Diffuse fibrosis leads to a decrease in unipolar voltage: Validation in a swine model of premature ventricular contraction–induced cardiomyopathy

Tanaka, Yasuaki; Rahmutula, Dolkun; Duggirala, Srikant; Nazer, Babak; Fang, Qizhi; Olgin, Jeffrey E.; Sievers, Richard E.; Gerstenfeld, Edward P.

doi:10.1016/j.hrthm.2015.09.025

Cited by 34 publications

(16 citation statements)

References 15 publications

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“…Our key findings are: (a) high PAC burden is associated with a higher SVT and AF burden (Table ); (b) in contrast to PVCs, PACs are not associated with LV dysfunction; (c) LV dysfunction was not observed in an animal model despite 50% PAC burden and a significant increase in HR after a 3‐month period. This is in contrast to findings in experimental PVC models where 50% and 100% of animals developed CM when exposed to 33% and 55% PVC burden, respectively . 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.…”

Section: Discussioncontrasting

confidence: 77%

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: 77%

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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“…Further, it has anti-fibrotic properties 40 and myocardial fibrosis has been characterized in a model of PVC-induced CMP 41 and could compromise recovery, even after successful PVC suppression.…”

Section: Discussionmentioning

confidence: 99%

Premature Ventricular Contraction Coupling Interval Variability Destabilizes Cardiac Neuronal and Electrophysiological Control

Hamon¹,

Rajendran²,

Chui³

et al. 2017

Circ: Arrhythmia and Electrophysiology

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Background Variability in premature ventricular contraction (PVC) coupling interval (CI) increases the risk of cardiomyopathy and sudden death. The autonomic nervous system regulates cardiac electrical and mechanical indices, and its dysregulation plays an important role in cardiac disease pathogenesis. The impact of PVCs on the intrinsic cardiac nervous system (ICNS), a neural network on the heart, remains unknown. The objective was to determine the effect of PVCs and CI on ICNS function in generating cardiac neuronal and electrical instability using a novel cardio-neural mapping approach. Methods and Results In a porcine model (n=8) neuronal activity was recorded from a ventricular ganglion using a microelectrode array, and cardiac electrophysiological mapping was performed. Neurons were functionally classified based on their response to afferent and efferent cardiovascular stimuli, with neurons that responded to both defined as convergent (local reflex processors). Dynamic changes in neuronal activity were then evaluated in response to right ventricular outflow tract PVCs with fixed short, fixed long, and variable CI. PVC delivery elicited a greater neuronal response than all other stimuli (P<0.001). Compared to fixed short and long CI, PVCs with variable CI had a greater impact on neuronal response (P<0.05 versus short CI), particularly on convergent neurons (P<0.05), as well as neurons receiving sympathetic (P<0.05) and parasympathetic input (P<0.05). The greatest cardiac electrical instability was also observed following variable (short) CI PVCs. Conclusions Variable CI PVCs affect critical populations of ICNS neurons and alter cardiac repolarization. These changes may be critical for arrhythmogenesis and remodeling leading to cardiomyopathy.

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“…26,28,31 Myocardial fibrosis produces a leftward shift in the F I G U R E 6 Adjustment of the endocardial unipolar voltage slider bar from the reference 8.3 mV value in different pathological scenarios. 26,28,31 Myocardial fibrosis produces a leftward shift in the F I G U R E 6 Adjustment of the endocardial unipolar voltage slider bar from the reference 8.3 mV value in different pathological scenarios.…”

Section: Unip Voltage Mapping To Predict Clinical Outcome After Ablmentioning

confidence: 99%

“…Reference populations of healthy individuals without imaging and/or histological evidence of scar or decreased myocardial systolic function have served to establish normal endo UNIP voltage values, based on the identification of the voltage value that includes the 95% of UNIP EGMs from this reference group (Figure 3). 21,23,24,[26][27][28] For these studies, the UNIP recordings were usually registered from 4-or 3.5-mm-tip electrodes with signals filtered at 1 to 240 Hz.…”

Section: Defining Normal Unip Voltage Valuesmentioning

confidence: 99%

“…Endocardial UNIP EAVM has recently proven useful to define irreversibility of myocardial disease in the human and animal settings. 26,28,31 Myocardial fibrosis produces a leftward shift in the F I G U R E 6 Adjustment of the endocardial unipolar voltage slider bar from the reference 8.3 mV value in different pathological scenarios. A, In the setting of LV hypertrophy (LV thickness 14 mm), adjustment of the UNIP voltage slider bar from the standard cutoff of 8.3 to 10 or even 12 mV results in clearer representation of a localized confluent area of epi scarring on bipolar voltage mapping and MR imaging that was only suggested at the conventional 8.3 mV value.…”

Section: Unip Voltage Mapping To Predict Clinical Outcome After Ablmentioning

confidence: 99%

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Three‐dimensional myocardial scar characterization from the endocardium: Usefulness of endocardial unipolar electroanatomic mapping

Bazán

Frankel

García

et al. 2019

Cardiovasc electrophysiol

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Epicardial ablation may be required to eliminate ventricular tachycardia (VT) in patients with underlying structural heart disease. The decision to gain epicardial access is frequently based on the suspicion of an epicardial origin for the VT and/or presence of an arrhythmogenic substrate. Epicardial pathology and VT is frequently present in patients with nonischemic right and/or left cardiomyopathies even in the setting of modest or no endocardial bipolar voltage substrate. In this setting, unipolar voltage mapping from the endocardium serves to help identify midmyocardial and/or epicardial VT substrate. The additional value of endocardial unipolar mapping includes its usefulness to predict the clinical outcome after VT ablation, to determine the irreversibility of myocardial disease, and to guide endomyocardial biopsy procedures to specific areas of intramural scarring. In this review, we aim to provide a guide to the use of endocardial unipolar mapping and its appropriate interpretation in a variety of clinical situations.

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Diffuse fibrosis leads to a decrease in unipolar voltage: Validation in a swine model of premature ventricular contraction–induced cardiomyopathy

Cited by 34 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

Premature Ventricular Contraction Coupling Interval Variability Destabilizes Cardiac Neuronal and Electrophysiological Control

Three‐dimensional myocardial scar characterization from the endocardium: Usefulness of endocardial unipolar electroanatomic mapping

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