Coupling Interval Ratio Is Associated with Ventricular Premature Complex-Related Symptoms

Background and Objectives

Frequent ventricular premature complex (VPC) is one of the most common arrhythmia syndromes. Symptoms observed frequently with this arrhythmia syndrome remain limited. We sought to identify predictors of VPC-related symptoms by analyzing demographic information, VPC burden, and VPC surface electrocardiogram characteristics.

Subjects and Methods

We prospectively enrolled 109 patients with idiopathic outflow tract VPCs (63 males, 49±16 years old). They were divided into Group A (n=30, without VPC-related symptoms of palpitations or "dropped beats") and Group B (n=79, with VPC-related symptoms). Measured parameters were sinus and VPC QRS width, coupling interval (CI) between the previous sinus beat and VPC, CI ratio (%, CI/sinus cycle length), post-VPC CI and CI ratio, and VPC amplitude.

Results

Both groups had similar age (p=0.22), daily VPC burden (p=0.15), and VPC site of origin (p=0.36). The VPC CI ratio was higher in Group B (60±15%) than in Group A (49±22%) (p=0.01).

Conclusion

VPC-related symptoms are associated with a higher VPC CI ratio (>50%). The physiologic basis for these results deserves further study.

Asymptomatic ventricular premature depolarizations are not necessarily benign

AIMS

Most patients with idiopathic ventricular premature depolarizations (VPDs) complain of symptoms related to this arrhythmia, but some patients are asymptomatic even with a high VPD burden. Our understanding of the relationship between symptoms and cardiomyopathy related to this arrhythmia remains limited.

METHODS AND RESULTS

We evaluated 801 subjects (381 men; mean age, 55 ± 17 years) who visited our outpatient clinic. All subjects were diagnosed with frequent VPDs (1% or >1000 beats/day). The patients were divided into two groups according to the presence or absence of typical VPD symptoms (palpitations or skipped beats during VPDs): symptomatic patients (n = 455) and asymptomatic patients (n = 346). Clinical and electrocardiogram parameters were compared between these two groups. In the symptomatic group, palpitations were the most frequent symptom (91%). Daily VPD burden (P = 0.90) and electrocardiogram parameters (P>0.05) did not differ significantly between groups. The incidence of frequent VPDs with left ventricular dysfunction was significantly higher in the asymptomatic group (symptomatic patients, 3.0%; asymptomatic patients, 10.5%; P < 0.001).

CONCLUSION

The absence of typical VPD-related symptoms may be a risk factor for cardiomyopathy and be associated with an adverse outcome.

Prevalence and characteristics of idiopathic right ventricular outflow tract arrhythmias associated with J-waves

AIM

The arrhythmogenic relationship between the presence of J-waves during sinus rhythm and idiopathic ventricular tachycardia (VT) or pre-mature ventricular contractions (PVCs) originating from the right ventricular outflow tract (RVOT) has not been reported. The aim of this study was to investigate the prevalence and characteristics of idiopathic RVOT-VT/PVCs associated with J-waves.

METHODS AND RESULTS

The study enrolled 138 consecutive idiopathic RVOT-VT/PVC patients undergoing radiofrequency catheter ablation (RFCA) and 276 age- and gender-matched control subjects. The prevalence of J-waves was assessed in each cohort, and the clinical and electrophysiological data were compared between the RVOT-VT/PVC patients with J-waves (J-RVOT-VT/PVC group) and those without (non-J-RVOT-VT/PVC group). J-waves were more common among patients with idiopathic RVOT-VT/PVCs than among the matched control subjects (40 vs. 16% P < 0.001). The J-RVOT-VT/PVC group had a higher incidence of sustained VT (25 vs. 5%, P < 0.01), shorter VT cycle length (302 ± 57 vs. 351 ± 58 ms, P < 0.001), and more episodes of syncope (25 vs. 2%, P < 0.001) than did the non-J-RVOT-VT/PVC group. However, no patients demonstrated any ventricular fibrillation (VF) or cardiac sudden death in either group.

CONCLUSIONS

There was a high prevalence of J-waves in the idiopathic RVOT-VT/PVC patients referred for RFCA. Although patients with idiopathic RVOT arrhythmias associated with J-waves might have a more enhanced arrhythmogenicity than those without J-waves, the significance of those J-waves was limited in terms of the prognosis and VF.

Ventricular tachycardia without apparent heart disease: long-term follow-up

The purpose of the study was to evaluate the long-term prognosis of ventricular tachycardia (VT) in patients without structural heart disease (HD).

METHODS

Holter monitoring, exercise test, echocardiography, right angiography, coronary angiography, and electrophysiologic study were performed in 810 patients with VT.

RESULTS

Eighty patients (mean age, 45 ± 17 years) had no apparent HD. VT was reproduced at electrophysiologic study in 62 patients. Mean follow-up was 9.7 ± 7 years. Initially, 91% were treated with drugs. Defibrillator was implanted in 4, including 2 for arrhythmogenic right ventricular cardiomyopathy diagnosed later. VT ablation was performed in 3 patients. Three patients older than 70 years died of nonarrhythmic cause. Other patients are alive without antiarrhythmic drug treatment in 50%. Three developed a dilated cardiomyopathy; and 2, atrial fibrillation.

CONCLUSIONS

Invasive treatment was rarely required in patients with VT without HD. The prognosis was only dependent on the age and the pattern of electrocardiogram in VT.