Masked premature ventricular contractions and intradevice interaction causing ventricular fibrillation.
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ABSTRACT:
SUBMITTER: Do DH
PROVIDER: S-EPMC7897743 | biostudies-literature | 2021 Feb
REPOSITORIES: biostudies-literature
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Masked premature ventricular contractions and intradevice interaction causing ventricular fibrillation.
Do Duc H DH Meyer Scott S Bradfield Jason J Shivkumar Kalyanam K Boyle Noel G NG Khakpour Houman H
HeartRhythm case reports 20201110 2
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Project description:AimsThe aim of the present study was to estimate the accuracy of a novel non-invasive epicardial and endocardial electrophysiology system (NEEES) for mapping ectopic ventricular depolarizations.Methods and resultsThe study enrolled 20 patients with monomorphic premature ventricular contractions (PVCs) or ventricular tachycardia (VT). All patients underwent pre-procedural computed tomography or magnetic resonance imaging of the heart and torso. Radiographic data were semi-automatically processed by the NEEES to reconstruct a realistic 3D model of the heart and torso. In the electrophysiology laboratory, body-surface electrodes were connected to the NEEES followed by unipolar EKG recordings during episodes of PVC/VT. The body-surface EKG data were processed by the NEEES using its inverse-problem solution software in combination with anatomical data from the heart and torso. The earliest site of activation as denoted on the NEEES 3D heart model was compared with the PVC/VT origin using a 3D electroanatomical mapping system. The site of successful catheter ablation served as final confirmation. A total of 21 PVC/VT morphologies were analysed and ablated. The chamber of interest was correctly diagnosed non-invasively in 20 of 21 (95%) PVC/VT cases. In 18 of the 21 (86%) cases, the correct ventricular segment was diagnosed. Catheter ablation resulted in acute success in 19 of the 20 (95%) patients, whereas 1 patient underwent successful surgical ablation. During 6 months of follow-up, 19 of the 20 (95%) patients were free from recurrence off antiarrhythmic drugs.ConclusionThe NEEES accurately identified the site of PVC/VT origin. Knowledge of the potential site of the PVC/VT origin may aid the physician in planning a successful ablation strategy.
| S-EPMC5437699 | biostudies-literature
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| S-EPMC10774534 | biostudies-literature
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| S-EPMC10801071 | biostudies-literature
Project description:Mechanisms behind development of premature ventricular contraction (PVC)-induced cardiomyopathy remain unclear. PVCs may adversely modulate the autonomic nervous system to promote development of heart failure. Afferent neurons in the inferior vagal (nodose) ganglia transduce cardiac activity and modulate parasympathetic output. Effects of PVCs on cardiac parasympathetic efferent and vagal afferent neurotransmission are unknown. The purpose of this study was to evaluate effects of PVCs on vagal afferent neurotransmission and compare these effects with a known powerful autonomic modulator, myocardial ischemia. In 16 pigs, effects of variably coupled PVCs on heart rate variability (HRV) and vagal afferent neurotransmission were evaluated. Direct nodose neuronal recordings were obtained in vivo, and cardiac-related afferent neurons were identified based on their response to cardiovascular interventions, including ventricular chemical and mechanical stimuli, left anterior descending (LAD) coronary artery occlusion, and variably coupled PVCs. On HRV analysis before versus after PVCs, parasympathetic tone decreased (normalized high frequency: 83.6?±?2.8 to 72.5?±?5.3; P < 0.05). PVCs had a powerful impact on activity of cardiac-related afferent neurons, altering activity of 51% of neurons versus 31% for LAD occlusion (P < 0.05 vs. LAD occlusion and all other cardiac interventions). Both chemosensitive and mechanosensitive neurons were activated by PVCs, and their activity remained elevated even after cessation of PVCs. Cardiac afferent neural responses to PVCs were greater than any other intervention, including ischemia of similar duration. These data suggest that even brief periods of PVCs powerfully modulate vagal afferent neurotransmission, reflexly decreasing parasympathetic efferent tone.NEW & NOTEWORTHY Premature ventricular contractions (PVCs) are common in many patients and, at an increased burden, are known to cause heart failure. This study determined that PVCs powerfully modulate cardiac vagal afferent neurotransmission (exerting even greater effects than ventricular ischemia) and reduce parasympathetic efferent outflow to the heart. PVCs activated both mechano- and chemosensory neurons in the nodose ganglia. These peripheral neurons demonstrated adaptation in response to PVCs. This study provides additional data on the potential role of the autonomic nervous system in PVC-induced cardiomyopathy.
| S-EPMC6766725 | biostudies-literature
Project description:Recent studies have demonstrated the utility of cardiac sympathetic denervation (CSD) in patients with ventricular tachycardia (VT) refractory to antiarrhythmic drugs and catheter or surgical ablation. We present our experience with bilateral CSD in a patient with a recurrent VT despite attempts at treatment with catheter ablation and antiarrhythmic drugs, and this is the first description of the successful management of an idiopathic refractory VT with a bilateral CSD and concomitant oral amiodarone, occurring after catheter ablation of persistent atrial fibrillation and idiopathic outflow tract premature ventricular contractions.
| S-EPMC6457378 | biostudies-literature
Project description:In some cases with idiopathic ventricular fibrillation, short-coupled premature ventricular contractions (PVCs) initiate fatal arrhythmia, which has recently been proposed as short-coupled ventricular fibrillation (SCVF). In the present case of SCVF, catheter ablation for trigger PVCs originating from the His-Purkinje system in both ventricles caused transient complete atrioventricular block, and a combination of quinidine and verapamil suppressed ventricular tachyarrhythmia. <Learning objective: In some cases with short-coupled ventricular fibrillation, a combination of quinidine and verapamil can suppress fatal ventricular tachyarrhythmia.>.
| S-EPMC9169001 | biostudies-literature
Project description:BackgroundWe lack data on the effect of single premature ventricular contractions (PVCs) on the clinical and echocardiographic response after cardiac resynchronization therapy (CRT) device implantation. We aimed to assess the predictive value of PVCs at early, 1 month-follow up on echocardiographic response and all-cause mortality.MethodsIn our prospective, single-center study, 125 heart failure patients underwent CRT implantation based on the current guidelines. Echocardiographic reverse remodeling was defined as a ≥ 15% improvement in left ventricular ejection fraction (LVEF), end-systolic volume (LVESV), or left atrial volume (LAV) measured 6 months after CRT implantation. All-cause mortality was investigated by Wilcoxon analysis.ResultsThe median number of PVCs was 11,401 in those 67 patients who attended the 1-month follow-up. Regarding echocardiographic endpoints, patients with less PVCs develop significantly larger LAV reverse remodeling compared to those with high number of PVCs. During the mean follow-up time of 2.1 years, 26 (21%) patients died. Patients with a higher number of PVCs than our median cut-off value showed a higher risk of early all-cause mortality (HR 0.97; 95% CI 0.38-2.48; P = 0.04). However, when patients were followed up to 9 years, its significance diminished (HR 0.78; 95% CI 0.42-1.46; P = 0.15).ConclusionsIn patients undergoing CRT implantation, lower number of PVCs predicted atrial remodeling and showed a trend for a better mortality outcome. Our results suggest the importance of the early assessment of PVCs in cardiac resynchronization therapy and warrant further investigations.
| S-EPMC9233778 | biostudies-literature
Project description:AimsPremature ventricular contractions (PVCs) are a common form of arrhythmia associated with an unfavourable prognosis in patients with structural heart disease. However, the prognostic significance in absence of heart disease is debated. With this study, we aim to investigate whether subjects with PVC, without structural heart disease, have a worse prognosis than the general population.Methods and resultsPatients evaluated for PVC at a secondary care centre in Stockholm County from January 2010 to December 2016 were identified. We included patients without history of previous heart disease who had undergone echocardiography and exercise test with normal findings. Based on sex and age, we matched the PVC cohort to a four times bigger control group from the general population and compared the outcome in terms of mortality and cardiovascular morbidity during a median follow-up time of 5.2 years. We included 820 patients and 3,264 controls. Based on a non-inferiority analysis, the PVC group did not have a higher mortality than the control group (0.44, CI 0.27-0.72). Sensitivity analysis with propensity score matching confirmed this result.ConclusionsPVC patients, who after thorough evaluation showed no signs of structural heart disease, did not have a worse prognosis when compared to an age- and sex- control group based on the general population.
| S-EPMC9935042 | biostudies-literature
Project description:Premature ventricular contractions (PVCs) and slow coronary flow phenomenon (SCFP) are primarily separate entities. Each one of them has different characteristics and a diverse spectrum of presentation. However, and despite many suggested theories, a comprehensive understanding of the etiology of both of them is still a matter of debate. PVCs, which can be triggered by consuming cannabis (marijuana), and through decreasing the diastolic time (DT), can affect the slow blood flow found in SCFP even more and worsen the clinical picture in patients who have PVCs and SCFP. In this paper, we present a patient who uses marijuana and has PVCs and SCFP, try to address different aspects of PVCs and SCFP, pinpoint any suspected interaction between both of them and the role of marijuana in this context. <Learning objective: (i) PVCs are extra abnormal heartbeats arising in one of the ventricles and disrupting the normal rhythm of the heart. (ii) PVCs are very common and occur in a broad spectrum of the population including those with and without underlying heart disease. (iii) SCFP is an angiographic finding characterized by delayed progression of the contrast injected inside large coronary arteries without any significant CAD. (iv) It has an incidence of 1% among patients who undergo coronary angiography, especially those presenting with acute coronary syndrome. (v) PVCs, which can be triggered by consuming cannabis (marijuana), and throughout decreasing the DT, can affect the slow blood flow found in SCFP even more and worsen the clinical picture in patients who have PVCs and SCFP.>.
| S-EPMC6281510 | biostudies-literature
Project description:BackgroundPremature ventricular contractions (PVCs) are frequently observed with left ventricular (LV) systolic dysfunction, although the prevalence of these associated conditions in the general population remains unknown.ObjectiveWe sought to understand the prevalence of frequent PVCs (defined PVCs > 5%) and high burden PVCs (defined PVCs > 10%) and LV systolic dysfunction in patients receiving ambulatory Holter monitors (HM).MethodsA prospective multicenter (eight US medical centers) cross-sectional study collected demographic and PVC burden data from consecutive patients undergoing 24-h, 48-h, and 14-day HM (July 2018-June 2020). Left ventricle ejection fraction (LVEF) data was collected if obtained within 6 months of HM. Four PVC burden groups were analyzed (<1%, 1%-5%, 5.1%-10%, and >10% burden) and stratified by normal LVEF (≥50%) or presence LVEF < 50%.ResultsThe prevalence of PVC burden of 5.1%-10% and >10% was 4% and 5%, respectively in the population undergoing HM (n = 6529). Age was significantly different between PVC groups (p < .001). In those with LVEF assessment (n = 3713), the prevalence of LVEF < 50% and both LVEF < 50% and PVC > 5% was 16.4% and 4.2%, respectively. The prevalence of PVC > 5% and PVC > 10% in patients with LVEF < 50% was 26% and 16%, respectively. PVC > 5% were more prevalent in older, male, and Caucasians (p < .001). Females had a lower prevalence of PVC > 5% than males (6% vs. 11%; p < .001), but not among those with LVEF < 50% (24% vs. 26%, p = .10).ConclusionPVC > 5% and PVC > 10% and LVEF < 50% are prevalent in patients undergoing HM. PVC > 5% are associated with older age. Females have a lower prevalence of PVC > 5% than males but similar combined PVC > 5% and LVEF < 50%.Clinicaltrialgov identifier: NCT03228823.
| S-EPMC11727014 | biostudies-literature