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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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Takahashi S, Mine T, Ashida K, Kishima H, Masuyama T, Ishihara M. Left Ventricular Inflow Velocity Pattern in Patients With Symptomatic Premature Ventricular Contraction. Circ J 2019; 84:26-32. [PMID: 31801920 DOI: 10.1253/circj.cj-19-0605] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND Because premature ventricular contractions (PVCs) are one of the most common arrhythmias, but with unclear causative mechanisms, we studied the hemodynamic features that can cause symptomatic PVCs.Methods and Results:We studied 109 patients (48 males, age 60±19 years) with frequent monomorphic PVCs and no structural heart disease. The left ventricular inflow diastolic filling velocity was recorded by transthoracic echocardiography (TTE) at the time of PVCs in all patients. We assessed the PVC E wave flow (E wave velocity×duration at PVC). A total of 38 patients (35%) had PVC-related symptoms (19 palpitations, 12 pulse deficit, 6 shortness of breath, 6 malaise, 1 syncope). These patients showed reduced PVC E wave flow (9.3±6.0 vs. 14.6±6.5 cm, P<0.0001), and reduced PVC stroke volume (20.5±10.8 vs. 29.9±17.2 mL, P=0.0030). In the multivariate analysis, only reduced PVC E wave flow was independently associated with PVC-related symptoms (P=0.00349, odds ratio: 1.134029, each 1.0 cm increase in PVC E wave flow, 95% confidence interval: 1.040726-1.247544). CONCLUSIONS Decreased E wave flow at the time of PVC was independently related with PVC-related symptoms in patients with PVCs. The LV contraction at the time of inadequate filling might be a cause of PVC-related symptoms.
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Affiliation(s)
- Satoshi Takahashi
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine
| | - Takanao Mine
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine
| | - Kenki Ashida
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine
| | - Hideyuki Kishima
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine
| | - Tohru Masuyama
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine
| | - Masaharu Ishihara
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine
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Gwag HB, Kim EK, Hwang JK, Park SJ, On YK, Kim JS, Park KM. Is the stroke volume during post-ectopic beat associated with ventricular premature complex-related symptoms? Europace 2018; 20:f204-f210. [PMID: 29106575 DOI: 10.1093/europace/eux170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 04/25/2017] [Indexed: 01/10/2023] Open
Abstract
Aims This study aimed to investigate if increased stroke volume (SV) after a ventricular premature complex (VPC) was related to VPC-related symptoms. Methods and results We selected patients having an isolated VPC during echocardiography from a prospective registry that included patients with a structurally normal heart and 24-h VPC >1%. Patients were divided into two groups according to the presence or absence of VPC-related symptoms (skipped beat or palpitation) when VPC occurred. Left ventricular (LV) volumes and time-velocity integral (TVI) at the LV outflow tract were measured during the preceding sinus beat, VPC, and post-ectopic sinus beat. Percent LV SV of the VPC and post-ectopic sinus beat were calculated by dividing each SV by the SV of the preceding sinus beat. A total of 47 patients were eligible. Most patients had VPC with left bundle branch block morphology and inferior axis. Patients in the symptom (+) group had a significantly lower SV, %LV SV, and TVI during post-ectopic sinus beat than those in the symptom (-) group. The sum of SVs during VPC and post-ectopic beat was significantly lower in symptomatic patients than non-symptomatic patients (103.4 mL vs. 125.1 mL, P = 0.02), while the sum of %LV SVs during VPC and post-ectopic beat tended to be lower in patients with symptoms than those without symptoms (P = 0.08). The sum of %LV SVs during VPC and post-VPC was positively correlated with coupling interval (CI) and CI ratio. Conclusion Ventricular premature complex-related symptoms may not be associated with the amount of post-VPC SV.
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Affiliation(s)
- Hye Bin Gwag
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, #81 Irwon-ro Gangnam-gu, Seoul, Republic of Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, #81 Irwon-ro Gangnam-gu, Seoul, Republic of Korea
| | - Jin Kyung Hwang
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, #81 Irwon-ro Gangnam-gu, Seoul, Republic of Korea
| | - Seung-Jung Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, #81 Irwon-ro Gangnam-gu, Seoul, Republic of Korea
| | - Young Keun On
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, #81 Irwon-ro Gangnam-gu, Seoul, Republic of Korea
| | - June Soo Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, #81 Irwon-ro Gangnam-gu, Seoul, Republic of Korea
| | - Kyoung-Min Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, #81 Irwon-ro Gangnam-gu, Seoul, Republic of Korea
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Im SI, Kim SH, Kim BJ, Cho KI, Kim HS, Heo JH. Association of frequent premature ventricular complex >10% and stroke-like symptoms without a prior diagnosis of stroke or transient ischemic attack. IJC HEART & VASCULATURE 2018; 19:58-62. [PMID: 29946566 PMCID: PMC6016067 DOI: 10.1016/j.ijcha.2018.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 04/08/2018] [Accepted: 05/03/2018] [Indexed: 11/27/2022]
Abstract
Introduction Premature ventricular complex (PVCs) detected from long-term ECG recordings have been associated with an increased risk of ischemic stroke. However, there was limited data about the association between high PVCs burdens (>10%) and stroke-like symptoms without a prior diagnosis of stroke or transient ischemic attack in the long-term follow up. Methods The Kosin University 24-hours holter monitoring, echocardiography, electrocardiogram (ECG) database were reviewed from 2013 to 2015 to identify patients with frequent PVCs (>10%). We compared the long-term clinical outcomes between the patients with frequent PVCs (>10%) and control group without PVC. Results Among 572 patients who underwent 24-hours holter monitoring, finally, 373 consecutive patients (mean age; 59.5 ± 15.8 years, 45.2% male) were enrolled. Among them, 203(54.4%) patients had high PVCs burdens (>10%). There was no difference of the baseline characteristics. In the long term follow-up, PVCs burden was not associated with PVCs -related symptoms (P = 0.210). In univariate analysis, female, non-sustained ventricular tachycardia (VT), sinus QRS duration, PVC coupling interval (CI), post- PVC CI, and late precordial R-wave transition of PVCs were associated with PVCs-related symptoms. In multivariate analysis, non-sustained VT (P = 0.022) and late precordial R-wave transition of PVCs (P = 0.044) were independent risk factors for PVCs-related stroke-like symptoms with frequent idiopathic PVCs > 10%. Conclusion High PVCs burdens (>10%) were associated with and stroke-like symptoms without a prior diagnosis of stroke or transient ischemic attack in the long-term follow up, suggesting more intensive medical therapy with close clinical follow-up will be required.
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Affiliation(s)
- Sung Il Im
- Division of cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan 602-702, Republic of Korea
| | - Seok Hyun Kim
- Division of cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan 602-702, Republic of Korea
| | - Bong Joon Kim
- Division of cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan 602-702, Republic of Korea
| | - Kyoung Im Cho
- Division of cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan 602-702, Republic of Korea
| | - Hyun Su Kim
- Division of cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan 602-702, Republic of Korea
| | - Jung Ho Heo
- Division of cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan 602-702, Republic of Korea
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Lindow T, Niklasson A, Manna D, Pahlm O. Bigeminal sandwiches galore. Ann Noninvasive Electrocardiol 2017; 23:e12484. [PMID: 28653364 DOI: 10.1111/anec.12484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 05/19/2017] [Indexed: 11/29/2022] Open
Abstract
A long run of PVCs "sandwiched" in between the sinus beats resulting in an almost doubling of the heart rate-interpolated PVCs in bigeminy-is described. This case illustrates three interesting aspects of interpolated PVCs. Although they are not uncommon, long runs of interpolated PVCs in bigeminy are rare findings. In this case, the arrhythmia had a duration of 3 minutes. Second, it illustrates the "age-old wisdom" of partial retrograde conduction. Also, even though the arrhythmia resulted in an almost doubling of the heart rate, the patient remained asymptomatic.
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Affiliation(s)
- Thomas Lindow
- Department of Clinical Physiology, Vaxjo Central Hospital, Vaxjo, Sweden.,Department of Research and Development, Region Kronoberg, Vaxjo, Sweden.,Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden
| | - Angelica Niklasson
- Department of Clinical Physiology, Ostersund Hospital, Ostersund, Sweden
| | - Daniel Manna
- Department of Clinical Physiology, Vaxjo Central Hospital, Vaxjo, Sweden
| | - Olle Pahlm
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden
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Martin AP, Skinner JR. Ventricular extrasystoles and ventricular dysfunction: Too close for comfort? Heart Rhythm 2016; 13:2149-2150. [PMID: 27496585 DOI: 10.1016/j.hrthm.2016.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Andrew P Martin
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Jonathan R Skinner
- Cardiac Inherited Disease Group, Auckland City Hospital, Auckland, New Zealand; Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand; Department of Child Health, University of Auckland, Auckland, New Zealand.
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Cha MJ, Oh S. The Theory of Relativity in E (ectopy) and C (coupling): Who Will Prove It? Korean Circ J 2015; 45:273-4. [PMID: 26240580 PMCID: PMC4521104 DOI: 10.4070/kcj.2015.45.4.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 07/09/2015] [Accepted: 07/14/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Myung-Jin Cha
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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