Persistent Proarrhythmic Neural Remodeling Despite Recovery From Premature Ventricular Contraction-Induced Cardiomyopathy

Tan, Alex Y.; Elharrif, Khalid; Cardona-Guarache, Ricardo; Mankad, Pranav; Ayers, Owen; Joslyn, Martha; Das, Anindita; Kaszala, Károly; Lin, Shien Fong; Ellenbogen, Kenneth A.; Minisi, Anthony J.; Huízar, José F.

doi:10.1016/j.jacc.2019.10.046

Cited by 34 publications

(17 citation statements)

References 25 publications

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“… 8 Moreover, atrial contraction during mitral valve closure owing to PVC has been shown to cause a significant increase in pulmonary venous regurgitation flow. 22 Consequently, this hemodynamic impairment can lead to the activation of renin-angiotensin-aldosterone and sympathetic nervous systems with known detrimental long-term effects on LV structure and function 23 , 24 that could also trigger eccentric remodeling. These could be part of the substrate that contributes to the potential increase in morbidity and mortality associated with PVC-cardiomyopathy.…”

Section: Discussionmentioning

confidence: 99%

“…Various triggers have been implicated in PVC-cardiomyopathy, including (1) heart rate irregularity and/or higher mean heart rate 2 , 6 with similar pathophysiology responsible for atrial fibrillation– and tachycardia-induced cardiomyopathy, respectively; (2) abnormal LV mechanics and dyssynchrony with subsequent disruption of LV wall motion synergy 7 , 22 , 26 , 27 ; (3) increased intracellular calcium concentration and myocardial oxygen consumption associated with post-extrasystolic potentiation 8 ; and (4) hemodynamic alterations with remodeling of the autonomic nervous system. 23 , 28 Our premature pacing algorithm 6 , 15 has allowed us to systematically study and compare the chronic effects of PACs and PVCs on LV function and dimensions.…”

Section: Discussionmentioning

confidence: 99%

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Eccentric hypertrophy in an animal model of mid- and long-term premature ventricular contraction–induced cardiomyopathy

et al. 2021

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Background Tachycardia and heart rate irregularity are proposed triggers of premature ventricular contraction–induced cardiomyopathy (PVC-cardiomyopathy). Bigeminal premature atrial and ventricular contractions (PACs and PVCs) increase heart rate and result in rhythm irregularities but differ in their effects on ventricular synchrony. Comparing chronic bigeminal PACs with PVCs would provide insights into mechanisms of PVC-cardiomyopathy. Objective To compare the impact of chronic PACs and PVCs on ventricular hemodynamics, structure, and function. Methods Pacemakers were implanted in 27 canines to reproduce atrial (PACs, n = 7) or ventricular bigeminy (PVCs, n = 11) for 12 weeks, and compared to sham-operated animals (n = 9). Four additional animals were exposed to long-term bigeminal PVCs (48 weeks). Hemodynamic changes were assessed using a pressure-transducing catheter at baseline and 12 weeks. Cardiac remodeling was monitored by transthoracic echocardiography throughout the 12- and 48-week protocols in the respective groups. Results PVC group demonstrated a significant decrease in left ventricular (LV) ejection fraction and contractility (max dP/dt), impaired LV lusitropy (min dP/dt), and increase in LV dimensions and LV mass at 12 weeks without further deterioration beyond 16 weeks. Despite increased LV mass, relative wall thickness decreased, consistent with eccentric hypertrophy. No significant cardiac remodeling was noted in either sham or PAC groups at 12 weeks. Conclusion In contrast to bigeminal PACs, PVCs result in a cardiomyopathy characterized by reduced LV ejection fraction, LV dilation, and eccentric hypertrophy that plateaus between 12 and 16 weeks. The lack of remodeling in chronic PACs suggests that tachycardia and heart rate irregularity do not play a significant role on the development of PVC-cardiomyopathy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Eccentric hypertrophy in an animal model of mid- and long-term premature ventricular contraction–induced cardiomyopathy

et al. 2021

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“…Adrenergic tone has been shown to be an important influence on all OTVA (10). Furthermore, whilst the autonomic nervous system (ANS) influences VE activity, the presence of modest burden ectopy has also been shown to alter the activity of cardiac neurons and VE-induced cardiomyopathy can be characterised by sympathetic hyperinnervation, which may exacerbate arrhythmogenesis (11,12). This suggests a bidirectional relationship between the ANS and VE.…”

Section: Discussionmentioning

confidence: 99%

Hourly Variability in Outflow Tract Ectopy as a Predictor of its Site of Origin

Waight

Leung

et al. 2021

Preprint

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Introduction: Prior to ablation, predicting the site of origin (SOO) of outflow tract ventricular arrhythmia (OTVA), can inform patient consent and facilitate appropriate procedural planning. We set out to determine if OTVA variability can accurately predict SOO. Methods: Consecutive patients with a clear SOO identified at OTVA ablation had their prior 24-hour ambulatory ECGs retrospectively analysed (derivation cohort). Percentage ventricular ectopic (VE) burden, hourly VE values, episodes of trigeminy/bigeminy, and the variability in these parameters were evaluated for their ability to distinguish right from left sided SOO. Effective parameters were then prospectively tested on a validation cohort of consecutive patients undergoing their first OTVA ablation. Results: High VE variability (coefficient of variation ≥ 0.7) and the presence of any hour with < 50 VE, were found to accurately predict RVOT SOO in a derivation cohort of 40 patients. In a validation cohort of 29 patients, the correct SOO was prospectively identified in 23/29 patients (79.3%) using CoV, and 26/29 patients (89.7%) using VE < 50. Including current ECG algorithms, VE < 50 had the highest Youden Index (78), the highest positive predictive value (95.0%) and the highest negative predictive value (77.8%). Conclusion: VE variability and the presence of a single hour where VE < 50 can be used to accurately predict SOO in patients with OTVA. Accuracy of these parameters compares favourably to existing ECG algorithms.

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“…10 Furthermore, while the autonomic nervous system (ANS) influences VE activity, the presence of modest burden ectopy has also been shown to alter the activity of cardiac neurons and VEinduced cardiomyopathy can be characterized by sympathetic hyperinnervation, which may exacerbate arrhythmogenesis. 11,12 This suggests a bidirectional relationship between the ANS and VE.…”

Section: Inter-holter Reproducibilitymentioning

confidence: 95%

Hourly variability in outflow tract ectopy as a predictor of its site of origin

Waight

Leung

et al. 2021

Cardiovasc electrophysiol

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Disclosure: MW and BW are receiving funding from the Advanced Ventricular Arrhythmia Training and Research program administered by The St. George's Hospital Charity. AL, MG, and MSa have received funding from Abbott Laboratories. MG and LL have received funding from Attune medical. BW has received funding and consultancy payments from Boston Scientific. MG has acted as a consultant or paid speaker for Johnson and Johnson, Medtronic, Biotronik, and Cook Medical. The remaining authors have no conflicts.

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Persistent Proarrhythmic Neural Remodeling Despite Recovery From Premature Ventricular Contraction-Induced Cardiomyopathy

Cited by 34 publications

References 25 publications

Eccentric hypertrophy in an animal model of mid- and long-term premature ventricular contraction–induced cardiomyopathy

Eccentric hypertrophy in an animal model of mid- and long-term premature ventricular contraction–induced cardiomyopathy

Hourly Variability in Outflow Tract Ectopy as a Predictor of its Site of Origin

Hourly variability in outflow tract ectopy as a predictor of its site of origin

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