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Electrocardiographic characteristics for predicting idiopathic right ventricular outflow tract premature ventricular complex-induced cardiomyopathy

  • Shinya Yamada
  • Fa-Po Chung
  • Yenn-Jiang Lin
  • Shih-Lin Chang
  • Li-Wei Lo
  • Yu-Feng Hu
  • Tze-Fan Chao
  • Jo-Nan Liao
  • Chung-Hsing Lin
  • Chin-Yu Lin
  • Yao-Ting Chang
  • Abigail Louise D. Te
  • Ying-Chieh Liao
  • Po-Ching Chi
  • Shih-Ann Chen
Article
  • 95 Downloads

Abstract

Purpose

In spite of several proposed predictors for premature ventricular complex (PVC)-induced cardiomyopathy (PVC-CMP), the specific ECG features of idiopathic right ventricular outflow tract (RVOT) PVC-CMP remain unknown.

Methods

A total of 130 patients (49 males, mean age 44 years) with symptomatic and drug-refractory idiopathic RVOT PVCs undergoing radiofrequency catheter ablation (RFCA) were enrolled. The patients were categorized into two groups, including those with and without RVOT PVC-CMP (left ventricular ejection fraction (LVEF) < 50%, n = 25 and LVEF ≥ 50%, n = 105, respectively). The 12-lead PVC morphologies were assessed.

Results

Patients with RVOT PVC-CMP had a lower LVEF (42 ± 5% vs. 60 ± 7%, P < 0.01) and higher PVC burden (24 ± 14% vs. 15 ± 11%, P = 0.02) when compared to patients without RVOT PVC-CMP. The PVC features in those with PVC-CMP displayed a significantly wider QRS duration (143 ± 14 ms vs. 132 ± 17 ms, P < 0.01) and higher peak deflection index (PDI; 0.60 ± 0.07 vs. 0.55 ± 0.08, P < 0.01). A multivariate analysis demonstrated that the QRS duration (odds ratio (OR) 1.130, 95% confidence interval (CI) 1.020–1.253, P = 0.02) and PDI (OR 1.240, 95% CI 1.004–1.532, P = 0.04) were independently associated with RVOT PVC-CMP. Based on the receiver-operating characteristic analysis, a QRS duration > 139 ms and PDI > 0.57 could predict RVOT PVC-CMP (area under the curve (AUC) 0.710 and AUC 0.690, respectively). The elimination and suppression of PVCs by RFCA resulted in the recovery of the LVEF in RVOT PVC-CMP.

Conclusions

The ECG parameters, including a wider QRS duration and higher PDI, could predict the development of RVOT PVC-CMP, which could be effectively treated by RFCA.

Keywords

Electrocardiography Ventricular arrhythmia Premature ventricular complex-induced cardiomyopathy Catheter ablation 

Notes

Acknowledgments

This work was supported by the Center for Dynamical Biomarkers and Translational Medicine, Ministry of Science and Technology (grant no. MOST 106-2314-B-075-006-MY3, MOST 106-2314-B-010-046-MY3, MOST 106-2314-B-075-073-MY3, MOST 104-2314-B-010-063-MY2, MOST 104-2314-B-075-089-MY3), Research Foundation of Cardiovascular Medicine, TVGH-NTUH Joint Research Program (grant no. VGHUST105-G7-9-1, VGHUST105-G7-4-1, VGHUST104-G7-3-1), Szu-Yuan Research Foundation of Internal Medicine, and Taipei Veterans General Hospital (grant no. V104B-018, V104E7-001, V104C-121, V104C-109, V105B-014, V105C-122, V105C-116, V106C-158, V106B-010, V106C-104, V107B-014, V107C-060, and V107C-054).

Compliance with ethical standards

Conflict of interest disclosures

All authors have no conflicts of interest to declare.

Ethical approval

This study was conducted at the Taipei Veterans General Hospital in Taiwan and was approved by the institutional review board of the Taipei Veterans General Hospital and Department of Health, Taiwan (IRB no. 2014-10-004BC).

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Buxton AE, Marchlinski FE, Doherty JU, Cassidy DM, Vassallo JA, Flores BT, et al. Repetitive, monomorphic ventricular tachycardia: clinical and electrophysiologic characteristics in patients with and patients without organic heart disease. Am J Cardiol. 1984;54:997–1002.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Barrett PA, Peter CT, Swan HJ, Singh BN, Mandel WJ. The frequency and prognostic significance of electrocardiographic abnormalities in clinically normal individuals. Prog Cardiovasc Dis. 1981;23:299–319.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Lee GK, Klarich KW, Grogan M, Cha YM. Premature ventricular contraction-induced cardiomyopathy: a treatable condition. Circ Arrhythm Electrophysiol. 2012;5:229–36.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Yamada S, Lo LW, Chou YH, Lin WL, Chang SL, Lin YJ, et al. Beneficial effect of renal denervation on ventricular premature complex induced cardiomyopathy. J Am Heart Assoc. 2017;6:e004479.  https://doi.org/10.1161/JAHA.116.004479.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Bogun F, Crawford T, Reich S, Koelling TM, Armstrong W, Good E, et al. Radiofrequency ablation of frequent, idiopathic premature ventricular complexes: comparison with a control group without intervention. Heart Rhythm. 2007;4:863–7.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Krittayaphong R, Bhuripanyo K, Punlee K, Kangkagate C, Chaithiraphan S. Effect of atenolol on symptomatic ventricular arrhythmia without structural heart disease: a randomized placebo-controlled study. Am Heart J. 2002;144:e10.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Deyell MW, Park KM, Han Y, Frankel DS, Dixit S, Cooper JM, et al. Predictors of recovery of left ventricular dysfunction after ablation of frequent ventricular premature depolarizations. Heart Rhythm. 2012;9:1465–72.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Tanaka Y, Rahmutula D, Duggirala S, Nazer B, Fang Q, Olgin J, et al. Diffuse fibrosis leads to a decrease in unipolar voltage: validation in a swine model of premature ventricular contraction-induced cardiomyopathy. Heart Rhythm. 2016;13:547–54.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Hachiya H, Hirao K, Sasaki T, Higuchi K, Hayashi T, Tanaka Y, et al. Novel ECG predictor of difficult cases of outflow tract ventricular tachycardia: peak deflection index on an inferior lead. Circ J. 2010;74:256–61.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Betensky BP, Park RE, Marchlinski FE, Hutchinson MD, Garcia FC, Dixit S, et al. The V(2) transition ratio: a new electrocardiographic criterion for distinguishing left from right ventricular outflow tract tachycardia origin. J Am Coll Cardiol. May 31 2011;57:2255–62.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Yoshida N, Yamada T, McElderry HT, Inden Y, Shimano M, Murohara T, et al. A novel electrocardiographic criterion for differentiating a left from right ventricular outflow tract tachycardia origin: the V2S/V3R index. J Cardiovasc Electrophysiol. 2014;25:747–53.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Ouyang F, Fotuhi P, Ho SY, Hebe J, Volkmer M, Goya M, et al. Repetitive monomorphic ventricular tachycardia originating from the aortic sinus cusp: electrocardiographic characterization for guiding catheter ablation. J Am Coll Cardiol. 2002;39:500–8.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Baman TS, Lange DC, Ilg KJ, Gupta SK, Liu TY, Alguire C, et al. Relationship between burden of premature ventricular complexes and left ventricular function. Heart Rhythm. 2010;7:865–9.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Del Carpio MF, Syed FF, Noheria A, Cha YM, Friedman PA, et al. Characteristics of premature ventricular complexes as correlates of reduced left ventricular systolic function: study of the burden, duration, coupling interval, morphology and site of origin of PVCs. J Cardiovasc Electrophysiol. 2011;22:791–8.CrossRefGoogle Scholar
  15. 15.
    Yokokawa M, Kim HM, Good E, Crawford T, Chugh A, Pelosi F Jr, et al. Impact of QRS duration of frequent premature ventricular complexes on the development of cardiomyopathy. Heart Rhythm. 2012;9:1460–4.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Olgun H, Yokokawa M, Baman T, Kim HM, Armstrong W, Good E, et al. The role of interpolation in PVC-induced cardiomyopathy. Heart Rhythm. 2011;8:1046–9.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Kawamura M, Badhwar N, Vedantham V, Tseng ZH, Lee BK, Lee RJ, et al. Coupling interval dispersion and body mass index are independent predictors of idiopathic premature ventricular complex-induced cardiomyopathy. J Cardiovasc Electrophysiol. 2014;25:756–62.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Chung FP, Chong E, Lin YJ, Chang SL, Lo LW, Hu YF, et al. Different characteristics and electrophysiological properties between early and late recurrences after acute successful catheter ablation of idiopathic right ventricular outflow tract arrhythmias during long-term follow-up. Heart Rhythm. 2014;11:1760–9.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Kurosaki K, Nogami A, Sakamaki M, Kowase S, Sugiyasu A, Oginosawa Y, et al. Automated template matching to pinpoint the origin of right ventricular outflow tract tachycardia. Pacing Clin Electrophysiol. 2009;32(Suppl 1):S47–51.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Wang J, Kurrelmeyer KM, Torre-Amione G, Nagueh SF. Systolic and diastolic dyssynchrony in patients with diastolic heart failure and the effect of medical therapy. J Am Coll Cardiol. 2007;49:88–96.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Kanei Y, Friedman M, Ogawa N, Hanon S, Lam P, Schweitzer P. Frequent premature ventricular complexes originating from the right ventricular outflow tract are associated with left ventricular dysfunction. Ann Noninvasive Electrocardiol. 2008;13:81–5.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Lerman BB, Belardinelli L, West GA, Berne RM, DiMarco JP. Adenosine-sensitive ventricular tachycardia: evidence suggesting cyclic AMP-mediated triggered activity. Circulation. 1986;74:270–80.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Shinya Yamada
    • 1
    • 2
  • Fa-Po Chung
    • 1
    • 3
  • Yenn-Jiang Lin
    • 1
    • 3
  • Shih-Lin Chang
    • 1
    • 3
  • Li-Wei Lo
    • 1
    • 3
  • Yu-Feng Hu
    • 1
    • 3
  • Tze-Fan Chao
    • 1
    • 3
  • Jo-Nan Liao
    • 1
    • 3
  • Chung-Hsing Lin
    • 1
    • 4
  • Chin-Yu Lin
    • 1
  • Yao-Ting Chang
    • 1
  • Abigail Louise D. Te
    • 1
  • Ying-Chieh Liao
    • 3
  • Po-Ching Chi
    • 3
  • Shih-Ann Chen
    • 1
    • 3
  1. 1.Heart Rhythm Center and Department of Medicine, Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan
  2. 2.Department of Cardiovascular MedicineFukushima Medical UniversityFukushimaJapan
  3. 3.Department of MedicineNational Yang-Ming University School of MedicineTaipeiTaiwan
  4. 4.Department of Internal Medicine, Division of Cardiology, Shuang Ho HospitalTaipei Medical UniversityTaipeiTaiwan

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