Abstract 12591: Premature Ventricular Beats as Evidence for the Immature Development of the Cardiac Conduction System
Introduction: Non-compaction cardiomyopathy (NCCM) is considered to be the result of an arrest in the normal myocardial embryogenesis. The histological, developmental and electrophysiological explanation of ventricular arrhythmias in NCCM is still unknown. The aim of this study was to determine the origin of PVC’s in NCCM and to identify any predominant arrhythmic foci.
Methods: Retrospective data from our NCCM-registry including 101 patients, were analysed. A total number of 2069 ECG’s were studied to determine the origin of PVC’s. Echocardiographic data was analysed in patients with PVC’s in all 12 leads. Segments affected by non-compaction (NC) were compared with the origin of PVC’s.
Results: PVC’s were documented in 250 ECG’s from 55 (54%) patients. Thirty-five ECG’s recorded PVC’s on all 12 leads. Of these 35 ECG’s the origin of 20 types of PVC’s could be determined. Ninety-five percentofPVC’s did not originate from left ventricular NC-myocardial areas. Two PVC’s (10 %) had a true myocardial origin. All other PVC’s originated from structures such as the outflow tracts (8/20), the fascicles (7/20), especially the posteromedial fascicle (6/20), and the mitral and tricuspid annulus (3/20).
Conclusion: Our data suggests that PVC’s in NCCM predominantly originate from His-Purkinje related structures or other remnants of the primary cardiac conduction system (CCS), predominantly the posteromedial fascicle. Based on these findings we hypothesize that in NCCM the arrest in embryogenesis is not limited to the myocardium but also extends to a simultaneous underdevelopment of the CCS, resulting in a substrate for arrhythmia.
- © 2013 by American Heart Association, Inc.