Coupling interval variability of premature ventricular contractions in patients with different underlying pathology: an insight into the arrhythmia mechanism

Abstract

PurposeCoupling 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.MethodsSixty-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.ResultsThe 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).ConclusionsLow 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 materialThe online version of this article (10.1007/s10840-017-0309-8) contains supplementary material, which is available to authorized users.

Characteristics and Prevalence of Premature Ventricular Complex: A Telemedicine Study

“…In addition, they also added that higher CI variability had tendency to occur in patients with structural heart disease, while patients with frequent PVC without structural heart disease were more likely to have persistent CI. Moreover, they also described the connection between CI variability and the benefits of anti-arrhythmic drug therapy [15].…”

Catheter Ablation of Left Ventricular Summit Arrhythmia in a Patient with Critical Coronary Artery Stenosis: A Sequential Approach

“…Because the PVCs exhibit variable coupling intervals, increased abnormal automaticity is more likely to be the source of the rhythm disturbance. 18 , 19 Therefore, sequential PCI and RF ablation were performed in the same session.…”

Electrophysiological and anatomical factors determine arrhythmic risk in acute myocardial ischaemia and its modulation by sodium current availability

“…The vulnerability window for reentry (VW) was defined as the range of coupling intervals (CI, i.e. time difference between the last S1 and S2) [ 6 , 28 , 39 ] which induced reentrant arrhythmias, as used previously for quantification of arrhythmic risk in whole-ventricular simulation studies [ 12 , 14 , 20 ]. Six different ectopic S2 locations were considered for each scenario, equally spaced around the ischemic BZ (in agreement with the location of ectopy in ischaemia experiments [ 22 , 38 ]).…”