Early detection of electromechanical dysfunction in patients with idiopathic premature ventricular contractions

Abstract

Background Premature ventricular contractions (PVCs) induced by subtle cardiac dysfunction are missed by echocardiography. We evaluated acoustic cardiography for detection of early electromechanical dysfunction in patients with idiopathic PVCs and normal left ventricular ejection fraction (LVEF), and investigated the impact of radiofrequency ablation (RFA) in reversing this adverse effect. Methods Eighty‐six patients with PVCs and 33 normal controls having normal LVEF were studied. Fifty PVC patients were in the ablation group and 36 in the nonablation group. %Electromechanical activation time (%EMAT), %left ventricular systolic time (%LVST), third (S3) and fourth heart sound (S4), and systolic dysfunction index (SDI) during sinus rhythm (SR) were measured by acoustic cardiography (Audicor, Inovise Medical, Inc., Beaverton, OR, USA) pre‐ and postablation. In 28 patients, acoustic parameters were compared during SR without PVCs, and SR with single PVC, ≥ 2 PVCs, or ventricular tachycardia over 10‐second Audicor recording in a single patient at different times. Twenty‐four‐hour acoustic cardiographic and acoustic cardiographic Holter recording were used to assess the impact of PVC burden on electromechanical function in 41 patients. Results %EMAT, S3, S4, and SDI showed significant worsening in the PVC versus control group. %EMAT and SDI were worsened with increasing PVC number in a 10‐second strip. %EMAT showed significant linear increment with increasing PVC burden. There was a significant improvement in %EMAT, %LVST, S3, S4, and SDI postablation in patients with PVCs. Conclusion Acoustic cardiography can detect PVC‐induced minor electromechanical dysfunction in patients with normal LVEF. RFA can reverse this adverse effect.

Simultaneous widefield voltage and interferometric dye-free optical mapping quantifies electromechanical waves in human iPSC-cardiomyocytes

“…Samples for which the spontaneous activity site had a characteristic pacemaking-like AP, with a hyperpolarization phase (Figure S8), showed lower spatial APD variations and lower global aEMD, compared to sites with more ventricular-like AP with a characteristic APD "hump" (like in early after-depolarization) at the origin site. This EAD-driven wave sequences exhibited higher APD spatial dispersion (longer APD at the origin vs. distal site) and longer global aEMD, Figure S7-S8, consistent with clinical reports on abnormal beats, such as premature ventricular contractions, PVCs, in humans (Walia, Chang et al 2019). Our human iPSC-CMs comprise a purified ventricular-like cell population.…”

“…Longer EMDs distinguish abnormal beats -they are characteristic for EADs, a known mechanism for emergence of PVCs, compared to regular sinus rhythm beats (Walia, Chang et al 2019). Furthermore, it has been observed that single-site ventricular pacing increases EMD heterogeneity and worsens ventricular pump performance; it may therefore present a path towards development of heart failure (Andersen, Nielsen et al 1997, Bordachar, Garrigue et al 2003, Kerckhoffs, Faris et al 2005.…”

“…Our dual mapping approach provides new means to dissect such key parameters in a simplified, well controlled setting. For example, our culture system seems capable of distinguishing “regular” spontaneous pacing sites from sporadic, EAD-driven ones, Figure S7-S8 , based on their different aEADs, as seen clinically(Walia, Chang et al 2019). While we work with purified ventricular myocytes, persistent pacemaking sites may still establish preferred activation sequences, minimizing EMD when waves travel along those paths.…”

Reintroducing Heart Sounds for Early Detection of Acute Myocardial Ischemia in a Porcine Model – Correlation of Acoustic Cardiography With Gold Standard of Pressure-Volume Analysis

“…Nevertheless, by coupling heart sound recordings together with ECG tracings, investigators can acquire important insights regarding the electrical-mechanical activity of the heart in an unsupervised, non-invasive and inexpensive manner. Such a hybrid technique, acoustic cardiography (AC) (Erne, 2008), has been proven as a reliable method for patient stratification and prognosis in diverse pathological conditions [pulmonary arterial hypertension (Chan et al, 2013), atrial fibrillation (Dillier et al, 2010), coronary artery disease (Zuber and Erne, 2010; Thomas et al, 2017), acute myocardial ischemia (AMI) (Lee et al, 2009), premature ventricular contractions (Walia et al, 2019), heart failure with either preserved or reduced ejection fraction (Wang et al, 2013, 2016)].…”

Evaluation of patients with high burden of premature ventricular contractions by comprehensive transthoracic echocardiography

“…However, it has been debated whether individuals with a high PVC burden and normal findings at echocardiogram are actually free of structural heart disease or if rather more comprehensive imaging methods should be used to identify subtle disease that PVCs could cause or ensue from [10] . Despite most PVC patients having a normal left ventricular (LV) Ejection Fraction (EF) at TTE, early signs of an eventual deterioration of the ventricular function may be missed by standard echocardiographic investigation [11] , while comprehensive echocardiography could detect early electromechanical dysfunction [12] , [13] . A prompt detection of ventricular impairment is expected to be clinically relevant, and echocardiography could be the most suitable non-invasive tool, being a widespread and inexpensive method of detection.…”