Effects of atrial electromechanical delay and ventriculoatrial conduction over the atrial functions in patients with frequent extrasystole and preserved ejection fraction

Abstract

Background:The deterioration of left atrial and ventricular functions was demonstrated in patients with frequent ventricular extrasystole (fVES). The exact pathophysiology of left atrial dysfunction in patients with fVES is unclear. Retrograde ventriculoatrial conduction (VAC) often accompanies fVES, which may contribute to atrial dysfunction. We investigated whether atrial electromechanical delay and VAC are related to these atrial functions in patients with frequent right ventricular outflow tract (RVOT) VES and preserved ejection fraction (pEF). Methods:This study included 21 patients with pEF (eight males, 48 ± 11 years), who had experienced more than 10 000 RVOT-VES during 24-h Holter monitoring and had undergone electrophysiological study/ablation. The study also included 20 healthy age-and sex-matched control subjects. Transthoracic echocardiography was performed on all of the subjects. Atrial conduction time was obtained by using tissue Doppler imaging. Strain analysis was performed with two-dimensional speckle tracking echocardiography. Results:The peak atrial longitudinal strain was significantly impaired in patients with fVES (P = 0.01). In addition, although the interatrial and left atrial conduction delay times were significantly different between each group (P < 0.001, P < 0.001), the right atrial conduction delay times were similar. When patients with fVES were divided into groups depending on the existence of retrograde VAC, atrial deformation parameters and conduction delay time did not significantly differ between either group.Conclusion: Frequent RVOT-VES causes left atrial dysfunction. This information is obtained through strain analyses and recordings of left atrial conduction times in patients with pEF. Regardless, retrograde VAC is not related to atrial dysfunction. K E Y W O R D Satrial conduction time, atrial fibrillation, electrophysiological study, left atrial deformation, speckle-tracking strain imaging, ventricular extrasystole, ventriculoatrial conduction

Impaired left ventricular global longitudinal strain improves with radiofrequency catheter ablation in patients with PVC‐induced cardiomyopathy

“…14 In several studies in the literature, it was reported that LV-GLS value obtained with STE significantly decreased in patients with normal LVEF with frequent PVCs. 16,17,[23][24][25] In addition to LV-GLS, the LA-GLS was also evaluated, and it was reported that both LA-GLS and LV-GLS values decreased in PVCs patients with normal LVEF. 24 Although LVEF reduction in PVCs patients is more common in patients with PVCs burden ≥20%, less frequent PVCs burden >8% are reported to be sufficient to reduce LV-GLS.…”

“…16,17,[23][24][25] In addition to LV-GLS, the LA-GLS was also evaluated, and it was reported that both LA-GLS and LV-GLS values decreased in PVCs patients with normal LVEF. 24 Although LVEF reduction in PVCs patients is more common in patients with PVCs burden ≥20%, less frequent PVCs burden >8% are reported to be sufficient to reduce LV-GLS. 25 As a result of the study, they suggested that LV-GLS evaluation should be a routine examination in patients with PVCs since decreased LV-GLS occurs earlier and with less PVCs burden.…”

“…In a recent article, it has been reported that PVC‐induced cardiomyopathy does not only cause a decrease in LVEF, but also the development of LV remodeling because frequent PVCs cause LV‐GLS reduction and LV diastolic dysfunction 14 . In several studies in the literature, it was reported that LV‐GLS value obtained with STE significantly decreased in patients with normal LVEF with frequent PVCs 16,17,23‐25 . In addition to LV‐GLS, the LA‐GLS was also evaluated, and it was reported that both LA‐GLS and LV‐GLS values decreased in PVCs patients with normal LVEF 24 .…”

“…19,21,22 In a limited number of recent studies, LV-GLS evaluation has been performed in patients with PVCs and preserved LVEF. 16,[23][24][25] In these studies, there is evidence that LV-GLS decreases in patients with PVCs and preserved LVEF. 16,[23][24][25] As far as we have investigated, there is no clear information about the evaluation of LA-GLS in patients with PVCs and reduced LVEF and the effect of RFA treatment on LV-GLS in these patients.…”

“…LVEF was shown to be improved by radiofrequency ablation (RFA) treatment in 47.1‐100% of patients with frequent PVCs 19,21,22 . In a limited number of recent studies, LV‐GLS evaluation has been performed in patients with PVCs and preserved LVEF 16,23‐25 . In these studies, there is evidence that LV‐GLS decreases in patients with PVCs and preserved LVEF 16,23‐25 .…”