Post-Extrasystolic Potentiation as a Predictor of Recovery of Left Ventricular Dysfunction After Radiofrequency Catheter Ablation.

Abstract

OBJECTIVES:

This study hypothesizes that post-extrasystolic potentiation reflects left ventricle contractile reserve and therefore may predict an improvement of premature ventricular contraction (PVC)-induced cardiomyopathy after PVC ablation.

BACKGROUND:

Post-extrasystolic potentiation is a physiologic phenomenon of blood pressure accentuation after a PVC beat.

METHODS:

We performed a retrospective study of patients with a PVC burden of ≥10% PVC/24 h and left ventricular ejection fraction (LVEF) of <50% who underwent successful ablation between January 1, 2009, to June 30, 2015. Subjects were classified as having reversible (a final LVEF ≥50%) or irreversible (final LVEF <50%) LV dysfunction on a follow-up echocardiogram. A reference (control) group with ≥10% PVC but normal LV function was also identified.

RESULTS:

Sixty-one patients (age 68 ± 11 years, 98% male) were studied: 30 with preserved and 31 with reduced LVEF. During median follow-up of 9.4 months, the LVEF of 17 of 31 reduced EF patients improved (reversible) but 14 did not (irreversible). The post-PVC beat systolic blood pressure (SBP) (mm Hg) increase ranged from 12.1 in control subjects (LVEF >50%) to 11.5 in reversible patients to 5 in irreversible patients. In multivariate analysis, the independent predictors of reversible LV function were post-PVC SBP rise (odds ratio [OR]: 4.61; 95% confidence interval [CI]: 1.45 to 15.83 per 5-mm Hg increase; p < 0.001), post-PVC pulse pressure change (OR: 5.2; 95% CI: 2.3 to 18.6 per 5-mm Hg increase; p < 0.001), and PVC QRS duration (OR: 2.78; 95% CI: 1.63 to 10.94 per 10-ms increase; p < 0.001).

CONCLUSIONS:

In patients with LV dysfunction and frequent PVC, post-PVC SBP accentuation may be a marker for subsequent recovery of LVEF after ablation in presumed PVC-induced cardiomyopathy.

• Authors: Balaji Krishnan, Ashwini Sankar, Inder Anand, Selcuk Adabag, Jian-Ming Li, Edward O McFalls, David G Benditt, Kalyanam Shivkumar, Venkatakrishna N Tholakanahalli
• Journal: JACC. Clinical electrophysiology (JACC Clin Electrophysiol) Vol. 3 Issue 11 Pg. 1283-1291 (11 2017) ISSN: 2405-5018 [Electronic] United States
• PMID: 29759625 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Published by Elsevier Inc.

Topics

• Aged
• Blood Pressure (physiology)
• Cardiac Complexes, Premature
• Cardiomyopathies (complications, epidemiology, physiopathology)
• Catheter Ablation (adverse effects, methods)
• Electrocardiography
• Female
• Humans
• Male
• Middle Aged
• Predictive Value of Tests
• Retrospective Studies
• Stroke Volume (physiology)
• Treatment Outcome
• Ventricular Dysfunction, Left (diagnostic imaging, physiopathology, therapy)
• Ventricular Premature Complexes (etiology, physiopathology, therapy)