Atrial Bigeminy Results in Decreased Left Ventricular Function: An Insight into the Mechanism of PVC‐Induced Cardiomyopathy

Pacchia, Christina F.; Akoum, Nazem; Wasmund, Stephen L.; Hamdan, M.B.A. Mohamed H.

doi:10.1111/j.1540-8159.2012.03466.x

Cited by 15 publications

(22 citation statements)

References 15 publications

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“…Persistent HR irregularity and PESP generated by frequent ectopy have been proposed as a potential mechanism of PVC‐CM. This hypothesis arose in part from the development of LV systolic dysfunction in subjects with AF despite appropriate rate control and from a single report of an experimental canine model of chronic PAC‐induced CM . HR irregularity and PESP occur with both PACs and PVCs .…”

Section: Discussioncontrasting

confidence: 87%

“…Ambulatory ECGs in our atrial bigeminy (50% PACs) animal model resulted in a 40% prematurity of R‐R (conducted PAC) which in theory should have caused CM in at least half of all animals exposed to PACs. Findings from our translational PAC canine model are supported by a recent PAC and PVC swine model, where atrial bigeminy was not associated with a significant change in LV systolic function These studies are inconsistent with the results of Pacchia et al, where 4 of 5 animals exposed to 50% PAC burden (using a dual‐chamber pacemaker) developed LV dysfunction (LVEF <50%). Unfortunately, the authors did not obtain holters to document mean HR, mean PAC or R‐R coupling interval, only assessing atrial bigeminy during an intermittent device interrogation.…”

Section: Discussionmentioning

confidence: 99%

“…Frequent ventricular ectopy is known to cause nonischemic cardiomyopathy (CM), often referred to as premature ventricular contraction (PVC)‐CM . Similar to PVCs, atrial fibrillation (AF) and frequent premature atrial contractions (PACs) are believed to cause CM due to increased heart rate (HR), HR irregularity and/or associated postextrasystolic potentiation (PESP). These phenomena are not unique to PVCs as they also occur in PACs.…”

Section: Introductionmentioning

confidence: 99%

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Consequences of chronic frequent premature atrial contractions: Association with cardiac arrhythmias and cardiac structural changes

Gunda

Akyeampong

Gomez-Arroyo

et al. 2019

Cardiovasc electrophysiol

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Introduction Frequent premature ventricular contractions (PVCs) can cause cardiomyopathy (CM). Postextrasystolic potentiation (PESP) and irregularity have been in implicated as triggers of PVC‐CM. Because both phenomena can also be found in premature atrial contractions (PACs), it is speculated that frequent PACs have similar consequences. Methods and results A single‐center, retrospective study included all consecutive patients undergoing a 14‐day Holter monitors (November 2014 to October 2016). Patients were divided into four groups by ectopy burden group 1 (<1%) and remaining by tertiles (group 2‐4). Echocardiographic and arrhythmic data were compared between PAC and PVC burdens. In addition, a translational PAC animal model was used to assess the chronic effects of frequent PACs. A total 846 patients were reviewed. In contrast to PVCs, we found no difference in left ventricular ejection fraction (LVEF), end‐systolic and end‐diastolic dimensions and presence of CM (LVEF <50%) between different PAC groups. Multivariate regression analysis demonstrated that only PVC burden predicted low EF (odds ratio, 1.1; confidence interval, 1.03‐1.13; P = .001). While there was a weak correlation between PAC burden and supraventricular tachycardia (SVT) episodes and atrial fibrillation (AF) burden (r = 0.19; P < .001), there was no correlation between PAC burden and LVEF or CM. Finally, atrial bigeminy in our animal model did not significantly decrease LVEF after 3 months. Conclusion PAC burden is associated with increased AF and SVT episodes. In contrast to a high PVC burden, a high PAC burden is not associated with CM. Our findings suggest that heart rate irregularity and/or PESP may play a minimal role in the pathophysiology of PVC‐CM.

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Section: Discussioncontrasting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Consequences of chronic frequent premature atrial contractions: Association with cardiac arrhythmias and cardiac structural changes

Gunda

Akyeampong

Gomez-Arroyo

et al. 2019

Cardiovasc electrophysiol

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“…Irregular atrial rhythm and the result of variant coupling interval cause blood‐flow stasis and promote thrombus development. In addition, the effect of premature ventricular contractions on ventricular dilation and function decline could be exacerbated by frequent PACs …”

Section: Discussionmentioning

confidence: 99%

Relation of premature atrial complexes with stroke and death: Systematic review and meta‐analysis

Huang

Peng

et al. 2017

Clinical Cardiology

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“…Recently, the presence of frequent PACs (>100 beats per day) in symptomatic patients without AF or structural heart disease was shown to increase the risks of developing AF, ischemic stroke, heart failure, and death during a 6.1‐year follow‐up study . Frequent PACs could predispose an individual to new‐onset AF, ischemic stroke, and heart failure, which, in turn, increase the risks of CV hospitalization and mortality . Increments in such pathological conditions may contribute, at least in part, to the observed increases in hospital admissions and mortality rate.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Significance of Premature Atrial Complexes Burden in Prediction of Long‐Term Outcome

Lin

Chen

Chang

et al. 2015

JAHA

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BackgroundThe prognostic significance of premature atrial complex (PAC) burden is not fully elucidated. We aimed to investigate the relationship between the burden of PACs and long-term outcome.Methods and ResultsWe investigated the clinical characteristics of 5371 consecutive patients without atrial fibrillation (AF) or a permanent pacemaker (PPM) at baseline who underwent 24-hour electrocardiography monitoring between January 1, 2002, and December 31, 2004. Clinical event data were retrieved from the Bureau of National Health Insurance of Taiwan. During a mean follow-up duration of 10±1 years, there were 1209 deaths, 1166 cardiovascular-related hospitalizations, 3104 hospitalizations for any reason, 418 cases of new-onset AF, and 132 PPM implantations. The optimal cut-off of PAC burden for predicting mortality was 76 beats per day, with a sensitivity of 63.1% and a specificity of 63.5%. In multivariate analysis, a PAC burden >76 beats per day was an independent predictor of mortality (hazard ratio: 1.384, 95% CI: 1.230 to 1.558), cardiovascular hospitalization (hazard ratio: 1.284, 95% CI: 1.137 to 1.451), new-onset AF (hazard ratio: 1.757, 95% CI: 1.427 to 2.163), and PPM implantation (hazard ratio: 2.821, 95% CI: 1.898 to 4.192). Patients with frequent PAC had increased risk of mortality attributable to myocardial infarction, heart failure, and sudden cardiac death. Frequent PACs increased risk of PPM implantation owing to sick sinus syndrome, high-degree atrioventricular block, and/or AF.ConclusionsThe burden of PACs is independently associated with mortality, cardiovascular hospitalization, new-onset AF, and PPM implantation in the long term.

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Atrial Bigeminy Results in Decreased Left Ventricular Function: An Insight into the Mechanism of PVC‐Induced Cardiomyopathy

Abstract: We have shown that 4 weeks of coupled pacing simulating atrial bigeminy significantly reduced LV function. Our findings suggest that premature complexes independent of ventricular dyssynchrony might lead to the development of cardiomyopathy.

Cited by 15 publications

References 15 publications

Consequences of chronic frequent premature atrial contractions: Association with cardiac arrhythmias and cardiac structural changes

Consequences of chronic frequent premature atrial contractions: Association with cardiac arrhythmias and cardiac structural changes

Relation of premature atrial complexes with stroke and death: Systematic review and meta‐analysis

Prognostic Significance of Premature Atrial Complexes Burden in Prediction of Long‐Term Outcome

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