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Zhang B, Yu J, Wu Y, Li X, Xie X, Tao A, Yang B. The significance of heart rate variability in patients with frequent premature ventricular complex originating from the ventricular outflow tract. Clin Cardiol 2024; 47:e24174. [PMID: 37859500 PMCID: PMC10766131 DOI: 10.1002/clc.24174] [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: 08/22/2023] [Revised: 09/27/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND As an indicator of cardiac autonomic nervous activity, heart rate variability (HRV) is closely linked to premature ventricular complexes (PVCs). However, its role in patients with frequent PVCs originating from the ventricular outflow tract remains unclear. HYPOTHESIS Here, we hypothesize that there may be alterations in HRV among patients with frequent PVCs originating from the ventricular outflow tract, which could play significant roles in the management of such patients. METHODS A retrospective study was conducted, including 106 patients with frequent outflow tract PVCs and 106 healthy participants as controls. HRV was assessed based on the 24-hour Holter recording. The originating foci of PVCs were identified during radiofrequency catheter ablation. RESULTS Patients with frequent outflow tract PVCs exhibited decreased levels of high frequency (HF), standard deviation of all NN intervals, and standard deviation of the average NN intervals, but increased ratios of low frequency to HF (LF/HF ratio), even after propensity score-matched analysis. Further investigation revealed that patients with PVCs originating from right ventricular outflow tract (RVOT) had much higher LF/HF ratios. Multivariate logistic regression analysis demonstrated that the LF/HF ratio was independently associated with PVCs originating from RVOT. Receiver operating characteristics curve indicated that the LF/HF ratio effectively determined the origin of PVCs (the area under the curve = 0.75, p < .001). CONCLUSIONS Patients with frequent outflow tract PVCs exhibited impaired HRV. Additionally, the LF/HF ratio played a significant role in determining the origin of outflow tract PVCs.
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Affiliation(s)
- Baowei Zhang
- Center of Cardiology, Shanghai East HospitalTongji University School of MedicineShanghaiChina
| | - Jinbo Yu
- Center of Cardiology, Shanghai East HospitalTongji University School of MedicineShanghaiChina
| | - Yizhang Wu
- Center of Cardiology, Shanghai East HospitalTongji University School of MedicineShanghaiChina
| | - Xiaorong Li
- Center of Cardiology, Shanghai East HospitalTongji University School of MedicineShanghaiChina
| | - Xin Xie
- Center of Cardiology, Shanghai East HospitalTongji University School of MedicineShanghaiChina
| | - Aibin Tao
- Department of Cardiologythe affiliated People's Hospital of Jiangsu UniversityZhenjiangJiangsuChina
| | - Bing Yang
- Center of Cardiology, Shanghai East HospitalTongji University School of MedicineShanghaiChina
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Salavatian S, Yamaguchi N, Hoang J, Lin N, Patel S, Ardell JL, Armour JA, Vaseghi M. Premature ventricular contractions activate vagal afferents and alter autonomic tone: implications for premature ventricular contraction-induced cardiomyopathy. Am J Physiol Heart Circ Physiol 2019; 317:H607-H616. [PMID: 31322427 DOI: 10.1152/ajpheart.00286.2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Mechanisms behind development of premature ventricular contraction (PVC)-induced cardiomyopathy remain unclear. PVCs may adversely modulate the autonomic nervous system to promote development of heart failure. Afferent neurons in the inferior vagal (nodose) ganglia transduce cardiac activity and modulate parasympathetic output. Effects of PVCs on cardiac parasympathetic efferent and vagal afferent neurotransmission are unknown. The purpose of this study was to evaluate effects of PVCs on vagal afferent neurotransmission and compare these effects with a known powerful autonomic modulator, myocardial ischemia. In 16 pigs, effects of variably coupled PVCs on heart rate variability (HRV) and vagal afferent neurotransmission were evaluated. Direct nodose neuronal recordings were obtained in vivo, and cardiac-related afferent neurons were identified based on their response to cardiovascular interventions, including ventricular chemical and mechanical stimuli, left anterior descending (LAD) coronary artery occlusion, and variably coupled PVCs. On HRV analysis before versus after PVCs, parasympathetic tone decreased (normalized high frequency: 83.6 ± 2.8 to 72.5 ± 5.3; P < 0.05). PVCs had a powerful impact on activity of cardiac-related afferent neurons, altering activity of 51% of neurons versus 31% for LAD occlusion (P < 0.05 vs. LAD occlusion and all other cardiac interventions). Both chemosensitive and mechanosensitive neurons were activated by PVCs, and their activity remained elevated even after cessation of PVCs. Cardiac afferent neural responses to PVCs were greater than any other intervention, including ischemia of similar duration. These data suggest that even brief periods of PVCs powerfully modulate vagal afferent neurotransmission, reflexly decreasing parasympathetic efferent tone.NEW & NOTEWORTHY Premature ventricular contractions (PVCs) are common in many patients and, at an increased burden, are known to cause heart failure. This study determined that PVCs powerfully modulate cardiac vagal afferent neurotransmission (exerting even greater effects than ventricular ischemia) and reduce parasympathetic efferent outflow to the heart. PVCs activated both mechano- and chemosensory neurons in the nodose ganglia. These peripheral neurons demonstrated adaptation in response to PVCs. This study provides additional data on the potential role of the autonomic nervous system in PVC-induced cardiomyopathy.
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Affiliation(s)
- Siamak Salavatian
- University of California, Los Angeles Cardiac Arrhythmia Center, Los Angeles, California.,University of California, Los Angeles Neurocardiology Research Center of Excellence, Los Angeles, California
| | - Naoko Yamaguchi
- University of California, Los Angeles Cardiac Arrhythmia Center, Los Angeles, California.,University of California, Los Angeles Neurocardiology Research Center of Excellence, Los Angeles, California
| | - Jonathan Hoang
- University of California, Los Angeles Cardiac Arrhythmia Center, Los Angeles, California.,University of California, Los Angeles Neurocardiology Research Center of Excellence, Los Angeles, California
| | - Nicole Lin
- University of California, Los Angeles Cardiac Arrhythmia Center, Los Angeles, California.,University of California, Los Angeles Neurocardiology Research Center of Excellence, Los Angeles, California
| | - Saloni Patel
- University of California, Los Angeles Cardiac Arrhythmia Center, Los Angeles, California.,University of California, Los Angeles Neurocardiology Research Center of Excellence, Los Angeles, California
| | - Jeffrey L Ardell
- University of California, Los Angeles Cardiac Arrhythmia Center, Los Angeles, California.,University of California, Los Angeles Neurocardiology Research Center of Excellence, Los Angeles, California
| | - J Andrew Armour
- University of California, Los Angeles Cardiac Arrhythmia Center, Los Angeles, California.,University of California, Los Angeles Neurocardiology Research Center of Excellence, Los Angeles, California
| | - Marmar Vaseghi
- University of California, Los Angeles Cardiac Arrhythmia Center, Los Angeles, California.,University of California, Los Angeles Neurocardiology Research Center of Excellence, Los Angeles, California
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Crosson JE, Callans DJ, Bradley DJ, Dubin A, Epstein M, Etheridge S, Papez A, Phillips JR, Rhodes LA, Saul P, Stephenson E, Stevenson W, Zimmerman F. PACES/HRS expert consensus statement on the evaluation and management of ventricular arrhythmias in the child with a structurally normal heart. Heart Rhythm 2014; 11:e55-78. [PMID: 24814375 DOI: 10.1016/j.hrthm.2014.05.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Indexed: 01/02/2023]
Affiliation(s)
- Jane E Crosson
- Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David J Callans
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Anne Dubin
- Lucile Packard Children's Hospital, Stanford School of Medicine, Stanford, California
| | | | - Susan Etheridge
- University of Utah and Primary Children's Medical Center, Salt Lake City, Utah
| | - Andrew Papez
- Phoenix Children's Hospital/Arizona Pediatric Cardiology Consultants Phoenix, Arizona
| | | | | | - Philip Saul
- Nationwide Children's Hospital, Ohio State University, Columbus, Ohio
| | | | - William Stevenson
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Frank Zimmerman
- Advocate Heart Institute for Children Advocate Children's Hospital, Oak Lawn, Illinois.
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NAKANO EMI, HARADA TOMOO, AONUMA KAZUTAKA, SOEJIMA KYOKO, WAKIMOTO HIROFUMI, MATSUMOTO NAOKI, MIYAKE FUMIHIKO. Identification of Unusual Reentry Circuit Sites of Nonischemic Ventricular Outflow Tract Tachycardia. J Cardiovasc Electrophysiol 2011; 23:179-87. [DOI: 10.1111/j.1540-8167.2011.02149.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hsu JT, Lin KH, Luqman N, Sung RJ, Kuo CT. Unusual Features of an Idiopathic Ventricular Tachycardia Arising from the Left Ventricular Outflow Tract. Pacing Clin Electrophysiol 2005; 28:160-3. [PMID: 15679648 DOI: 10.1111/j.1540-8159.2005.09435.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We encountered a 40-year-old man with recurrent symptomatic palpitations manifested as monomorphic ventricular tachycardia (VT) of a right bundle branch block (RBBB) pattern with an inferior frontal axis. Physical examination, chest roentgenogram, and echocardiogram were unremarkable. The VT could be provoked by treadmill exercise testing. Electrophysiologic study revealed that the VT could be reproducibly initiated with either atrial or ventricular pacing at cycle lengths between 500 and 400 ms. With overdrive ventricular pacing, the VT could be terminated. Of note was the observation that intravenous adenosine was not effective, but intravenous verapamil could interrupt the VT. The VT was pace mapped to be arising from a site at the left ventricular outlet tract (LVOT). Notably, during pace mapping, the pacing spike was immediately followed by the beginning of the paced QRS complex, and during VT, there was no time delay between the earliest local activation and the onset of QRS complex. Furthermore, there was no mid-diastolic activity or Purkinje potential that could be recorded during sinus rhythm and VT. Subsequently, the VT was successfully ablated with radiofrequency energy as guided by pace mapping. In summary, an idiopathic VT arising from the LVOT was found to be cycle lengths- and catecholamine-dependent, adenosine-insensitive but verapamil responsive. These unusual features suggest that either microreentry or triggered activity could be the underlying mechanism.
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Affiliation(s)
- Jen-Te Hsu
- Division of Cardiology, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taipei, Taiwan
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Ashihara T, Yao T, Namba T, Kawase A, Ikeda T, Nakazawa K, Ito M. Afterdepolarizations promote the transition from ventricular tachycardia to fibrillation in a three-dimensional model of cardiac tissue. Circ J 2002; 66:505-10. [PMID: 12030349 DOI: 10.1253/circj.66.505] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Recent experimental results regarding the action potential duration restitution curve have explained the transition from ventricular tachycardia (VT) to fibrillation (VF) in terms of spiral wave (SW) meandering and breakup. However, it remains unclear whether VF always has a steep restitution curve. The present study was designed to test the hypothesis that afterdepolarizations occur at excitable gaps during VF and affect the SW dynamics, even if the restitution curve is gentle. Homogeneous and isotropic 3-dimensional tissue was simulated with a LRd model. Because of the gentle restitution curve, it was not expected that SW instabilities would occur in this condition. In the tissue, a stationary SW reentry was initially observed; however, afterdepolarizations erupted from the excitable gap near the SW tip, and the SW then meandered widely. Following that, afterdepolarizations erupted far from the SW tip, resulting in SW breakup. In this manner, the wave dynamics degenerated into a chaotic state within a few seconds. Furthermore, not only triggered activity but also subthreshold afterdepolarizations were found to cause SW instabilities. These results suggest that afterdepolarizations may play an important role in the transition to VF and that the mechanism is independent of restitution properties.
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Affiliation(s)
- Takashi Ashihara
- First Department of Internal Medicine, Shiga University of Medical Science, Otsu, Japan.
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