1
|
Chevance V, Azarine A, Hamon DA, Dhanjal TS, Teiger E, Deux JF, Lellouche N. Wall shear stress in outflow tract premature ventricular contraction location assessed through 4D-flow MRI. Europace 2024; 26:euae034. [PMID: 38290435 PMCID: PMC10849830 DOI: 10.1093/europace/euae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/22/2024] [Indexed: 02/01/2024] Open
Affiliation(s)
- Virgile Chevance
- Radiology Department, Hopital Henri Mondor, APHP, Creteil, France
- Radiology Department, Centre Chirurgical Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Arshid Azarine
- Radiology Department, Centre Chirurgical Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - David A Hamon
- Cardiology and Electrophysiology Unit, Hopital Henri Mondor, APHP, 51 Avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
- University of Iowa Hospitals and Clinics (UIHC), Department of Cardiology, Carver College of Medicine, Iowa City, IA
| | - Tarvinder S Dhanjal
- Department of Cardiac Electrophysiology, University of Warwick, Gibbet Hill, Coventry, UK
| | - Emmanuel Teiger
- Cardiology and Electrophysiology Unit, Hopital Henri Mondor, APHP, 51 Avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
| | - Jean-François Deux
- Radiology Department, Hopital Henri Mondor, APHP, Creteil, France
- Radiology Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Nicolas Lellouche
- Cardiology and Electrophysiology Unit, Hopital Henri Mondor, APHP, 51 Avenue du Marechal de Lattre de Tassigny, 94000 Creteil, France
| |
Collapse
|
2
|
Yalin K, Soysal AU, Aksu T, Onder SE, Ozturk S, Yalman H, Mutlu D, Ercan OT, Ikitimur B, Cimci M, Durmaz E, Karadag B, Bilge AK, Huang H, Karpuz H. Safety and efficacy of coronary angiographic image integration tool-guided ablation of left sided outflow tract ventricular arrhythmias. J Interv Card Electrophysiol 2024; 67:31-34. [PMID: 37578671 DOI: 10.1007/s10840-023-01619-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Affiliation(s)
- Kivanc Yalin
- Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ali Ugur Soysal
- Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, 34100, Turkey.
| | | | - Sila Ozturk
- Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Hakan Yalman
- Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Deniz Mutlu
- Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Osman Talha Ercan
- Johnson and Johnson, Biosense Webster-Turkey Office, Istanbul, Turkey
| | - Baris Ikitimur
- Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Murat Cimci
- Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Eser Durmaz
- Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Bilgehan Karadag
- Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ahmet Kaya Bilge
- Istanbul Faculty of Medicine, Department of Cardiology, Istanbul University, Istanbul, Turkey
| | - Henry Huang
- Division of Cardiology, Rush University Medical Center, 1717 West Congress Parkway, Chicago, IL, 60612, USA
| | - Hakan Karpuz
- Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| |
Collapse
|
3
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
4
|
Kraft D, Bieber G, Jokisch P, Rumm P. End-to-End Premature Ventricular Contraction Detection Using Deep Neural Networks. Sensors (Basel) 2023; 23:8573. [PMID: 37896666 PMCID: PMC10610630 DOI: 10.3390/s23208573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/06/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023]
Abstract
In Holter monitoring, the precise detection of standard heartbeats and ventricular premature contractions (PVCs) is paramount for accurate cardiac rhythm assessment. This study introduces a novel application of the 1D U-Net neural network architecture with the aim of enhancing PVC detection in Holter recordings. Training data comprised the Icentia 11k and INCART DB datasets, as well as our custom dataset. The model's efficacy was subsequently validated against traditional Holter analysis methodologies across multiple databases, including AHA DB, MIT 11 DB, and NST, as well as another custom dataset that was specifically compiled by the authors encompassing challenging real-world examples. The results underscore the 1D U-Net model's prowess in QRS complex detection, achieving near-perfect balanced accuracy scores across all databases. PVC detection exhibited variability, with balanced accuracy scores ranging from 0.909 to 0.986. Despite some databases, like the AHA DB, showcasing lower sensitivity metrics, their robust, balanced accuracy accentuates the model's equitable performance in discerning both false positives and false negatives. In conclusion, while the 1D U-Net architecture is a formidable tool for QRS detection, there's a clear avenue for further refinement in its PVC detection capability, given the inherent complexities and noise challenges in real-world PVC occurrences.
Collapse
Affiliation(s)
- Dimitri Kraft
- Fraunhofer IGD Rostock, 18059 Rostock, Germany; (D.K.); (G.B.)
| | - Gerald Bieber
- Fraunhofer IGD Rostock, 18059 Rostock, Germany; (D.K.); (G.B.)
| | | | - Peter Rumm
- custo med GmbH, 85521 Ottobrunn, Germany;
| |
Collapse
|
5
|
Wang Z, Jiao S, Chen J, Guo H, Ren L, Sun L, Sun Y, Chen Y. The relationship between frequent premature ventricular complexes and epicardial adipose tissue volume. Front Endocrinol (Lausanne) 2023; 14:1219890. [PMID: 37822598 PMCID: PMC10562624 DOI: 10.3389/fendo.2023.1219890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/25/2023] [Indexed: 10/13/2023] Open
Abstract
Background Epicardial adipose tissue (EAT) is related to atrial fibrillation. The association between EAT volume and premature ventricular complexes (PVCs) remains unclear. Our study aimed to investigate the effect of EAT volume on the risk of frequent PVCs and burden levels of PVCs. Methods This observational study retrospectively recruited consecutive patients who had consultation between 2019 and 2021 at the First Affiliated Hospital of Zhengzhou University. Frequent PVC patients (n = 402) and control patients (n = 402) undergoing non-contrast computed tomography (CT) were enrolled. We selected evaluation criteria for the conduct of a 1:1 propensity score matching (PSM) analysis. Multivariable logistic analysis was used to investigate factors related to frequent PVCs. Furthermore, the determinants of EAT volume and the burden levels of PVCs were evaluated. Results Patients with PVCs had a significantly larger EAT volume than control patients. EAT volume was significantly larger in male PVC patients with BMI ≥24 kg/m2, diabetes mellitus, and E/A ratio <1. EAT volume was independently associated with PVCs. Moreover, the larger EAT volume was an independent predictor for the high burden level of PVCs. We revealed that the risk of high PVC burden level was increased with the rising of EAT volume by restricted cubic splines. Conclusions EAT volume was larger in frequent PVC patients than in control patients, regardless of other confounding factors. A large EAT volume was independently associated with high burden levels of PVCs. EAT volume may be a new mechanism to explain the pathogenesis of PVCs.
Collapse
Affiliation(s)
- Zhe Wang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Siqi Jiao
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Jiawei Chen
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hehe Guo
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lichen Ren
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liping Sun
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yihong Sun
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Yingwei Chen
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
6
|
Shen J, Zhu D, Chen L, Cang J, Zhao Z, Ji Y, Liu S, Miao H, Liu Y, Zhou Q, He Y, Cai J. Relationship between epicardial adipose tissue measured by computed tomography and premature ventricular complexes originating from different sites. Europace 2023; 25:euad102. [PMID: 37083023 PMCID: PMC10228628 DOI: 10.1093/europace/euad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/27/2023] [Indexed: 04/22/2023] Open
Abstract
AIMS This study aims to explore the association between the features of epicardial adipose tissue (EAT) in different zones and premature ventricular complexes (PVCs) originating from different sites by computed tomography (CT). METHODS AND RESULTS A total of 136 patients who underwent radiofrequency ablation for PVCs were incorporated in this study. One hundred and thirty-six matched controls were included in this study using the case-control method (1:1 matching). PVCs were classified into four subgroups: (1) right ventricular outflow tract (RVOT-PVCs), (2) non-RVOT of the right ventricle (RV-PVCs), (3) left ventricular outflow tract (LVOT-PVCs), and (4) non-LVOT of the left ventricle (LV-PVCs). The volume and density of EAT were quantified by CT. Patients with PVCs had a significantly higher volume and lower density of EAT than the controls (P < 0.001). The LVOT-PVCs and LV-PVCs had a higher left ventricle periventricular EAT volume (LV-EATv) proportion (P < 0.05). The right ventricle periventricular EAT volume (RV-EATv) proportion was higher in ROVT-PVCs and LVOT-PVCs (P < 0.05). RVOT-PVC patients had a higher volume ratio and a smaller density differential (P < 0.05). Patients with LVOT-PVCs had a lower volume ratio and the LV-PVCs showed a greater density differential (P < 0.05). CONCLUSION Higher volume and lower density of EAT were significantly associated with frequent PVCs. The RVOT-PVC patients had a higher volume ratio and a smaller density differential. The LVOT-PVCs had a lower volume ratio and the LV-PVCs showed a greater density differential. These suggest a link between EAT structural properties and PVCs and a potential role for regional EAT in the development of PVCs.
Collapse
Affiliation(s)
- Junxian Shen
- Department of Cardiology, Zhongda Hospital of Southeast University, Southeast University,Nanjing, China
| | - Didi Zhu
- Department of Cardiology, Zhongda Hospital of Southeast University, Central Gate Street, Gulou District, Nanjing City, Jiangsu Province 210009, China
| | - Long Chen
- Department of Cardiology, Zhongda Hospital of Southeast University, Central Gate Street, Gulou District, Nanjing City, Jiangsu Province 210009, China
| | - Jiehui Cang
- Department of Cardiology, Zhongda Hospital of Southeast University, Southeast University,Nanjing, China
| | - Zhen Zhao
- Department of Radiology, Zhongda Hospital of Southeast University, Nanjing, China
| | - Yuqin Ji
- Department of Cardiology, Zhongda Hospital of Southeast University, Central Gate Street, Gulou District, Nanjing City, Jiangsu Province 210009, China
| | - Shangshang Liu
- Department of Cardiology, Zhongda Hospital of Southeast University, Southeast University,Nanjing, China
| | - Hongyu Miao
- Department of Cardiology, Zhongda Hospital of Southeast University, Southeast University,Nanjing, China
| | - Yaowu Liu
- Department of Cardiology, Zhongda Hospital of Southeast University, Central Gate Street, Gulou District, Nanjing City, Jiangsu Province 210009, China
| | - Qianxing Zhou
- Department of Cardiology, Zhongda Hospital of Southeast University, Central Gate Street, Gulou District, Nanjing City, Jiangsu Province 210009, China
| | - Yanru He
- Department of Cardiology, Zhongda Hospital of Southeast University, Central Gate Street, Gulou District, Nanjing City, Jiangsu Province 210009, China
| | - Junyan Cai
- Department of Cardiology, Zhongda Hospital of Southeast University, Central Gate Street, Gulou District, Nanjing City, Jiangsu Province 210009, China
| |
Collapse
|
7
|
Zhang Z, Zhang Z, Zou C, Pei Z, Yang Z, Wu J, Sun S, Gu F. ECGNet: An Efficient Network for Detecting Premature Ventricular Complexes Based on ECG Images. IEEE Trans Biomed Eng 2023; 70:446-458. [PMID: 35881595 DOI: 10.1109/tbme.2022.3193906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Preoperative prediction of the origin site of premature ventricular complexes (PVCs) is critical for the success of operations. However, current methods are not efficient or accurate enough. In addition, among the proposed strategies, there are few good prediction methods for electrocardiogram (ECG) images combined with deep learning aspects. METHODS We propose ECGNet, a new neural network for the classification of 12-lead ECG images. In ECGNet, 609 ECG images from 310 patients who had undergone successful surgery in the Division of Cardiology, the First Affiliated Hospital of Soochow University, are utilized to construct the dataset. We adopt dense blocks, special convolution kernels and divergent paths to improve the performance of ECGNet. In addition, a new loss function is designed to address the sample imbalance situation, whose cause is the uneven distribution of cases themselves, which often occurs in the medical field. We also conduct extensive experiments in terms of network prediction accuracy to compare ECGNet with other networks, such as ResNet and DarkNet. RESULTS Our ECGNet achieves extremely high prediction accuracy (91.74%) and efficiency with very small datasets. Our newly proposed loss function can solve the problem of sample imbalance during the training process. CONCLUSION The proposed ECGNet can quickly and accurately realize the multiclassification of PVCs after training with little data. Our network has the potential to be helpful to doctors with a preoperative diagnosis of PVCs. We will continue to collect similar cases and perfect our network structure to further improve the accuracy of our network's prediction.
Collapse
|
8
|
Zhao L, Li R, Zhang J, Xie R, Lu J, Liu J, Miao C, Liu S, Cui W. Clinical Characteristics of Patients with Arrhythmias of the Idiopathic Outflow Tract Ventricular: Age, Gender, Comorbidities, Laboratory Test Results, and Echocardiographic Parameters. Altern Ther Health Med 2022; 28:88-95. [PMID: 35687704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CONTEXT Idiopathic ventricular arrhythmias (IVAs) are a spectrum of ventricular arrhythmia (VA) without structural heart disease (SHD), that includes premature ventricular contractions (PVCs) and ventricular tachycardia (VT). The clinical characteristics of patients with PVCs or VT remain unclear, including distribution of the origin of arrhythmias, age and gender differences, comorbidities, laboratory tests, and electrocardiographic parameters. OBJECTIVE The study intended to compare the clinical characteristics of the right ventricular outflow tract (RVOT)- and left ventricular outflow tract (LVOT)-VT of a large group of consecutive patients, to investigate the distribution of the origin of the arrhythmias, age and gender differences, comorbidities, laboratory-examination results, and echocardiographic parameters. METHODS The research team designed a retrospective study to collect data on the above-mentioned variables. SETTING The study occurred at the Second Hospital of Hebei Medical University in Shijiazhuang, China. PARTICIPANTS Participants were 774 patients with symptomatic ventricular arrhythmias, 328 males and 446 females with the mean age of 48.6 ± 15.7 years, who underwent catheter ablation between January 2015 and January 2019. Participants were divided into the right ventricular outflow tract (RVOT) group and left ventricular outflow tract (LVOT) group, according to the different origins of their arrhythmias, with 428 participants in the RVOT group and 180 in the LVOT group. OUTCOME MEASURES The research team collected and analyzed the data for the original sites of the IVAs; ages; genders; comorbidities; laboratory examinations, including routine blood tests, liver function, kidney function, blood lipid and potassium; and echocardiographic parameters. RESULTS Among the 774 participants, 76 had experienced VTs and 698 PVCs. The original site of IVAs was 2.38 times more likely to be in the RVOT than the LVOT, with the ratio for RVOT/LVOT = 2.38. IVAs usually occurred in participants between 50 and 70 years old and exhibited a decreasing incidence after 70 years of age. IVAs derived from the His bundle were more common in older participants, with a mean age of 60.4 ± 10.4 years, while IVAs derived from the fascicular were more common in younger patients, with a mean age of 36.08 ± 16.01 years. Compared with the LVOT group, the RVOT group was younger, 51.91 ± 14.65 years vs 46.95 ± 14.95 years, respectively (P < .001). PVCs in the RVOT group were more common in women, with the ratio of females/males = 2.10, and no gender difference existed in the overall incidence of IVAs in the LVOT group (P > .05). The most common cardiovascular comorbidities of outflow tract ventricular arrhythmias (OTVAs) were hypertension, coronary heart disease, and hyperlipidemia, while the most common noncardiovascular comorbidities were diabetes, ischemic stroke, and thyroid disease. The red-blood-cell counts, hemoglobin, creatinine, and gamma-glutamyl transpeptidase (GGT) of the LVOT group were higher than those from the RVOT, with P = .008, P = .009, P = .001, and P < .001, respectively. The left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), interventricular septal thickness (IVS), and left ventricular posterior wall thickness (LVPWT) in the LVOT group were larger than those in the RVOT group (P <.001), while the LVOT group's left ventricular ejection fraction (LVEF%) was lower than that of the RVOT group. CONCLUSIONS The outflow tract served as the major original site of IVAs, and significant differences existed between participants in the LVOT and RVOT groups in age; gender; comorbidities; results of laboratory examinations, including red-blood-cell counts, hemoglobin, creatinine, and GGT; and echocardiographic parameters, including LVEF%, LAD, LVEDD, IVS, and LVPWT.
Collapse
|
9
|
AKDİ A, TEKİN TAK B, ÖZCAN ÇETİN EH, ÇETİN MS, YAYLA Ç. Electrocardiography clues in assessment of patients with premature ventricular contractions. Turk J Med Sci 2021; 51:2986-2993. [PMID: 34493030 PMCID: PMC10734884 DOI: 10.3906/sag-2012-70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/13/2021] [Accepted: 09/07/2021] [Indexed: 12/29/2022] Open
Abstract
Background/aim Some electrocardiography (ECG) parameters such as Tp-e interval, Tp-e / QT ratio, fragmented QRS (fQRS), and heart rate variability (HRV) are related to cardiovascular mortality and morbidity. We aim to investigate the relation between premature ventricular contraction burden and these parameters on 24-h ECG recording. Materials and methods The study is a retrospective investigation of the 24-h Holter ECG and echocardiography of 199 patients who underwent the procedures due to complaints of palpitation. A frequency of < 10% PVCs / 24 h was classified as seldom group (98 patients), while > 10% PVCs / 24 h was designated as frequent group (101 patients). Results Tp-e interval was significantly longer (62 [54–78] vs 75 [60–84], p < 0.001), Tp-e / QT ratio was significantly increased (0.18 [0.16–0.20] vs 0.21 [0.18–0.22], p = 0.001) in frequent PVC group. The percentage of fQRS was significantly increased in frequent PVC group (30.6% vs 47.5%, p = 0.015). When the groups were compared, no significant difference was found in HRV time domain indices. Positive correlations were observed between PVC burden and Tp-e (r = 0.304, p < 0.001), Tp-e / QT (r = 0.275, p < 0.001). Conclusion Our study showed that Tp-e interval, Tp-e / QT and fQRS are associated with frequency of PVCs. These measurements in patients with PVCs may form part of assessment of cardiovascular risk.
Collapse
Affiliation(s)
- Ahmet AKDİ
- Department of Cardiology, Ankara City Hospital, Ankara,
Turkey
| | - Bahar TEKİN TAK
- Department of Cardiology, Ankara City Hospital, Ankara,
Turkey
| | | | | | - Çağrı YAYLA
- Department of Cardiology, Ankara City Hospital, University of Health Sciences, Ankara,
Turkey
| |
Collapse
|
10
|
Zhang Z, Hou X, Qian Z, Guo J, Zou J. Target Characteristics and Voltage Mapping of the Matrix in Idiopathic Premature Ventricular Contractions Originating from the Right Ventricular Outflow Tract. Biomed Res Int 2021; 2021:5551325. [PMID: 33997005 PMCID: PMC8099527 DOI: 10.1155/2021/5551325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/30/2021] [Accepted: 04/21/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The study was aimed at exploring the electrophysiological characteristics (EPS) of the optimal ablation site and its relationship with electroanatomic voltage mapping (EVM) in idiopathic premature ventricular contractions (PVCs) originating from the right ventricular outflow tract (RVOT). METHODS A total of 28 patients with idiopathic RVOT PVCs underwent successful ablation and EVM using a 3D electroanatomical mapping (CARTO) system. RESULTS Both bipolar and unipolar EVM showed a similar band-like lower-voltage area (LVA) under the pulmonary valve in all the patients; 21.4% of the targets were located in the band-like LVA. 42.9% of the targets were at the border of the band-like LVA on the bipolar voltage map, but unipolar mapping showed that 53.6% of the targets were located in the band-like LVA, and 35.7% of the targets at the border of the band-like LVA. A significant difference was found in both unipolar and bipolar voltage values between the regions within 0-5 mm above the optimal ablation site and the other regions. A similar difference was observed only in unipolar voltage values below the optimal ablation site. At the ablation site, there were frequent occurrences of a fragmented wave and voltage reversion in the bipolar electrograms, frustrated falling limbs, W bottom, and a QS configuration width > 150 ms in the unipolar electrograms. CONCLUSIONS EVM showed that the band-like LVA was an interesting area for the search of the optimal ablation sites of idiopathic RVOT-PVCs, especially the border area. There was focal microscarring around the ablation targets; some characteristics of EPS proved significant for successful ablation.
Collapse
Affiliation(s)
- Zhiyong Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
- Department of Cardiology, Suqian First People's Hospital, Suqian, Jiangsu 223800, China
| | - Xiaofeng Hou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Zhiyong Qian
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jianghong Guo
- Department of Cardiology, Rugao First People's Hospital, Rugao, Jiangsu 226500, China
| | - Jiangang Zou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| |
Collapse
|
11
|
Sohns C, Guckel D, Piran M, Bergau L, El Hamriti M, Sommer P. [Treatment of premature ventricular contractions in patients with structural heart disease : Insights from imaging]. Herzschrittmacherther Elektrophysiol 2021; 32:34-40. [PMID: 33502570 DOI: 10.1007/s00399-021-00740-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 01/04/2021] [Indexed: 06/12/2023]
Abstract
The diagnosis of premature ventricular contractions (PVC) is presumptively based on the presence of frequent symptoms. Particularly in patients with a relatively low PVC burden, the relationship between the PVCs and an individual arrhythmia substrate can be challenging to ascertain. Late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) has been found to be beneficial in identifying the presence of potential individual arrhythmia substrates even in patients with normal left ventricular function. Consequently, CMR has been useful in risk stratification of patients with PVCs. The authors aimed to demonstrate and discuss the current role and future use of CMR in the diagnostic algorithm to guide PVC ablation.
Collapse
Affiliation(s)
- C Sohns
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland.
| | - D Guckel
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland
| | - M Piran
- Institut für Radiologie, Nuklearmedizin und Molekulare Bildgebung, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - L Bergau
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland
| | - M El Hamriti
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland
| | - P Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland
| |
Collapse
|
12
|
Dehghani P, Singer Z, Morrison J, Booker J, Lavoie A, Zimmermann R, Basran P, Webb JG, Cheema AN, Pibarot P, Clavel MA. Characteristics and usefulness of unintended premature ventricular contraction during invasive assessment of aortic stenosis. Int J Cardiol 2020; 313:35-38. [PMID: 32201098 DOI: 10.1016/j.ijcard.2020.02.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/18/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Postextrasystolic potentiation (PESP)-associated augmentation in left ventricular-aorta pressure gradient (LVAoG) observed after incidental premature ventricular contraction (PVC) during resting echocardiography is similar to dobutamine stress echocardiography (DSE)-associated augmentation in LVAoG in patients with low-flow, low-gradient (LF-LG) aortic stenosis (AS). What is not known is whether a similar relationship exists when unintended PVC causes PESP during cardiac catheterization in patients with AS. METHODS We retrospectively reviewed all catheterizations performed for patients with at least moderate AS who had LVAoG assessment. Univariate and multivariate analyses were conducted to determine the predictors of pre- and post-PVC mean LVAoG ≥ 40 mmHg. RESULTS Between September 2015 to September 2017, of 140 individuals undergoing cardiac catheterization, 34 met study criteria. Mean pre-PVC gradient was 38.9 ± 22.8 mmHg. All patients exhibited PESP-associated augmentation of LVAoG by an average of 28 ± 12%. In multivariate analysis, the only significant predictor of post-PVC mean LVAoG ≥ 40 mmHg was preserved LV function (OR 6.81; 95% CI 1.41-32.82, p = 0.02). Inability to generate ≥ 40 mmHg of mean LVAoG post-PVC had 100% specificity for nonsevere AS in our observational cohort. CONCLUSIONS Unintended but interpretable PVCs occurred in one in four patients with AS undergoing cardiac catheterization with measurable hemodynamics. All of our patients with PVCs, regardless of underlying LVEF, exhibited PESP-associated augmentation of LVAoG. Our exploratory analysis suggests that inability to generate ≥40 mmHg of mean LVAoG post-PVC is highly specific for nonsevere AS.
Collapse
Affiliation(s)
- Payam Dehghani
- Prairie Vascular Research Network, University of Saskatchewan, Regina, Canada.
| | - Zachary Singer
- College of Medicine, University of Saskatchewan, Regina, Canada.
| | - Jamie Morrison
- Prairie Vascular Research Network, University of Saskatchewan, Regina, Canada.
| | - Jeffery Booker
- Prairie Vascular Research Network, University of Saskatchewan, Regina, Canada.
| | - Andrea Lavoie
- Prairie Vascular Research Network, University of Saskatchewan, Regina, Canada.
| | - Rodney Zimmermann
- Prairie Vascular Research Network, University of Saskatchewan, Regina, Canada.
| | - Paul Basran
- Royal University Hospital, University of Saskatchewan, Saskatoon, Canada.
| | - John G Webb
- St Paul's Hospital, University of British Columbia, Vancouver, Canada.
| | - Asim N Cheema
- St. Michael's Hospital, University of Toronto, Toronto, Canada.
| | - Phillippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie, Université Laval, Québec, Canada.
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie, Université Laval, Québec, Canada.
| |
Collapse
|
13
|
Sandgren E, Almroth H, O Karlsson L, Hassel Jönsson A, Walfridsson H, Charitakis E, Liuba I. [Evaluation and treatment of PVC's]. Lakartidningen 2020; 117:FYT3. [PMID: 32639572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Premature ventricular complex (PVC) is common in the general population. Symptoms vary from none to pronounced. The prognostic significance of PVC's depends on the presence of underlying structural heart disease. The clinical evaluation in patients with PVC aims at excluding structural heart disease and usually involves transthoracic echocardiogram and Holter. Patients without structural heart disease usually have a good prognosis. Frequent PVC's may cause impaired left ventricular function, which usually is reversible after treatment with drugs or ablation. A 12-lead ECG provides important information about PVC localization, however anatomical factors such as the heart's localization in the thorax as well as electrode placement and pharmacological treatment may affect the ECG appearance. In symptomatic patients with or without left ventricular impairment, pharmacological treatment or catheter ablation is indicated. However, in most cases the main goal is to reasure the patient of the good prognosis. To summarize, treatment of choice depends on symptoms, comorbidities, left ventricular function and patient's choice.
Collapse
Affiliation(s)
- Emma Sandgren
- specialistläkare, kardiologiska kliniken, Linköpings universitetssjukhus
| | | | - Lars O Karlsson
- med dr överläkare, kardiologiska kliniken, Linköpings universitetssjukhus
| | | | | | | | - Ioan Liuba
- med dr, överläkare, kardiologiska kliniken, Linköpings universitetssjukhus
| |
Collapse
|
14
|
Marano PJ, Lim LJ, Sanchez JM, Alvi R, Nah G, Badhwar N, Gerstenfeld EP, Tseng ZH, Marcus GM, Delling FN. Long-term outcomes of ablation for ventricular arrhythmias in mitral valve prolapse. J Interv Card Electrophysiol 2020; 61:145-154. [PMID: 32506159 DOI: 10.1007/s10840-020-00775-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 05/04/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Prior studies reporting efficacy of radiofrequency catheter ablation for complex ventricular ectopy in mitral valve prolapse (MVP) are limited by selective inclusion of bileaflet MVP, papillary muscle only ablation, or short-term follow-up. We sought to evaluate the long-term incidence of hemodynamically significant ventricular tachycardia (VT) or fibrillation (VF) in patients with MVP after initial ablation. METHODS We studied consecutive patients with MVP undergoing ablation for complex ventricular ectopy between 2013 and 2017 at our institution. Of 580 patients with MVP, we included 15 (2.6%, 10 women; mean age 50 ± 14 years, 53% bileaflet) with complex ventricular ectopy treated with initial ablation. RESULTS Over a median follow-up of 3406 (1875-6551) days or 9 years, 5 of 15 (33%) patients developed hemodynamically significant VT/VF after their initial ablation and underwent placement of an implantable cardioverter defibrillator (ICD). Three of 5 also underwent repeat ablations. Sustained VT was inducible prior to index ablation in all 5 who developed VT/VF, compared to none of the 10 patients who did not develop VT/VF after index ablation (p = 0.002). Complex ventricular ectopy at index ablation was multifocal in all 5 patients who underwent repeat intervention versus 4 of 10 patients (40%) who did not (p = 0.04). All 3 patients with subsequent VT/VF who underwent repeat ablation had a new clinically dominant focus of ventricular arrhythmia and 3 of the patients with ICD had appropriate VT/VF therapies. CONCLUSIONS In the long term, a subset of MVP patients treated with ablation for ventricular arrhythmias, all with multifocal ectopy on initial EP study, develop hemodynamically significant VT/VF. Our findings suggest the progressive nature of ventricular arrhythmias in patients with MVP and multifocal ectopy.
Collapse
Affiliation(s)
- Paul J Marano
- Division of Cardiovascular Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Lisa J Lim
- Division of Cardiovascular Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jose M Sanchez
- Division of Cardiovascular Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Raza Alvi
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory Nah
- Division of Cardiovascular Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Nitish Badhwar
- Division of Cardiovascular Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Edward P Gerstenfeld
- Division of Cardiovascular Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Zian H Tseng
- Division of Cardiovascular Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Gregory M Marcus
- Division of Cardiovascular Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Francesca N Delling
- Division of Cardiovascular Medicine, University of California, San Francisco, San Francisco, CA, USA.
| |
Collapse
|
15
|
Tan AY, Elharrif K, Cardona-Guarache R, Mankad P, Ayers O, Joslyn M, Das A, Kaszala K, Lin SF, Ellenbogen KA, Minisi AJ, Huizar JF. Persistent Proarrhythmic Neural Remodeling Despite Recovery From Premature Ventricular Contraction-Induced Cardiomyopathy. J Am Coll Cardiol 2020; 75:1-13. [PMID: 31918815 PMCID: PMC7006705 DOI: 10.1016/j.jacc.2019.10.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/30/2019] [Accepted: 10/21/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The presence and significance of neural remodeling in premature ventricular contraction-induced cardiomyopathy (PVC-CM) remain unknown. OBJECTIVES This study aimed to characterize cardiac sympathovagal balance and proarrhythmia in a canine model of PVC-CM. METHODS In 12 canines, the investigators implanted epicardial pacemakers and radiotelemetry units to record cardiac rhythm and nerve activity (NA) from the left stellate ganglion (SNA), left cardiac vagus (VNA), and arterial blood pressure. Bigeminal PVCs (200 ms coupling) were applied for 12 weeks to induce PVC-CM in 7 animals then disabled for 4 weeks to allow complete recovery of left ventricular ejection fraction (LVEF), versus 5 sham controls. RESULTS After 12 weeks of PVCs, LVEF (p = 0.006) and dP/dT (p = 0.007) decreased. Resting SNA (p = 0.002) and VNA (p = 0.04), exercise SNA (p = 0.01), SNA response to evoked PVCs (p = 0.005), heart rate (HR) at rest (p = 0.003), and exercise (p < 0.04) increased, whereas HR variability (HRV) decreased (p = 0.009). There was increased spontaneous atrial (p = 0.02) and ventricular arrhythmias (p = 0.03) in PVC-CM. Increased SNA preceded both atrial (p = 0.0003) and ventricular (p = 0.009) arrhythmia onset. Clonidine suppressed SNA and abolished all arrhythmias. After disabling PVC for 4 weeks, LVEF (p = 0.01), dP/dT (p = 0.047), and resting VNA (p = 0.03) recovered to baseline levels. However, SNA, resting HR, HRV, and atrial (p = 0.03) and ventricular (p = 0.03) proarrhythmia persisted. There was sympathetic hyperinnervation in stellate ganglia (p = 0.02) but not ventricles (p = 0.2) of PVC-CM and recovered animals versus sham controls. CONCLUSIONS Neural remodeling in PVC-CM is characterized by extracardiac sympathetic hyperinnervation and sympathetic neural hyperactivity that persists despite normalization of LVEF. The altered cardiac sympathovagal balance is an important trigger and substrate for atrial and ventricular proarrhythmia.
Collapse
Affiliation(s)
- Alex Y Tan
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia.
| | - Khalid Elharrif
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Ricardo Cardona-Guarache
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Pranav Mankad
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Owen Ayers
- Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Martha Joslyn
- Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Anindita Das
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Karoly Kaszala
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Shien-Fong Lin
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kenneth A Ellenbogen
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Anthony J Minisi
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Jose F Huizar
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| |
Collapse
|
16
|
Yang Y, Meyer CH, Epstein FH, Kramer CM, Salerno M. Whole-heart spiral simultaneous multi-slice first-pass myocardial perfusion imaging. Magn Reson Med 2019; 81:852-862. [PMID: 30311689 PMCID: PMC6289615 DOI: 10.1002/mrm.27412] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 05/23/2018] [Accepted: 05/30/2018] [Indexed: 11/11/2022]
Abstract
PURPOSE To develop and evaluate a simultaneous multislice (SMS) spiral perfusion pulse sequence with whole-heart coverage. METHODS An orthogonal set of phase cycling angles following a Hadamard pattern was incorporated into a golden-angle (GA) variable density spiral perfusion sequence to perform SMS imaging at different multiband (MB) factors. Images were reconstructed using an SMS extension of L1-SPIRiT that we have termed SMS-L1-SPIRiT. The proposed sequence was evaluated in 40 subjects (10 each for MB factors of 1, 2, 3, and 4). Images were blindly graded by 2 cardiologists on a 5-point scale (5, excellent). To quantitatively evaluate the reconstruction performance against images acquired without SMS, the MB =1 data were used to retrospectively simulate data acquired at MB factors of 2 to 4. RESULTS Analysis of the SMS point-spread function for the desired slice showed that the proposed sampling strategy significantly canceled the main-lobe energy of the other slices and has low side-lobe energy resulting in an incoherent temporal aliasing pattern when rotated by the GA. Retrospective experiments demonstrated the SMS-L1-SPIRiT method removed aliasing from the interfering slices and showed excellent agreement with the ground-truth MB =1 images. Clinical evaluation demonstrated high-quality perfusion images with average image-quality scores of 4.3 ± 0.5 (MB =2), 4.2 ± 0.5 (MB =3), and 4.4 ± 0.4 (MB =4) with no significant quality difference in image quality between MB factors (P = 0.38). CONCLUSION SMS spiral perfusion at MB factors 2, 3, and 4 produces high-quality perfusion images with whole-heart coverage in a clinical setting with high sampling efficiency.
Collapse
Affiliation(s)
- Yang Yang
- Departments of Medicine, Cardiovascular Division, University of Virginia Health System
| | - Craig H. Meyer
- Radiology and Medical Imaging, University of Virginia Health System
- Department of Biomedical Engineering, University of Virginia
| | - Frederick H. Epstein
- Radiology and Medical Imaging, University of Virginia Health System
- Department of Biomedical Engineering, University of Virginia
| | - Christopher M. Kramer
- Departments of Medicine, Cardiovascular Division, University of Virginia Health System
- Radiology and Medical Imaging, University of Virginia Health System
| | - Michael Salerno
- Departments of Medicine, Cardiovascular Division, University of Virginia Health System
- Radiology and Medical Imaging, University of Virginia Health System
- Department of Biomedical Engineering, University of Virginia
| |
Collapse
|
17
|
Abstract
Dispersion of ventricular repolarization due to abnormal activation contributes to the susceptibility to cardiac arrhythmias. However, the global pattern of repolarization is difficult to assess clinically. Activation recovery interval (ARI) has been used to understand the properties of ventricular repolarization. In this study, we developed an ARI imaging technique to noninvasively reconstruct three-dimensional (3D) ARI maps in 10 premature ventricular contraction (PVC) patients and evaluated the results with the endocardial ARI maps recorded by a clinical navigation system (CARTO). From the analysis results of a total of 100 PVC beats in 10 patients, the average correlation coefficient is 0.86±0.05 and the average relative error is 0.06±0.03. The average localization error is 4.5±2.3 mm between the longest ARI sites in 3D ARI maps and those in CARTO endocardial ARI maps. The present results suggest that ARI imaging could serve as an alternative of evaluating global pattern of ventricular repolarization noninvasively and could assist in the future investigation of the relationship between global repolarization dispersion and the susceptibility to cardiac arrhythmias.
Collapse
Affiliation(s)
- Ting Yang
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States of America
| | - Long Yu
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States of America
| | - Qi Jin
- Department of Cardiology, Shanghai Ruijin Hospital, Shanghai, China
| | - Liqun Wu
- Department of Cardiology, Shanghai Ruijin Hospital, Shanghai, China
| | - Bin He
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States of America
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, United States of America
| |
Collapse
|
18
|
de Vries LJ, Martirosyan M, van Domburg RT, Wijchers SA, Géczy T, Szili-Torok T. Coupling interval variability of premature ventricular contractions in patients with different underlying pathology: an insight into the arrhythmia mechanism. J Interv Card Electrophysiol 2018; 51:25-33. [PMID: 29305677 PMCID: PMC5797566 DOI: 10.1007/s10840-017-0309-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/19/2017] [Indexed: 11/26/2022]
Abstract
Purpose Coupling interval (CI) variability of premature ventricular contractions (PVCs) is influenced by the underlying arrhythmia mechanism. The aim of this study was to compare CI variability of PVCs in different myocardial disease entities, in order to gain insight into their arrhythmia mechanism. Methods Sixty-four patients with four underlying pathologies were included: idiopathic (n = 16), non-ischemic dilated cardiomyopathy (NIDCM) (n = 16), familial cardiomyopathy (PLN/LMNA) (n = 16), and post-MI (n = 16)-associated PVCs. The post-MI group was included as a reference, on account of its known re-entry mechanism. On Holter registrations, the first 20 CIs of the dominant PVC morphology were measured manually after which median ΔCI and mean SD of CI/√R-R (= CI of PVC corrected for underlying heart rate) were obtained. Two observers independently measured PVC CIs on pre-selected Holter registrations in order to determine inter- and intra-observer reliability. Results The largest ΔCI was seen in the PLN/LMNA group (220 ms (120–295)), the lowest in the idiopathic group (120 ms (100–190)). The ΔCI in the PLN/LMNA group was significantly larger than the post-MI group (220 ms (120–295) vs 130 ms (105–155), p = 0.023). Mean SD of CI/√R-R in the PLN/LMNA group was also significantly higher than in the post-MI group (p = 0.044). Inter- and intra-observer reliability was good (ICC = 0.91 vs 0.86 and 0.96 vs 0.77, respectively). Conclusions Low ΔCI and SD of CI/√R-R of idiopathic and NIDCM PVCs suggest that the underlying arrhythmia mechanisms might be re-entry or triggered activity. Abnormal automaticity or modulated parasystole are unlikely mechanisms. High CI variability in PLN/LMNA patients suggests that the re-entry and triggered activity are less likely mechanisms in this group. Electronic supplementary material The online version of this article (10.1007/s10840-017-0309-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lennart J. de Vries
- Department of Cardiology, Electrophysiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Mihran Martirosyan
- Department of Cardiology, Electrophysiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ron T. van Domburg
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sip A. Wijchers
- Department of Cardiology, Electrophysiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tamas Géczy
- Department of Cardiology, Electrophysiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tamas Szili-Torok
- Department of Cardiology, Electrophysiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Thoraxcenter, Department of Clinical Electrophysiology, Erasmus MC, ‘s-Gravendijkwal 230, Kamer BD416, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| |
Collapse
|
19
|
Piekarski E, Chitiboi T, Ramb R, Feng L, Axel L. Use of self-gated radial cardiovascular magnetic resonance to detect and classify arrhythmias (atrial fibrillation and premature ventricular contraction). J Cardiovasc Magn Reson 2016; 18:83. [PMID: 27884152 PMCID: PMC5123392 DOI: 10.1186/s12968-016-0306-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 11/03/2016] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Arrhythmia can significantly alter the image quality of cardiovascular magnetic resonance (CMR); automatic detection and sorting of the most frequent types of arrhythmias during the CMR acquisition could potentially improve image quality. New CMR techniques, such as non-Cartesian CMR, can allow self-gating: from cardiac motion-related signal changes, we can detect cardiac cycles without an electrocardiogram. We can further use this data to obtain a surrogate for RR intervals (valley intervals: VV). Our purpose was to evaluate the feasibility of an automated method for classification of non-arrhythmic (NA) (regular cycles) and arrhythmic patients (A) (irregular cycles), and for sorting of common arrhythmia patterns between atrial fibrillation (AF) and premature ventricular contraction (PVC), using the cardiac motion-related signal obtained during self-gated free-breathing radial cardiac cine CMR with compressed sensing reconstruction (XD-GRASP). METHODS One hundred eleven patients underwent cardiac XD-GRASP CMR between October 2015 and February 2016; 33 were included for retrospective analysis with the proposed method (6 AF, 8 PVC, 19 NA; by recent ECG). We analyzed the VV, using pooled statistics (histograms) and sequential analysis (Poincaré plots), including the median (medVV), the weighted mean (meanVV), the total number of VV values (VVval), and the total range (VVTR) and half range (VVHR) of the cumulative frequency distribution of VV, including the median to half range (medVV/VVHR) and the half range to total range (VVHR/VVTR) ratios. We designed a simple algorithm for using the VV results to differentiate A from NA, and AF from PVC. RESULTS Between NA and A, meanVV, VVval, VVTR, VVHR, medVV/VVHR and VVHR/VVTR ratios were significantly different (p values = 0.00014, 0.0027, 0.000028, 5×10-9, 0.002, respectively). Between AF and PVC, meanVV, VVval and medVV/VVHR ratio were significantly different (p values = 0.018, 0.007, 0.044, respectively). Using our algorithm, sensitivity, specificity, and accuracy were 93 %, 95 % and 94 % to discriminate between NA and A, and 83 %, 71 %, and 77 % to discriminate between AF and PVC, respectively; areas under the ROC curve were 0.93 and 0.89. CONCLUSIONS Our study shows we can reliably detect arrhythmias and differentiate AF from PVC, using self-gated cardiac cine XD-GRASP CMR.
Collapse
Affiliation(s)
- Eve Piekarski
- Department of Radiology, The Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, 660 First Ave, New York, NY USA
- Department of Radiology, Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, New York, NY USA
| | - Teodora Chitiboi
- Department of Radiology, The Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, 660 First Ave, New York, NY USA
- Department of Radiology, Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, New York, NY USA
| | - Rebecca Ramb
- Department of Radiology, The Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, 660 First Ave, New York, NY USA
- Department of Radiology, Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, New York, NY USA
| | - Li Feng
- Department of Radiology, The Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, 660 First Ave, New York, NY USA
- Department of Radiology, Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, New York, NY USA
- Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY USA
| | - Leon Axel
- Department of Radiology, The Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, 660 First Ave, New York, NY USA
- Department of Radiology, Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, New York, NY USA
- Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY USA
| |
Collapse
|
20
|
Barutçu A, Gazi E, Temiz A, Bekler A, Altun B, Kırılmaz B, Küçük U. Assessment of left-atrial strain parameters in patients with frequent ventricular ectopic beats without structural heart disease. Int J Cardiovasc Imaging 2014; 30:1027-36. [PMID: 24752954 DOI: 10.1007/s10554-014-0423-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 04/11/2014] [Indexed: 11/26/2022]
Abstract
Ventricular ectopic beats (VEBs) are often encountered in daily clinical practice. Clinical significance of VEBs seen in patients without structural cardiovascular diseases is controversial. We aimed to investigate the effects of VEBs on left atrium (LA) function using speckle tracking echocardiography with LA strain parameters. Patients with frequent VEBs (more than 30 times in 1 h, according to the Lown classification) were identified. Identified patients were evaluated by speckle tracking methods. There were 40 patients with frequent VEBs and 40 controls in our study. The general characteristics were similar of the study population. The LA global longitudinal strain parameters were significantly different. Global Peak atrial longitudinal strain (PALS) (38.39 ± 7.93 vs. 44.15 ± 6.71, p = 0.001) and peak atrial contraction strain (PACS) (16.37 ± 4.58 vs. 20.49 ± 3.65, p = 0.000) were revealed significantly lower in the VEBs group. Time to peak longitudinal strain (TPLS) was found significantly longer in the VEBs group [485.5 (352-641) vs. 435 (339-516.5) p = 0.000]. Number of VEBS was correlated with TPLS (r = 0.499, p = 0.000). PALS and PACS were negatively correlated with number of VEBs (r = -0.348, p = 0.002 and r = -0.444, p = 0.000, respectively). We described that in this study, The LA functions are affected by VEBs adversely. This deterioration is increasing as the number of VEBs.
Collapse
Affiliation(s)
- Ahmet Barutçu
- Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey,
| | | | | | | | | | | | | |
Collapse
|
21
|
Chen XG, Feng S, Ge W, An JD. [Comparison of prognosis in children with acute viral myocarditis induced ventricular premature beats originating from different positions and the clinical value of mgocardial perfusion ECT]. Zhongguo Dang Dai Er Ke Za Zhi 2013; 15:281-284. [PMID: 23607951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To study the difference in prognosis for children with acute viral myocarditis induced ventricular premature beats (VPB) originating from different positions, and to study the role of 99Mtc-MIBI myocardial perfusion ECT in the prognostic evaluation of VPB. METHODS The clinical data of 83 children with viral myocarditis induced VPB were retrospectively studied. They were divided into four groups according to the original site of VPB, as shown by the ECG: right ventricular (RV) outflow tract, RV anterior wall and apex, left ventricular (LV) outflow tract, LV anterior wall and apex. All patients were treated with anti-viral drugs and myocardial nutritional medicine. Short-term and long term outcomes in the four groups were compared. The relationship between the results of 99Mtc-MIBI myocardial perfusion ECT and prognosis in 40 patients was observed. RESULTS There were no significant differences in short-term and long-term effective rates among the four groups (P>0.05). There were no differences in the ECT positive rates between the patients with VPB originating from RV and those with VPB originating from LV (P>0.05). The treatment effective rates of ECT-positive patients were higher than the treatment effective rates of ECT-negative ones (P<0.05). CONCLUSIONS The short-term and long-term prognosis of children with VPB originating from different positions are not significantly different. In children with viral myocarditis induced VPB, positive ECT results suggest a better prognosis.
Collapse
Affiliation(s)
- Xiao-Guang Chen
- Department of Pediatrics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | | | | | | |
Collapse
|
22
|
Yokokawa M, Kim HM, Good E, Chugh A, Pelosi F, Alguire C, Armstrong W, Crawford T, Jongnarangsin K, Oral H, Morady F, Bogun F. Relation of symptoms and symptom duration to premature ventricular complex-induced cardiomyopathy. Heart Rhythm 2011; 9:92-5. [PMID: 21855522 DOI: 10.1016/j.hrthm.2011.08.015] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 08/10/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Frequent idiopathic premature ventricular complexes (PVCs) can result in a reversible form of cardiomyopathy. In this study, the determinants of PVC-induced left ventricular (LV) dysfunction were assessed. METHODS The subjects of this study were 241 consecutive patients (115 men [48%], mean age 48 ± 14 years) referred for ablation of frequent PVCs. One hundred eighty patients (75%) experienced palpitations and 61 (25%) did not. The PVC burden was determined by 24-hour Holter monitoring, and echocardiograms were performed to assess LV function. An LV ejection fraction of <50% was considered abnormal. RESULTS LV ejection fraction (mean 0.36 ± 0.09) was present in 76 of 241 patients (32%). There was a higher prevalence of males among the patients with PVC cardiomyopathy compared to patients with normal LV function (51/76 [67%] vs 64/165 [39%]; P <.0001). The mean PVC burden was significantly higher in patients with PVC cardiomyopathy than in patients with normal LV function (28% ± 12% vs 15% ± 13%; P <.0001). Among symptomatic patients, those with cardiomyopathy had a significantly longer duration of palpitations (135 ± 118 months) compared with patients with normal LV function (35 ± 52 months; P <.0001). The proportion of asymptomatic patients was significantly higher in the presence of cardiomyopathy (36/76, 47%) than in normal LV function (25/165, 15%; P <.0001). Symptom duration of 30 to 60 months, symptom duration >60 months, the absence of symptoms, and the PVC burden in asymptomatic patients were independent predictors of impaired LV function (adjusted odds ratio [95% confidence interval]: 4.0 [1.1-14.4], 20.1 [6.3-64.1], 13.1 [4.1-37.8], and 2.1 [1.2-3.6], respectively). CONCLUSIONS The duration of palpitations and the absence of symptoms are independently associated with PVC-induced cardiomyopathy.
Collapse
Affiliation(s)
- Miki Yokokawa
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Chen HY. Circadian variation of heart rate turbulence and the number of ventricular premature beats in patients with mitral valve prolapse. Int J Cardiol 2010; 141:99-101. [PMID: 19126444 DOI: 10.1016/j.ijcard.2008.11.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2008] [Revised: 11/10/2008] [Accepted: 11/15/2008] [Indexed: 11/28/2022]
|
24
|
Ludwig AK, Chase K, Axt-Fliedner R, Gembruch U, Diedrich K, Krapp M. [Follow-up of children with prenatal diagnosis of supraventricular extrasystole]. Ultraschall Med 2009; 30:564-570. [PMID: 19544229 DOI: 10.1055/s-0028-1109479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE The aim of this study was the follow-up of children with a prenatal diagnosis of supraventricular extrasystole (SVES) up to an age of 5 years in order to assess the long term outcome of these children and in order to characterize factors influencing the outcome. MATERIALS AND METHOD All fetuses diagnosed with prenatal SVES between April 1993 and August 2005 were identified and the children's parents and pediatricians contacted for data regarding the children's health. Follow-up data about the children's health up to the age of 5 years could be obtained in 77 (46.1%) children. RESULTS 0.5% (167/34,770) of all fetuses were diagnosed with prenatal SVES. In 70% of cases the SVES resolved before or at birth. 30% of children presented with arrhythmia postpartum. 31% of children were diagnosed with cardiac anomalies postpartum. 87% of children were healthy at the age of 2 - 5 years. In the subgroup of children with isolated fetal SVES without further anomalies, 95% of children were healthy at the age of 2 - 5 years. In children with persisting arrhythmia and in children with cardiac anomalies, the prognosis was worse. CONCLUSIONS Overall, by the long-term follow-up of 77 children with prenatal SVES we could show that prenatal SVES has a good prognosis. However, 30% of children develop arrhythmia postpartum and 31% of children present with cardiac anomalies. These children still have a worse prognosis than children with isolated prenatal SVES.
Collapse
Affiliation(s)
- A K Ludwig
- ENDOKRINOLOGIKUM Hamburg, Zentrum für Hormon- und Stoffwechselerkrankungen, Reproduktionsmedizin und Pränatale Medizin, Hamburg.
| | | | | | | | | | | |
Collapse
|
25
|
Boskovski MT, Shmuylovich L, Kovács SJ. Transmitral flow velocity-contour variation after premature ventricular contractions: a novel test of the load-independent index of diastolic filling. Ultrasound Med Biol 2008; 34:1901-1908. [PMID: 18692298 DOI: 10.1016/j.ultrasmedbio.2008.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2007] [Revised: 03/20/2008] [Accepted: 05/01/2008] [Indexed: 05/26/2023]
Abstract
The new echocardiography-based, load-independent index of diastolic filling (LIIDF) M was assessed using load-/shape-varying E-waves after premature ventricular contractions (PVCs). Twenty-six PVCs in 15 subjects from a preexisting simultaneous echocardiography-catheterization database were selected. Perturbed load-state beats, defined as the first two post-PVC E-waves, and steady-state E-waves, were subjected to conventional and model-based analysis. M, a dimensionless index, defined by the slope of the peak driving-force vs. peak (filling-opposing) resistive-force regression, was determined from steady-state E-waves alone, and from load-perturbed E-waves combined with a matched number of subsequent beats. Despite high degrees of E-wave shape variation, M derived from load-varying, perturbed beats and M derived from steady-state beats alone were indistinguishable. Because the peak driving-force vs. peak resistive-force relation determining M remains highly linear in the extended E-wave shape and load variation regime observed, we conclude that M is a robust LIIDF.
Collapse
Affiliation(s)
- Marko T Boskovski
- Department of Physics, Washington University School of Arts and Sciences, St. Louis, MO, USA
| | | | | |
Collapse
|
26
|
Yamada T, Yoshida Y, Inden Y, Murohara T, Kay GN. Vagal reflex provoked by radiofrequency catheter ablation in the right aortic sinus cusp: a Bezold-Jarisch-like phenomenon. J Interv Card Electrophysiol 2008; 23:199-204. [PMID: 18758931 DOI: 10.1007/s10840-008-9292-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2008] [Accepted: 06/24/2008] [Indexed: 11/26/2022]
Abstract
A 66-year-old woman with idiopathic premature ventricular contractions with a left bundle branch block QRS morphology and left inferior axis underwent electrophysiologic testing. Successful radiofrequency ablation was achieved in the right coronary cusp (RCC). However, radiofrequency ablation at sites adjacent to the successful ablation site provoked sinus bradycardia followed by atrioventricular conduction block. That phenomenon might be explained by a vagal reflex through stimulation of vagal pathways or receptors in the anterior epicardial fat pads neighboring to the RCC. A vagal reflex should be kept in mind as a complication during catheter ablation of ventricular arrhythmias originating from the RCC.
Collapse
Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, AL 35294-0019, USA.
| | | | | | | | | |
Collapse
|
27
|
Topaloglu S, Aras D, Cagli K, Yildiz A, Cagirci G, Cay S, Gunel EN, Baser K, Baysal E, Boyaci A, Korkmaz S. Evaluation of left ventricular diastolic functions in patients with frequent premature ventricular contractions from right ventricular outflow tract. Heart Vessels 2007; 22:328-34. [PMID: 17879025 DOI: 10.1007/s00380-007-0978-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Accepted: 02/02/2007] [Indexed: 11/24/2022]
Abstract
This study was sought to examine the effects of repetitive monomorphic premature ventricular contractions (PVCs) on left ventricular (LV) diastolic function. Thirty-three symptomatic patients (Study group, 10 males, mean age 40 +/- 8 years) with normal LV systolic function and repetitive PVCs originating from the right ventricular outflow tract (RVOT-PVCs) on 24-h Holter monitoring, and 30 healthy controls (Control group, 9 males, mean age 37 +/- 9 years) were enrolled in the study. None of the patients had structural heart disease. Diastolic function was assessed by echocardiographic mitral inflow pattern and tissue Doppler imaging. The study group displayed a lower E/A ratio, longer isovolumetric relaxation time (IVRT), and longer E-wave deceleration time (EDT). In the study group 13 patients showed impaired relaxation. While mean values of the systolic velocity (Sa), early diastolic velocity (Ea), and early/late diastolic velocity (Ea/Aa) ratio were significantly lower in the study group, the Aa velocity and E/Ea ratio were significantly higher. Ea velocity was <10 cm/s in 7 study patients. Mitral inflow pattern and Ea velocity was normal in all controls. Significant correlations were found between ventricular premature beats percentage and early to late transmitral flow velocity ratio, EDT, IVRT, Ea velocity, the Ea/Aa ratio, and the E/Ea ratio. In multivariate analysis, total PVC count and age were found to be independent predictors of impaired relaxation. These results suggest that repetitive monomorphic RVOT-PVCs lead to abnormalities of LV diastolic function that may contribute to clinical symptoms in patients with structurally normal hearts.
Collapse
Affiliation(s)
- Serkan Topaloglu
- Department of Cardiology, Türkiye Yuksek Ihtisas Hospital, Ankara, Turkey.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Beeres SLMA, Zeppenfeld K, Bax JJ, Dibbets-Schneider P, Stokkel MPM, Fibbe WE, van der Wall EE, Atsma DE, Schalij MJ. Electrophysiological and arrhythmogenic effects of intramyocardial bone marrow cell injection in patients with chronic ischemic heart disease. Heart Rhythm 2007; 4:257-65. [PMID: 17341383 DOI: 10.1016/j.hrthm.2006.10.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Accepted: 10/30/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Bone marrow cell injection has been introduced to treat patients with ischemic heart disease. However, focal application of bone marrow cells may generate an arrhythmogenic substrate. OBJECTIVES To assess the electrophysiological and arrhythmogenic effects of intramyocardial bone marrow cell injection in patients with chronic myocardial ischemia. METHODS Bone marrow was aspirated in 20 patients (65+/-11 years, 19 male) with drug-refractory angina and myocardial ischemia. Electroanatomical mapping (NOGA, Biosense-Webster, Waterloo, Belgium) was performed during mononuclear cell isolation. Areas for cell injection were selected based on the localization of ischemia on SPECT. These areas were mapped in detail to evaluate local bipolar electrogram duration, amplitude and fragmentation. Mononuclear cells were injected in the ischemic area with the NOGA system. SPECT and electroanatomical mapping were repeated at 3 months. Holter monitoring was repeated at 3 and 6 months. RESULTS SPECT revealed a decrease in the number of segments with ischemia (3.5+/-2.5 vs. 1.1+/-1.0 at 3 months; P<0.01) and an increased left ventricular ejection fraction (44+/-13% vs. 49+/-17% at 3 months; P=0.02). The number of ventricular premature beats remained unchanged (10+/-24x10(2)/24h vs. 8+/-23x10(2)/24h at 3 months (P=NS) and 12+/-30x10(2)/24h at 6 months (P=NS)). At 3 months follow-up, bone marrow cell injection did not prolong electrogram duration (15.9+/-4.6 ms vs. 15.6+/-4.0 ms; P=NS), decrease electrogram amplitude (3.8+/-1.5 mV vs. 3.8+/-1.5 mV; P=NS), or increase fragmentation (2.0+/-0.5 vs. 1.9+/-0.4; P=NS). CONCLUSION Intramyocardial bone marrow cell injection does not increase the incidence of ventricular arrhythmias and does not alter the electrophysiological properties of the injected myocardium.
Collapse
Affiliation(s)
- Saskia L M A Beeres
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Zaborska B, Stec S, Flasińska K, Piluś A, Kułakowski P. [Echocardiography and tissue Doppler imaging in assessment of haemodynamics in patients with idiopathic, premature ventricular complexes]. Pol Merkur Lekarski 2006; 20:302-4. [PMID: 16780261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
UNLABELLED Premature ventricular complexes (PVC) in patients without organic heart disease may be associated with severe symptoms and haemodynamic disturbances. The aim of this study was to evaluate haemodynamics during PVC by echocardiography (ECHO) and tissue Doppler imaging (TDI). MATERIAL AND METHODS 40 consecutive patients (mean age 55 +/- 15) with frequent, idiopathic PVC were included into analysis. Patients were included if they had at least 2500 PVC on 24 - hour Holter monitoring (mean: 12124 +/- 6851, range: 2560 - 28677). Parameters of blood flow at the inflow and outflow tracts of the right and left ventricle (LV) as well as TDI of mitral annulus were recorded during sinus rhythm (S), PVC and sinus rhythm following PVC (post-PVC). RESULTS LV stroke volume (SV) in PVC correlated with PVC coupling interval (r = 0.65, p < 0.01). The absence of SV was observed in PVC with coupling interval below 400 ms. Significant differences in SV and duration of cardiac cycle periods between PVC, S and post-PVC were found. Peak systolic velocity (Sm) derived from TDI in PVC was significantly decreased (4.08 +/- 2.04 cm/s) compared to Sm in S (9.35 +/- 1.26 cm/s) and in post-PVC (9.58 +/- 1.26 cm/s) in all studied patients (p < 0.0001). CONCLUSIONS In patients with frequent, symptomatic, idiopathic PVC severe haemodynamic disturbances may be recorded by ECHO. Dysfunction of LV systolic movement is revealed by TDI.
Collapse
Affiliation(s)
- Beata Zaborska
- Szpital Grochowski w Warszawie, Klinika Kardiologii Centrum Medyczne Kształcenia Podyplomowego.
| | | | | | | | | |
Collapse
|
30
|
Loladze NV, Golitsyn SP, Samoĭlenko LE, Bekbosynova MS, Novikova DS, Nikitina DS, Nikitina TI, Sergienko VB. [Cardiac sympathetic innervation in patients with ventricular arrhythmias: an assessment by 123I-metaiodobenzylguanidine scintigraphy]. Kardiologiia 2006; 46:27-34. [PMID: 16858351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The aim of this study was to determine the state of sympathetic innervation in patients with ventricular arrhythmias (VA) using 123I-metaiodobenzylguanidine 123I -MIBG) scintigraphy. Fifty six patients (26 men and 30 women, mean age 37.4+/-11,6) underwent single-photon emission computed tomography (SPECT) imaging and planner scintigraphy after injection of 123I-MIBG (activity 148 MBq). They form three groups. Thirty patients with idiopathic VA (IVA) were included in group I: 14 patients with ventricular extrasystoles (VE) and 16 - with ventricular tachycardias (VT). Group II was formed by 17 patients (with dilated cardiomyopathy, n=7 and chronic myocarditis, n=10), 6 of them had VE and 11 - VT. The control group III was formed by 9 healthy subjects with structurally normal heart without VA. We analyzed early (30 minutes) and delayed (4 hours) images after 123I-MIBG administration. The global sympathetic activity (SA) was assessed by heart/mediastinum ratio and washout rate. Regional SA was assessed by extent and severity of defect. In group I 25 of 30 patients (83.3%) had regional SA abnormalities significantly different from controls (p<0.001). At the same time global uptake of 123I-MIBG in this group was not affected. In group II regional SA abnormalities were revealed in all patients (100%) and global reduction of 123I-MIBG uptake - in 14 patients (82.4%). Regional and global SA abnormalities in group II were different from controls (p<0.0001) and patients with IVA (p<0.001). There was no difference in SA abnormalities between patients with VE and VT. Our results suggest that patients with different VA have abnormalities of sympathetic innervation, including patients with structurally normal heart.
Collapse
|
31
|
Culić V, Silić N, Mirić D. Triggering of ventricular ectopic beats by emotional, physical, and meteorologic stress: role of age, sex, medications, and chronic risk factors. Croat Med J 2005; 46:894-906. [PMID: 16342342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
AIM To investigate the association of a single ventricular ectopic beat with physical, emotional, or meteorologic stress and the role of age, sex, antiarrhythmic and other medicament therapy and participant characteristics. METHODS The study included 457 participants who were consecutively assigned to undergo continuous 24-hour Holter monitoring and who completed a structured questionnaire about their physical activity and mental stress. Multiple regression analysis of data on 11 meteorologic parameters, participants' baseline characteristics, and medications they used was performed for subgroups according to sex and age, with 65 years as age limit. RESULTS Wind speed, low relative humidity, increasing relative humidity, and emotional stress were independent predictors of ventricular ectopic beat, whereas warm front passage showed a protective effect in all participant subgroups (P<0.05 in all cases). Physical activity was an independent predictor of ventricular ectopic beat in women (P=0.02) and cold front passage in men P=0.003). The circadian variation in frequency of ventricular ectopic beats persisted in all subgroups after adjustments for external triggers (P<0.001 in all cases). Among chronic risk factors, familial background and previous myocardial infarction were independent predictors of ventricular ectopic beat in men and younger (P<0.05 in all cases). Nitrates (P<0.03 in all cases) and angiotensin converting enzyme inhibitors (P<0.02 in all cases) exerted protective effect in younger participants as well as did beta-blockers in the elderly (P<0.003 in all cases). CONCLUSION In addition to existence of an endogenous, external triggering-independent circadian pattern, physical, emotional, and meteorologic stress may act as triggers of ventricular ectopic beat in a manner that differs from triggering more complex arrhythmias. Familial background seems to have a significant impact on arrhythmogenesis in men.
Collapse
Affiliation(s)
- Viktor Culić
- Viktor Culic, Division of Cardiology, Department of Medicine, University Hospital Split, Soltanska 1, 21000 Split, Croatia.
| | | | | |
Collapse
|
32
|
Tada H, Kurosaki K, Ito S, Naito S, Yamada M, Miyaji K, Hashimoto T, Oshima S, Nogami A, Taniguchi K. Idiopathic premature ventricular contractions arising from the pulmonary artery: importance of mapping in the pulmonary artery in left bundle branch block-shaped ventricular arrhythmias. Circ J 2005; 69:865-9. [PMID: 15988115 DOI: 10.1253/circj.69.865] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A patient underwent radiofrequency (RF) catheter ablation of symptomatic idiopathic ventricular contractions (PVCs). RF energy applications at 2 sites in the right ventricular outflow tract (RVOT), where both the earliest ventricular activation and near-perfect pace mapping were obtained, did not abolish the PVC but resulted in changes in the QRS morphology of the PVC. Complete elimination of the PVC was achieved with RF energy application at a site within the pulmonary artery 13 mm above the pulmonary valve, which was greater than 20 mm away from the failed ablation sites within the RVOT.
Collapse
Affiliation(s)
- Hiroshi Tada
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Brandão JMM, Miziara A, Figueiredo GLD, Lima-Filho MO, Ayres-Neto EM, Marin-Neto JA. [Post-extrasystolic potentiation in chronic Chagas' heart disease. A radiologic contrast ventriculography study]. Arq Bras Cardiol 2005; 84:376-80. [PMID: 15917969 DOI: 10.1590/s0066-782x2005000500005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine the existence and frequency of the phenomenon of post-extrasystolic potentiation in dyssynergic myocardial areas of patients with chronic Chagas' heart disease studied by use of radiologic contrast ventriculography. METHODS This study is a semiquantitative retrospective analysis of radiologic contrast ventriculography in patients with chronic Chagas' disease, who were consecutively studied to assess the mechanisms of ventricular tachycardia. RESULTS Of the 72 patients initially included, in only 20 patients was possible the ventriculographic analysis for the purposes of this study. The phenomenon of post-extrasystolic potentiation was observed in 11 (55%) of these patients, and a 15.31% improvement was observed in the contractility score from the baseline to the post-extrasystole condition (P=0.0001). That phenomenon occurred even in ventricular segments with an intense deficit in contractility. CONCLUSION The phenomenon of post-extrasystolic potentiation is observed in a significant proportion of patients with chronic Chagas' heart disease, in whom the phenomenon could be angiographically analyzed, indicating the existence of potentially recruitable contractile reserve in ventricular regions, showing marked dyssynergy. Additional studies for clarifying the underlying mechanisms are required.
Collapse
Affiliation(s)
- José Mário M Brandão
- Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, USP, Ribeirão Preto, SP
| | | | | | | | | | | |
Collapse
|
34
|
Tada H, Toide H, Naito S, Ito S, Kurosaki K, Kobayashi Y, Miyaji K, Yamada M, Oshima S, Nogami A, Taniguchi K. Tissue tracking imaging as a new modality for identifying the origin of idiopathic ventricular arrhythmias. Am J Cardiol 2005; 95:660-4. [PMID: 15721115 DOI: 10.1016/j.amjcard.2004.10.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2004] [Revised: 10/22/2004] [Accepted: 10/22/2004] [Indexed: 11/26/2022]
Abstract
Tissue tracking imaging was performed in 33 patients with idiopathic ventricular arrhythmias before radiofrequency catheter ablation. The site of the arrhythmia origin, defined as the site where the earliest color-coded signal appeared on the myocardium at the onset of the arrhythmia, corresponded to the site of origin as determined on fluoroscopy during activation mapping in all patients. Catheter ablation at that site abolished the arrhythmia in 29 patients (88%).
Collapse
Affiliation(s)
- Hiroshi Tada
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Grassi G, Seravalle G, Dell'Oro R, Facchini A, Ilardo V, Mancia G. Sympathetic and baroreflex function in hypertensive or heart failure patients with ventricular arrhythmias. J Hypertens 2005; 22:1747-53. [PMID: 15311103 DOI: 10.1097/00004872-200409000-00019] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether in hypertension and in heart failure the occurrence of ventricular arrhythmias is associated with alterations in sympathetic drive and baroreflex function. DESIGN AND METHODS We studied 28 untreated essential hypertensives (age, 53.0 +/- 1.1 years, mean +/- standard error of the mean), 15 without and 13 with monofocal premature ventricular contractions (PVCs) in Lown class I, and 30 heart failure patients (age, 53.8 +/- 1.3 years) in New York Health Association class II-III, 17 without and 13 with PVCs also in Lown class I. In each patient we measured, along with echocardiographic variables, the beat-to-beat mean blood pressure (Finapress), heart rate (HR) (EKG), muscle sympathetic nerve traffic (MSNA) (microneurography), venous plasma norepinephrine and renin activity (high-pressure liquid chromatography and radioimmunoassay, respectively). Measurements were performed at rest and during arterial baroreceptor stimulation and deactivation via stepwise intravenous infusion of phenylephrine and nitroprusside, respectively. RESULTS The mean blood pressure, HR and MSNA were similar in hypertensive patients without and with PVCs. However, compared with non-arrhythmic patients, hypertensives with PVCs displayed a baroreflex-HR and baroreflex-MSNA modulation reduced by 27.7 +/- 4.2 and 17.9 +/- 2.8%, respectively (P < 0.05). Heart failure patients with PVCs showed haemodynamic and echocardiographic variables superimposable to those without PVCs. Compared with these patients, however, they exhibited a significant increase in MSNA values (75.8 +/- 3.0 versus 63.6 +/- 2.8 bs/100 hb, P < 0.05), coupled with a significant impairment in baroreflex-HR and baroreflex-MSNA control (-52.5 +/- 5.4 and -37.5 +/- 3.6%, P < 0.01). CONCLUSIONS These data provide evidence that in both hypertension and heart failure, sympathetic and baroreflex mechanisms exert a pro-arrhythmogenic role. This role, however, appears to be more pronounced in heart failure than in hypertension, in which the impaired vagal function may exert a concomitant favouring effect.
Collapse
Affiliation(s)
- Guido Grassi
- Clinica Medica, Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università Milano Bicocca, Italy
| | | | | | | | | | | |
Collapse
|
36
|
Szumowski L, Sanders P, Walczak F, Hocini M, Jaïs P, Kepski R, Szufladowicz E, Urbanek P, Derejko P, Bodalski R, Haïssaguerre M. Mapping and ablation of polymorphic ventricular tachycardia after myocardial infarction. J Am Coll Cardiol 2004; 44:1700-6. [PMID: 15489106 DOI: 10.1016/j.jacc.2004.08.034] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2004] [Revised: 07/29/2004] [Accepted: 08/02/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The goal of this study was to describe the mapping and ablation of polymorphic ventricular tachycardia (VT) after myocardial infarction (MI). BACKGROUND The initiating mechanisms of polymorphic VT after MI have not been reported. METHODS Five patients (four males; age 61 +/- 7 years) with recurrent episodes of polymorphic VT after anterior MI (left ventricular ejection fraction 32 +/- 7%) despite revascularization and antiarrhythmic drugs were studied. All patients demonstrated frequent ventricular premature beats (PBs) initiating polymorphic VT. Pace mapping and activation mapping were used to identify the earliest site of PB activity. The presence of a Purkinje potential preceding PB defined its origin from the Purkinje network. Electroanatomic voltage mapping was performed to delineate the extent of MI. RESULTS The PBs were observed in all cases to arise from the Purkinje arborization in the MI border zone. These PBs were right bundle-branch block in all five patients, with morphologic variations in the limb leads in four; one also had a left bundle-branch block morphology. The coupling interval of the PB to the preceding QRS complex demonstrated significant variations (320 to 600 ms). During PB, the Purkinje potential at the same site preceded the QRS complex by 20 to 160 ms and was associated with different morphologies. Repetitive Purkinje activity was documented during polymorphic VT. Splitting of Purkinje activity and Purkinje to muscle conduction block were also observed. Ablation at these sites eliminated all PBs. At 16 +/- 5 months follow-up using defibrillator memory interrogation, no patient has had recurrence of arrhythmia. CONCLUSIONS The Purkinje arborization along the border-zone of scar has an important role in the mechanism of polymorphic VT in patients after MI. Ablation of the local Purkinje network allows suppression of polymorphic VT.
Collapse
|
37
|
Sun Y, Blom NA, Yu Y, Ma P, Wang Y, Han X, Swenne CA, van der Wall EE. The influence of premature ventricular contractions on left ventricular function in asymptomatic children without structural heart disease: an echocardiographic evaluation. Int J Cardiovasc Imaging 2004; 19:295-9. [PMID: 14598897 DOI: 10.1023/a:1025418531853] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Isolated monomorphic premature ventricular contractions (PVCs) are not uncommon in the pediatric population. The degree of cardiac dysfunction caused by PVCs in children without structural heart disease is unknown. PURPOSE To investigate the influence of PVCs on echocardiographic left ventricular (LV) systolic function in children without structural heart disease. METHODS Forty asymptomatic children with isolated monomorphic PVCs without structural heart disease were selected. The median age was 6 years, range of 3-12 years. The following subgroups were compared: frequent vs. infrequent PVCs (> or < or = 10/min); short vs. long coupling interval (RR'/RR ratio < or = or > 0.6); and short vs. long QT interval (QT < or = or > 400 ms). Using echocardiography the left ventricular ejection fraction (LVEF in percentage) and cardiac index (CI in L/min/m2) were measured for both normal sinus beats (SB-LVEF and CI), PVCs (PVC-LVEF and CI) and the average LVEF and CI were calculated. All values were expressed as means +/- SD. RESULTS In all children LV dimensions and the SB-LVEF and CI were within normal limits. The PVC-LVEF (48 +/- 5) and PVC-CI (1.57 +/- 0.19) were significantly decreased and the average CI was 2.41 +/- 0.29. In 27 pts with > 10 PVCs/min the average LVEF and CI decreased to 53 +/- 5 and 2.08 +/- 0.24 respectively. In 16 pts with PVCs and a short coupling interval (RR'/RR < or = 0.6) the PVC-LVEF and PVC-CI was 43 +/- 0.03 and 1.50 +/- 0.14, which was significantly lower than in 24 pts with a long coupling interval (58 +/- 4, 1.88 +/- 0.11). In 11 pts with a prolonged QT interval (> 400 ms) the PVC-LVEF and PVC-CI was significantly lower than in the 29 children with a shorter QT interval, 41 +/- 5 vs. 55 +/- 4 and 1.46 +/- 0.13 vs. 1.86 +/- 0.15 respectively (all p < 0.01). CONCLUSION In asymptomatic children with isolated monomorphic PVCs the average ejection fraction and cardiac output is markedly reduced if PVCs are frequent (> 10/min), have a short coupling interval or a prolonged QT interval.
Collapse
Affiliation(s)
- Yiping Sun
- Shandong Provincial Hospital, Jinan 250021, PR China
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Tada H, Ito S, Naito S, Kurosaki K, Ueda M, Shinbo G, Hoshizaki H, Oshima S, Nogami A, Taniguchi K. Prevalence and Electrocardiographic Characteristics of Idiopathic Ventricular Arrhythmia Originating in the Free Wall of the Right Ventricular Outflow Tract. Circ J 2004; 68:909-14. [PMID: 15459463 DOI: 10.1253/circj.68.909] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The prevalence and ECG characteristics of idiopathic ventricular arrhythmia originating in the free wall of the right ventricular outflow tract (RVOT) require further clarification, which was the aim of the present study of 110 patients with idiopathic ventricular tachycardia (n=34) or premature ventricular contraction (n=76; OT-VT/PVC) who underwent successful catheter ablation at the RVOT. METHODS AND RESULTS Ten OT-VT/PVCs (9%) were ablated successfully at the free wall (FW-VT/PVC); the remaining 100 (91%) were ablated at the RVOT septum (Sep-VT/PVC). R wave amplitudes in the inferior leads were significantly smaller in FW-VT/PVC than in Sep-VT/PVC (p<0.01). An RR' pattern in the inferior leads was observed significantly more often in FW-VT/PVC than in Sep-VT/PVC (p<0.001). QS-wave amplitude in each of leads V(1) to V(3) was significantly deeper in FW-VT/PVC than in Sep-VT/PVC (p<0.001). ECG criteria requiring an RR' pattern in all inferior leads as well as an S-wave amplitude of at least 3.0 mV in lead V(2) differentiated FW-VT/PVC from Sep-VT/PVC with high sensitivity, specificity, and predictive accuracy. CONCLUSIONS Although FW-VT/PVC has a relatively low prevalence, it has several distinctive ECG characteristics and detailed ECG analysis can differentiate it from Sep-VT/PVC.
Collapse
Affiliation(s)
- Hiroshi Tada
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Raisinghani A, Wei KS, Crouse L, Villanueva F, Feigenbaum H, Schiller NB, Weiss J, Naqvi TZ, Siegel R, Monaghan M, Goldman JH, Demaria A. Myocardial contrast echocardiography (MCE) with triggered ultrasound does not cause premature ventricular complexes: evidence from PB127 MCE studies. J Am Soc Echocardiogr 2003; 16:1037-42. [PMID: 14566296 DOI: 10.1016/s0894-7317(03)00549-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Previous studies suggest that myocardial contrast echocardiography using high mechanical index triggered ultrasound can be associated with increased frequency of the premature ventricular complex (PVC). However, this association has not been systematically examined. PB127 (Point Biomedical Corp, San Carlos, Calif) is a novel microsphere designed for evaluation of myocardial perfusion with ultrasound. PB127 myocardial contrast echocardiography was performed with triggered harmonic power Doppler in early/mid diastole (mechanical index </= 1.0). A total of 71 patients (cohort A) were studied at rest and another 64 (cohort B, age 62 +/- 12.6 years) were allocated to stress. Continuous electrocardigraphy was recorded. The study evaluated premature ventricular complex frequency at baseline, during, and after infusion of PB127 (dose < 0.175 mg/kg, <60-minute duration). Proportions of triggered and nontriggered intervals associated with premature ventricular complex were determined. PVC frequency did not increase with PB127 infusion in either cohort (P =.572, P =.263). Proportion of triggered intervals after QRS associated with PVC was similar to proportion of untriggered intervals in cohort A (P >.999) and was lower than untriggered intervals (P =.001) in B, suggesting that triggers do not cause PVC. PB127 does not cause increase PVC frequency during or after imaging with triggered ultrasound at mechanical index of 1.
Collapse
|
40
|
Miyasaka Y, Nakatani S, Suyama K, Kamakura S, Haiden M, Yamagishi M, Kitakaze M, Iwasaka T, Miyatake K. A simple and accurate method to identify early ventricular contraction sites in Wolff-Parkinson-White syndrome using high frame-rate tissue-velocity imaging. Am J Cardiol 2003; 92:617-20. [PMID: 12943891 DOI: 10.1016/s0002-9149(03)00738-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The high frame-rate tissue-velocity imaging method may be superior to the conventional M-mode method in accurately localizing accessory pathways without consuming large amounts of time.
Collapse
Affiliation(s)
- Yoko Miyasaka
- Cardiology Division of Medicine, National Cardiovascular Center, Suita, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
BACKGROUND Precise diagnosis of cardiac arrhythmias in the fetus is crucial for a managed therapeutic approach. However, many technical, positional, and gestational age-related limitations may render conventional methods, such as M-mode and Doppler flow methodologies, or newer techniques, such as fetal electrocardiography or magnetocardiography, difficult to apply, or these techniques may be unsuitable for the diagnosis of fetal arrhythmias. METHODS AND RESULTS In this prospective study, we describe a novel method based on raw scan-line tissue velocity data acquisition and analysis. The raw data are available from high-frame-rate 2D tissue velocity images and allow simultaneous sampling of right and left atrial and ventricular wall velocities to yield precise temporal analysis of atrial and ventricular events. Using this timing data, a ladder diagram-like "fetal kinetocardiogram" was developed to diagram and diagnose arrhythmias and to provide true intervals. This technique was feasible and fast, yielding diagnostic results in all 31 fetuses from 18 to 38 weeks of gestation. Analysis of various supraventricular and ventricular arrhythmias was readily obtained, including arrhythmias that conventional methods fail to diagnose. CONCLUSIONS The fetal kinetocardiogram opens a new window to aid in the diagnosis and understanding of fetal arrhythmias, and it provides a tool for studying the action of antiarrhythmic drugs and their effects on electrophysiological conduction in the fetal heart.
Collapse
Affiliation(s)
- A J J T Rein
- Unit of Pediatric Cardiology, Hadassah University Hospital, Jerusalem, Israel. rein@ cc.huji.ac.il
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Caso P, D'Andrea A, Musto C, Nardi S, Cavallaro C, Martiniello AR, Vecchione F, Mininni N, Calabrò R, Sutherland GR. Assessment of accessory atrioventricular pathways by Doppler myocardial imaging. Echocardiography 2002; 19:373-81. [PMID: 12174200 DOI: 10.1046/j.1540-8175.2002.00373.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The use of electrophysiologic studies (EPS) for the localization of accessory atrioventricular connections in Wolff-Parkinson-White syndrome (WPW) requires accurate evaluation of the site of bypass tract insertion. Doppler myocardial imaging (DMI) is a new ultrasound technique that allows the detection of abnormal and early regional myocardial depolarization. The purpose of this study was to identify an abnormal pathway site in WPW patients. METHODS Twenty-one patients with ventricular preexcitation were studied by DMI. Two-dimensional color DMI, velocity maps, acceleration maps, and pulsed-wave applications were used. A subsequent diagnostic EPS was performed. The results of EPS were taken as the gold standard diagnostic procedure. Radiofrequency catheter ablation therapy was then performed on all patients. RESULTS The anomalous pathway was detected by DMI in 16 (76%) of 21 patients (9 [90%] of 10 with left pathways and 7 [64%] of 11 with right pathways), with respect to results of the EPS. Pathway detection was better with pulsed-wave DMI (76%) with its higher temporal resolution as compared with M-mode velocity map (57%) and acceleration map (47%). In most of the patients with successful radiofrequency ablation, an immediate resolution of the abnormal ventricular depolarization occurred and was detectable by DMI. CONCLUSIONS Our findings demonstrate the feasibility of DMI to assess the early ventricular contraction associated with atrioventricular accessory pathways. Therefore, DMI appears to be a clinically useful adjunct to noninvasive evaluation of abnormal myocardial depolarization in WPW and to evaluate the results after radiofrequency ablation, even though its accuracy is considerably better for left-sided accessory pathways than for right-sided ones.
Collapse
Affiliation(s)
- Pio Caso
- Division of Cardiology, Monaldi Hospital, Naples, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Galderisi M, Cicala S, Sangiorgi G, Caso P, de Divitiis O. Tissue Doppler-derived postsystolic motion in a patient with left bundle branch block: a sign of myocardial wall asynchrony. Echocardiography 2002; 19:79-81. [PMID: 11884261 DOI: 10.1046/j.1540-8175.2002.00079.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Maurizio Galderisi
- Laboratorio di Ecocardiografia, Cattedra di Medicina d'Urgenza, Dipartimento di Medicina Clinica e Sperimentale, Università Federico II, 80131, Napoli, Italy.
| | | | | | | | | |
Collapse
|
44
|
Abstract
Left ventriculography provides useful information about cardiac function, wall motion, and mitral regurgitation (MR). However, standard volumes of contrast agent frequently are associated with ventricular ectopy. This study compares the use of low-volume (Low-vol) ventriculography to standard volume (Std-vol) ventriculography. Left ventricular (LV) ejection fraction (EF), changes in LV end-diastolic pressure (LVEDP), the incidence of ectopy, and > 2+ MR were prospectively determined from the random order use of standard (15 mL/ second for 3 sec) and low-volume (15 mL/sec for 1 sec) contrast agents in 102 patients. Each patient served as his or her own control. Twenty-seven percent of the 204 ventriculograms were not interpretable due to ectopy. Ectopy > or = 3 beats was more common with Std-vol angiograms (41% vs. 14%, P < 0.001). Post-injection LVEDP increased from baseline after both Std-vol and Low-vol injections (P < 0.001). In patients for whom both angiograms could be interpreted (n = 58), no differences were noted between planimetered EFs (Low-vol = 61 +/- 20% vs. Std-vol = 62 +/- 20%, with r = 0.87; P < 0.001). A Bland-Altman test of agreement indicated a mean difference +/- 95% CI = -2 +/- 19%. Low-volume ventriculography reduces contrast load and ectopy while providing similar estimates of EF compared with standard volumes.
Collapse
Affiliation(s)
- M C Hodges
- Cardiology Service, Brooke Army Medical Center, Fort Sam Houston, Texas 78234-6200, USA
| | | | | | | | | |
Collapse
|
45
|
Guerra FA, Isla AI, Aguilar RC, Fritz EG. Use of free-hand three-dimensional ultrasound software in the study of the fetal heart. Ultrasound Obstet Gynecol 2000; 16:329-334. [PMID: 11169308 DOI: 10.1046/j.1469-0705.2000.00186.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To propose a new approach to the study of the fetal heart using free-hand three-dimensional (3D) ultrasound software. METHODS We studied a total of 28 fetuses, of which 26 were normal and two were known to have heart pathology. In all of them a B-mode scan was performed. After obtaining a four-chamber view, and keeping the transducer in the same position, the free-hand 3D-View software was activated. A sequence of frames was stored. Additional information was recorded looking from the four-chamber view towards the outflow tract, and also adding color Doppler. RESULTS We obtained a multiplanar display of one B-mode and two perpendicular M-modes in all cases studied. In this multiplanar mode, Y and X axes represent distance and Z axis represents time. We were able to obtain M-modes and a variation of color-M-mode in any desired position. Moving the information along the Z axis, a frame sequence of the B-mode was obtained. Using this approach we observed one case of fetal supraventricular extrasystoles and other having an interventricular septum defect. CONCLUSIONS This modality gives a new perspective of fetal heart scanning using the free-hand 3D-View software, in which there is benefit from many of the advantages of the 3D software, although the power of this procedure must be improved.
Collapse
Affiliation(s)
- F A Guerra
- Department of Obstetrics and Gynecology, Facultad de Medicina, Universidad Austral de Chile, PO. BOX 567, Valdivia, Chile
| | | | | | | |
Collapse
|
46
|
Duffee DF, Shen WK, Smith HC. Suppression of frequent premature ventricular contractions and improvement of left ventricular function in patients with presumed idiopathic dilated cardiomyopathy. Mayo Clin Proc 1998; 73:430-3. [PMID: 9581582 DOI: 10.1016/s0025-6196(11)63724-5] [Citation(s) in RCA: 137] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To examine the hypothesis that suppression of frequent premature ventricular contractions may be associated with improvement in left ventricular function in patients with presumed idiopathic dilated cardiomyopathy. DESIGN We conducted a retrospective case study and statistical analysis of the effect of cardiac medical therapy on outcome. MATERIAL AND METHODS The study population consisted of 14 patients with more than 20,000 premature ventricular contractions in 24 hours recorded by Holter monitoring and associated left ventricular dysfunction (ejection fraction, 40% or less). Clinical characteristics, number of premature ventricular contractions per hour on 24-hour ambulatory Holter monitoring, and ejection fraction based on transthoracic echocardiography were compared before and after cardiac therapeutic intervention. RESULTS Of the 14 patients, 10 had presumed idiopathic dilated cardiomyopathy, and 4 had ischemic heart disease. Of the overall study group, seven had received additional cardiac medical therapy after the index evaluation, including four patients who had amiodarone therapy. A significant reduction (75% or more from baseline) in premature ventricular contractions after medical therapeutic intervention was observed in five patients at the first follow-up examination. The mean interval to the first follow-up examination was 6 +/- 3 months. Of the five patients, four had significant improvement in clinical functional status and the ejection fraction. The mean ejection fraction of these five patients increased from 27 +/- 10% at baseline to 49 +/- 17% after medical therapy (P = 0.04). CONCLUSION The suppression of frequent premature ventricular contractions may be associated with improvement of left ventricular function in patients with presumed idiopathic dilated cardiomyopathy.
Collapse
Affiliation(s)
- D F Duffee
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic Rochester, Minnesota 55905, USA
| | | | | |
Collapse
|
47
|
Raungratanaamporn O, Bhuripanyo K, Krittayaphong R, Wansanit K, Kangkagate C, Chaithiraphan S. Radiofrequency catheter ablation for frequent premature ventricular contractions: a preliminary report of 15 cases. J Med Assoc Thai 1998; 81:98-102. [PMID: 9529838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Between February 1995 and March 1997, 15 patients, 13 women and 2 men, underwent radiofrequency catheter ablation (RFCA) for symptomatic frequent premature ventricular contractions (PVC's). The mean age was 43.3 +/- 11.9 years. Thirteen patients (86.7%) had right PVC's and the remainder had both right and left PVC's. RFCA were done under local anesthesia, using both earliest endocardial activation time and pace mapping in complement. The immediate success rate was 14/15 (93%) with only minor complications in 2 patients (13.3%). The fluoroscopic and procedure times were 40.6 +/- 24.0 and 170.7 +/- 81.2 minutes, respectively. From the Holter monitoring, total PVC count, per cent of PVC per total heart beat in 24 hours and couplets count were significantly reduced, (more than 90%, p < 0.05), by RFCA. Triplets and repetitive ventricular tachycardia were totally abolished. During the follow-up period of 10.1 +/- 7.5 months, 2 patients (14.3%) had recurrences of right PVC's within 2 weeks after ablation. Reablation was successfully done in both patients without recurrence, giving the final success rate of 93 per cent. In conclusion, RFCA could be safely performed with a high success rate in patients with symptomatic frequent PVC's. It can be considered an alternative treatment in patients resistant to medical therapy.
Collapse
Affiliation(s)
- O Raungratanaamporn
- Her Majesty's Cardiac Centre, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | | | | | | |
Collapse
|
48
|
Merino JL, Jiménez-Borreguero J, Peinado R, Merino SV, Sobrino JA. Unipolar mapping and magnetic resonance imaging of "idiopathic" right ventricular outflow tract ectopy. J Cardiovasc Electrophysiol 1998; 9:84-7. [PMID: 9475581 DOI: 10.1111/j.1540-8167.1998.tb00870.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Radiofrequency catheter ablation of symptomatic ventricular ectopy guided by unipolar mapping was successfully accomplished at the right ventricular outflow tract in a patient who did not exhibit apparent structural heart disease. A "QS" morphology with a fast slope of the downstroke deflection at the successful ablation site was observed on the unipolar electrogram. Focal thinning of the lateral wall of the right ventricular outflow tract was shown in the magnetic resonance image, similar to that reported in patients with "idiopathic" right ventricular outflow tract tachycardia.
Collapse
Affiliation(s)
- J L Merino
- U.M.Q. Cardiología, Hospital La Paz, Universidad Autónoma, Madrid, Spain.
| | | | | | | | | |
Collapse
|
49
|
Abstract
A 36-year-old male, who 1 year previously had survived a large anterior myocardial infarction, followed by cardiac arrest, was treated a few months for psoriasis with oral methotrexate, at single weekly oral doses of up to 10 mg, when he had to be hospitalized due to anginal pain and palpitation. Repeated 24-hour electrocardiogram recordings revealed ventricular ectopy up to 580 premature beats per hour. The ventricular premature beats were almost completely abolished after a few days' discontinuation of methotrexate therapy but recurred a few hours after an attempt to restart it had been made. A coronary angiogram showed only minimal wall abnormalities. Electrophysiological testing and endomyocardial biopsy were normal.
Collapse
Affiliation(s)
- R Kettunen
- Department of Internal Medicine, Oulu University Central Hospital, Finland
| | | | | | | |
Collapse
|