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Enriquez A, Muser D, Markman TM, Garcia F. Mapping and Ablation of Premature Ventricular Complexes: State of the Art. JACC Clin Electrophysiol 2024; 10:1206-1222. [PMID: 38639702 DOI: 10.1016/j.jacep.2024.02.008] [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: 10/25/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 04/20/2024]
Abstract
Premature ventricular complexes (PVCs) are common arrhythmias in clinical practice. Although benign and asymptomatic in most cases, PVCs may result in disabling symptoms, left ventricular systolic dysfunction, or PVC-induced ventricular fibrillation. Catheter ablation has emerged as a first-line therapy in such cases, with high rates of efficacy and low risk of complications. Significant progress in mapping and ablation technology has been made in the past 2 decades, along with the development of a growing body of knowledge and accumulated experience regarding PVC sites of origin, anatomical relationships, electrocardiographic characterization, and mapping/ablation strategies. This paper provides an overview of the main indications for catheter ablation of PVCs, electrocardiographic features, PVC mapping techniques, and contemporary ablation approaches. The authors also review the most common sites of PVC origin and the main considerations and challenges with ablation in each location.
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Affiliation(s)
- Andres Enriquez
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Daniele Muser
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Timothy M Markman
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fermin Garcia
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Shen X, Zhu X, Zuo L, Liu X, Qin M. Mechanisms and Risk Factors for Premature Ventricular Contraction Induced Cardiomyopathy. Rev Cardiovasc Med 2023; 24:353. [PMID: 39077080 PMCID: PMC11272849 DOI: 10.31083/j.rcm2412353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/20/2023] [Accepted: 05/05/2023] [Indexed: 07/31/2024] Open
Abstract
Frequent premature ventricular contractions (PVCs) can cause a reversible form of cardiomyopathy in patients without structural heart disease. Because of the challenging nature of PVC-induced cardiomyopathy (PVICM), the mechanisms and risk factors for PVICM are still unclear. Based on the evidence from retrospective and observational studies, the risk factors for the development of PVICM, in addition to PVC exposure, include QRS duration, coupling interval and male sex. Based on animal models, abnormal calcium handling and cardiac remodeling may be the crucial mechanism underlying the development of cardiomyopathy. We have summarized the current knowledge on PVICM in this review. Understanding these mechanisms and risk factors is important for the diagnosis and management of this condition, which can lead to heart failure if left untreated.
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Affiliation(s)
- Xiaoyu Shen
- Shanghai Jiaotong University, 200030 Shanghai, China
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China
| | - Xiyao Zhu
- Shanghai Jiaotong University, 200030 Shanghai, China
- Shandong University of Traditional Chinese Medicine, 250355 Jinan, Shandong, China
| | - Lingyan Zuo
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China
| | - Xu Liu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China
| | - Mu Qin
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China
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Trongtorsak A, Thangjui S, Chaisidhivej N, Sharma A, Ariyachaipanich A. A Premature Ventricular Contraction Associated With Transient Worsening Pulsus Alternans: A Case Report. Cureus 2021; 13:e20284. [PMID: 35018271 PMCID: PMC8742136 DOI: 10.7759/cureus.20284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 12/01/2022] Open
Abstract
Pulsus alternans is a rare condition characterized by alternation between strong and weak pulses during regular heart rhythm. Although pulsus alternans occurs mostly in severe heart failure, it can also be seen in other conditions that alternate ventricular contraction such as rapid tachycardia and extrasystole. Here, we report the case of a patient with peripartum cardiomyopathy who developed worsening pulsus alternans after a premature ventricular contraction.
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Kowlgi GN, Ramirez RJ, Kaszala K, Joslyn M, Koneru JN, Ellenbogen KA, Tan AY, Huizar JF. Post-extrasystolic potentiation as a predictor of premature ventricular contraction-cardiomyopathy in an animal model. Europace 2020; 22:813-820. [PMID: 32142121 PMCID: PMC7828467 DOI: 10.1093/europace/euaa025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 01/21/2020] [Indexed: 12/21/2022] Open
Abstract
AIMS High premature ventricular contractions (PVCs) burden does not always predict the development of PVC-cardiomyopathy (CM). We sought to evaluate post-extrasystolic potentiation (PESP) of left ventricular ejection fraction (LVEF) to predict the severity of PVC-CM in an animal model. METHODS AND RESULTS Right ventricular apical bigeminal PVCs were introduced for 12 weeks in 11 canines to induce PVC-CM. Echocardiograms were performed to obtain LVEF without ectopy (Echo-1) and during PVCs (200 and 350 ms coupling intervals, Echo-2, and Echo-3, respectively), and premature atrial contractions (PACs) (Echo-4) at baseline and after 12 weeks of bigeminal PVCs. PESP was calculated as delta-LVEF between the sinus beat post-ectopy LVEF (Echo-2, -3, and -4, respectively) and LVEF without PVC (Echo-1) at baseline and 12 weeks of high PVC burden. A hyperdynamic LV function (LVEF > 70%) was noted in all animals only with early-coupled PVCs (LVEF at 200 ms: 74.4 ± 6%) at baseline. While PVC PESP at 200 ms had a strong significant correlation with the final 12-week LVEF (R = 0.8, P = 0.003), PVC PESP at 350 ms and PAC PESP had a positive but non-significant correlation (R = 0.53, P = 0.09, and R = 0.29, P = 0.34, respectively). Premature ventricular contraction PESP at 350 ms was significantly higher after PVC-CM had developed (delta-LVEF baseline 2.7 ± 2.9% vs. 12 weeks 18.6 ± 12.3% P < 0.001). CONCLUSION Bigeminal early-coupled PVCs cause hyperdynamic left ventricular function in the structurally normal canine heart due to PESP. The degree of PESP at baseline is inversely proportional to the PVC-CM severity at 12 weeks and maybe a predictor of PVC-CM as it may assess the myocardial adaptation reserve to PVCs.
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Affiliation(s)
- Gurukripa N Kowlgi
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Ste. 4A-100, Richmond, VA 23249, USA
| | - Rafael J Ramirez
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Ste. 4A-100, Richmond, VA 23249, USA
| | - Karoly Kaszala
- Hunter Holmes McGuire Veterans Affairs Medical Center, 1201 Broad Rock Blvd, Richmond, VA, USA
| | - Martha Joslyn
- Hunter Holmes McGuire Veterans Affairs Medical Center, 1201 Broad Rock Blvd, Richmond, VA, USA
| | - Jayanthi N Koneru
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Ste. 4A-100, Richmond, VA 23249, USA
| | - Kenneth A Ellenbogen
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Ste. 4A-100, Richmond, VA 23249, USA
| | - Alex Y Tan
- Hunter Holmes McGuire Veterans Affairs Medical Center, 1201 Broad Rock Blvd, Richmond, VA, USA
| | - Jose F Huizar
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Ste. 4A-100, Richmond, VA 23249, USA
- Hunter Holmes McGuire Veterans Affairs Medical Center, 1201 Broad Rock Blvd, Richmond, VA, USA
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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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Zhao MM, Lian WW, Li Z, Shao DX, Chen SC, Sun XF, Hu HY, Feng R, Guo F, Hao LY. Astragaloside IV Inhibits Membrane Ca[Formula: see text] Current but Enhances Sarcoplasmic Reticulum Ca[Formula: see text] Release. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2017; 45:863-877. [PMID: 28595501 DOI: 10.1142/s0192415x1750046x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Astragaloside IV (AS-IV) is one of the active ingredients in Astragalus membrananceus (Huangqi), a traditional Chinese medicine. The present study investigated the effects of AS-IV on Ca[Formula: see text] handling in cardiac myocytes to elucidate its possible mechanism in the treatment of cardiac disease. The results showed that AS-IV at 1 and 10[Formula: see text][Formula: see text]M reduced KCl-induced [Ca[Formula: see text]]i increase ([Formula: see text] from 1.33[Formula: see text][Formula: see text][Formula: see text]0.04 (control, [Formula: see text] 28) to 1.22[Formula: see text][Formula: see text][Formula: see text]0.02 ([Formula: see text], [Formula: see text] 29) and 1.22[Formula: see text][Formula: see text][Formula: see text]0.02 ([Formula: see text] 0.01, [Formula: see text]), but it enhanced Ca[Formula: see text] release from SR ([Formula: see text] from 1.04[Formula: see text][Formula: see text][Formula: see text]0.01 (control, [Formula: see text]) to 1.44[Formula: see text][Formula: see text][Formula: see text]0.03 ([Formula: see text], [Formula: see text]) and 1.60[Formula: see text][Formula: see text][Formula: see text]0.04 ([Formula: see text] 0.01, [Formula: see text]0), in H9c2 cells. Similar results were obtained in native cardiomyocytes. AS-IV at 1 and 10[Formula: see text][Formula: see text]M inhibited L-type Ca[Formula: see text] current ([Formula: see text] from [Formula: see text]4.42[Formula: see text][Formula: see text][Formula: see text]0.58 pA/pF of control to [Formula: see text]2.25[Formula: see text][Formula: see text][Formula: see text]0.12 pA/pF ([Formula: see text] 0.01, [Formula: see text] 5) and [Formula: see text]1.78[Formula: see text][Formula: see text][Formula: see text]0.28 pA/pF ([Formula: see text] 0.01, [Formula: see text] 5) respectively, when the interference of [Ca[Formula: see text]]i was eliminated due to the depletion of SR Ca[Formula: see text] store by thapsigargin, an inhibitor of Ca[Formula: see text] ATPase. Moreover, when BAPTA, a rapid Ca[Formula: see text] chelator, was used, CDI (Ca[Formula: see text]-dependent inactivation) of [Formula: see text] was eliminated, and the inhibitory effects of AS-IV on ICaL were significantly reduced at the same time. These results suggest that AS-IV affects Ca[Formula: see text] homeostasis through two opposite pathways: inhibition of Ca[Formula: see text] influx through L-type Ca[Formula: see text] channel, and promotion of Ca[Formula: see text] release from SR.
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Affiliation(s)
- Mei-Mi Zhao
- 1 Department of Pharmaceutical Toxicology, School of Pharmacy, China Medical University, Shenyang 110122, P. R. China
| | - Wen-Wen Lian
- 1 Department of Pharmaceutical Toxicology, School of Pharmacy, China Medical University, Shenyang 110122, P. R. China
| | - Zhuo Li
- 1 Department of Pharmaceutical Toxicology, School of Pharmacy, China Medical University, Shenyang 110122, P. R. China
| | - Dong-Xue Shao
- 1 Department of Pharmaceutical Toxicology, School of Pharmacy, China Medical University, Shenyang 110122, P. R. China
| | - Si-Chong Chen
- 1 Department of Pharmaceutical Toxicology, School of Pharmacy, China Medical University, Shenyang 110122, P. R. China
| | - Xue-Fei Sun
- 1 Department of Pharmaceutical Toxicology, School of Pharmacy, China Medical University, Shenyang 110122, P. R. China
| | - Hui-Yuan Hu
- 1 Department of Pharmaceutical Toxicology, School of Pharmacy, China Medical University, Shenyang 110122, P. R. China
| | - Rui Feng
- 1 Department of Pharmaceutical Toxicology, School of Pharmacy, China Medical University, Shenyang 110122, P. R. China
| | - Feng Guo
- 1 Department of Pharmaceutical Toxicology, School of Pharmacy, China Medical University, Shenyang 110122, P. R. China
| | - Li-Ying Hao
- 1 Department of Pharmaceutical Toxicology, School of Pharmacy, China Medical University, Shenyang 110122, P. R. China
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