Quebec Canada
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HAMON DAVID, BLAYE-FELICE MARIESADRON, BRADFIELD JASONS, CHAACHOUI NAJIA, TUNG RODERICK, ELAYI CLAUDES, VASEGHI MARMAR, DHANJAL TARVINDERS, BOYLE NOELG, MAURY PHILIPPE, SHIVKUMAR KALYANAM, LELLOUCHE NICOLAS. A New Combined Parameter to Predict Premature Ventricular Complexes Induced Cardiomyopathy: Impact and Recognition of Epicardial Origin. J Cardiovasc Electrophysiol 2016; 27:709-17. [DOI: 10.1111/jce.12967] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 01/27/2016] [Accepted: 02/15/2016] [Indexed: 11/29/2022]
Affiliation(s)
- DAVID HAMON
- Federation de Cardiologie; Hôpital Henri Mondor; Assistance Publique Hôpitaux de Paris and INSERM U955; Créteil France
- UCLA Cardiac Arrhythmia Center; David Geffen School of Medicine; University of California-Los Angeles; Los Angeles California USA
| | | | - JASON S. BRADFIELD
- UCLA Cardiac Arrhythmia Center; David Geffen School of Medicine; University of California-Los Angeles; Los Angeles California USA
| | - NAJIA CHAACHOUI
- Federation de Cardiologie; Hôpital Henri Mondor; Assistance Publique Hôpitaux de Paris and INSERM U955; Créteil France
| | - RODERICK TUNG
- UCLA Cardiac Arrhythmia Center; David Geffen School of Medicine; University of California-Los Angeles; Los Angeles California USA
| | - CLAUDE S. ELAYI
- Gill Heart Institute and VAMC, Cardiology Division; University of Kentucky; Lexington Kentucky USA
| | - MARMAR VASEGHI
- UCLA Cardiac Arrhythmia Center; David Geffen School of Medicine; University of California-Los Angeles; Los Angeles California USA
| | - TARVINDER S. DHANJAL
- Federation de Cardiologie; Hôpital Henri Mondor; Assistance Publique Hôpitaux de Paris and INSERM U955; Créteil France
| | - NOEL G. BOYLE
- UCLA Cardiac Arrhythmia Center; David Geffen School of Medicine; University of California-Los Angeles; Los Angeles California USA
| | | | - KALYANAM SHIVKUMAR
- UCLA Cardiac Arrhythmia Center; David Geffen School of Medicine; University of California-Los Angeles; Los Angeles California USA
| | - NICOLAS LELLOUCHE
- Federation de Cardiologie; Hôpital Henri Mondor; Assistance Publique Hôpitaux de Paris and INSERM U955; Créteil France
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Gopinathannair R, Etheridge SP, Marchlinski FE, Spinale FG, Lakkireddy D, Olshansky B. Arrhythmia-Induced Cardiomyopathies: Mechanisms, Recognition, and Management. J Am Coll Cardiol 2016; 66:1714-28. [PMID: 26449143 DOI: 10.1016/j.jacc.2015.08.038] [Citation(s) in RCA: 206] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/28/2015] [Accepted: 08/17/2015] [Indexed: 12/19/2022]
Abstract
Arrhythmia-induced cardiomyopathy (AIC) is a potentially reversible condition in which left ventricular dysfunction is induced or mediated by atrial or ventricular arrhythmias. Cellular and extracellular changes in response to the culprit arrhythmia have been identified, but specific pathophysiological mechanisms remain unclear. Early recognition of AIC and prompt treatment of the culprit arrhythmia using pharmacological or ablative techniques result in symptom resolution and recovery of ventricular function. Although cardiomyopathy in response to an arrhythmia may take months to years to develop, recurrent arrhythmia can result in rapid decline in ventricular function with development of heart failure, suggesting residual ultrastructural abnormalities. Reports of sudden death in patients with normalized left ventricular ejection fraction cast doubt on the complete reversibility of this condition. Several aspects of AIC, including specific pathophysiological mechanisms, predisposing factors, optimal therapeutic strategies to prevent ultrastructural changes, and long-term risk of sudden death remain unresolved and need further research.
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Affiliation(s)
- Rakesh Gopinathannair
- Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky.
| | - Susan P Etheridge
- Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah
| | | | - Francis G Spinale
- Department of Internal Medicine, University of South Carolina, Charleston, South Carolina
| | | | - Brian Olshansky
- Mercy Heart and Vascular Institute, Mercy Medical Center North Iowa, Mason City, Iowa
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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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