Influence of Intracardiac Pressure on Spontaneous Ventricular Arrhythmias in Patients With Systolic Heart Failure

Abstract

Background— The implantation of a combination hemodynamic monitor-cardioverter-defibrillator in the Reducing Decompensation Events Utilizing Intracardiac Pressures in Patients with Chronic Heart Failure (REDUCEhf) study allowed assessment of the relationship between daily intracardiac pressure and occurrence of ventricular arrhythmic (VT/VF) events. Methods and Results— Median estimated pulmonary artery diastolic pressures (ePAD) were calculated every 24 hours in 378 subjects with New York Heart Association functional class II-III heart failure who had at least 60 days of hemodynamic data. Forty-six subjects experienced 140 VT/VF events on 80 unique study days in which daily median ePAD was available. The incidence of days with VT/VF events was significantly higher when the daily median ePAD for a subject was elevated, defined as >1 SD above that subject’s average median ePAD for the whole study: (2.8 episode days per patient-year compared with 1.7 episode days per patient-year; P =0.040). However, the incidence of days with VT/VF events was not significantly different on days when ePAD was >25 mm Hg compared with days when ePAD was <25 mm Hg. For all 378 subjects, the risk of VT/VF increased with average median ePAD calculated over the whole follow-up period (odds ratio, 1.072 for a 1-mm Hg increase; 95% confidence interval, 1.023–1.124; P =0.003). Conclusions— There is significant positive association between average daily median ePAD and risk for VT/VF. Among patients with VT/VF, elevated intracardiac pressures are associated with higher VT/VF risk only when the definition of increased pressure is subject specific.

Rabbit models of cardiac mechano-electric and mechano-mechanical coupling

“…On the other hand, ventricular tachyarrhythmias can be induced by increases in intra-ventricular volume, as occur during balloon valvuloplasty ( Levine et al., 1988 ), and in heart failure there is an association between average daily median pulmonary artery pressure and arrhythmia risk ( Reiter et al., 2013 ). Mechanically-induced tachyarrhythmias are also commonly caused by central venous and pulmonary artery catheters ( Kusminsky, 2007 ), with incidences of up to 40% ( Fiaccadori et al., 1996 ), by contact of intracardiac catheters and electrodes with the myocardium ( Bohm et al., 2002 , Lee et al., 2009 , Lindsay et al., 2006 ), during chest compressions after electrical defibrillation ( Berdowski et al., 2010 ), or by non-traumatic impacts to the precordium (in the setting of Commotio cordis ( Cayla et al., 2007 ); a subject for which pioneering experiments over 80 years ago were performed partly in rabbits ( Schlomka, 1934 )).…”

Mechano-electrical feedback in the clinical setting: Current perspectives

“…A significant and positive association between pulmonary artery diastolic pressure and arrhythmic risk has been also recently found (Reiter et al, 2013). Further evidence supporting a MEF contribution to arrhythmogenesis in heart failure is given by the association between indirect estimates of volume overload and malignant ventricular tachyarrhythmia (Ip et al, 2011) and by the association between B-Type Natriuretic Peptide, which is secreted in response to excessive stretch of the heart, and sudden cardiac death (Berger et al, 2002).…”

Pulmonary arterial pressure sensing in a patient with left ventricular assist device during ventricular arrhythmia

“…Hemodynamic parameters have been demonstrated previously to predict VA in patients with advanced heart failure, 11 and hemodynamic sensors have been incorporated into ICD systems 12, 13. Recently, the CardioMEMS PA sensor readings have been incorporated into the same remote monitoring system as cardiac rhythm management devices (Merlin.net; St. Jude Medical, Sylmar, CA).…”