Abstract 10023: The Mechanism of Hemodynamic Deterioration From Frequent Premature Ventricular Complexes: How to Identify the Malignant Subgroup That Should be Treated with Radiofrequency Catheter Ablation
Background: Frequent premature ventricular complexes (PVCs) may cause hemodynamic deterioration and reversible cardiomyopathy, but its mechanism has not been sufficiently clarified. We aimed to clarify this point.
Methods: The hemodynamics, echocardiographic parameters, and plasma B-type natriuretic peptide (BNP) level were assessed in 31 consecutive patients with idiopathic, frequent PVCs undergoing radiofrequency catheter ablation. The patients were classified into 2 groups according to the presence (n=19) or absence (n=12) of marked augmentation of the pulmonary capillary wedge pressure (PCWP) following PVCs (post-PVC PCWP augmentation; PPPA), defined as a pressure of >10 mmHg greater than the mean PCWP.
Results: Before the ablation, the mean PCWP (p<0.001), right atrial pressure (p<0.05), left ventricular (LV) end-diastolic pressure (p<0.005), and plasma BNP level (p<0.05) were greater in the PPPA(+) group than PPPA(-) group. In the PPPA(+) group, the former 3 hemodynamic parameters improved (all for p<0.0005) and the cardiac index increased (p<0.005) just after a successful ablation. Furthermore, in the PPPA(+) group, at 7.4±0.9 months after the ablation, the LV dimension (p<0.005), ejection fraction (p<0.05) and plasma BNP level (p<0.005) improved. However, in the PPPA(-) group, no hemodynamic or echocardiographic impairment was found before ablation, and those parameters did not change significantly after ablation. Echocardiography disclosed that left atrial contractions during mitral valve closure following the PVCs caused a marked pulmonary venous flow reversal and PPPA. In the ECG analysis, the coupling interval (CI) of the PVCs was shorter in the PPPA(+) group than PPPA(-) group (435±46 vs. 543±61 [ms]; p<0.0001). The interval from the PVC to the following P wave was also shorter in the PPPA(+) group than PPPA(-) group (195±45 vs. 300±207 [ms]; p<0.05). PVC CIs of <500 ms and the presence of a following P wave of <300 ms from the PVC predicted PPPAs with a 95 % sensitivity and 92 % specificity.
Conclusions: The PPPA may be the main mechanism of the hemodynamic deterioration in patients with frequent PVCs. This hemodynamically malignant subgroup could be identified by the surface ECG and improved dramatically with catheter ablation.
- © 2011 by American Heart Association, Inc.