Influence of left ventricular filling profile during preceding control beats on the occurrence of pulse deficit caused by ventricular premature contractions

Abstract

This study was designed to investigate whether the left ventricular filling profile during preceding control beats significantly affects the pulse deficit caused by ventricular premature contractions (VPCs). The study group consisted of 18 patients (10 men, eight women, 15-85 years old) who underwent electrophysiological catheterization because of sinus bradycardia. Using a temporary pacing lead inserted in the right ventricular apex, isolated VPCs with various coupling intervals were produced by electrical stimulation of the right ventricle. During the production of the VPCs, the mitral filling flow velocity using pulsed wave Doppler echocardiography, the femoral arterial pressure curve and the electrocardiogram were simultaneously recorded. The right ventricle was stimulated 800, 750, 700, 650, 600, 550, 500, 450 and 400 ms after the triggered control beat QRS complex. Pulse pressures during VPCs gradually decreased in relation to the shortening of the extrasystolic beat coupling interval. The longest coupling interval for each subject, which caused complete abolition of the pressure pulse during the VPC, was defined as the pulse deficit coupling interval. The early to late diastolic velocity-time integral ratio (Ei/Ai ratio) of the mitral filling flow velocity during the control beats which precede the VPC was obtained as an index expressing the left ventricular filling profile. The Ei/Ai ratio of the mitral filling flow velocity ranged from 0.7 to 4.5 (1.8 +/- 1.0). The pulse deficit coupling interval ranged from 440 to 640 ms (510 +/- 60 ms).(ABSTRACT TRUNCATED AT 250 WORDS)

Association of frequent premature ventricular complex >10% and stroke-like symptoms without a prior diagnosis of stroke or transient ischemic attack

“…First of all, PVCs may impair atrioventricular synchrony and PVCs can be associated with transient lower blood pressure which may deteriorate the cerebrovascular microcirculation both locally and systemically. During the arterial blood pressure monitoring, we can see the transient lowering blood pressure when ventricular ectopic beats occurs, which was consistent with previous study [ [20] , [21] , [22] ]. However, further prospective studies are needed to determine if a true causal mechanism exists between frequent PVCs and stroke-like symptoms, as well as to access whether the mechanisms is dependent on a specific subtype of VPCs.…”

Coupling Interval Ratio Is Associated with Ventricular Premature Complex-Related Symptoms

“…If OT VPCs occur after a short CI, there may be an inadequate time for LV filling, thus reducing the stroke volume, in accordance with the Frank-Starling's law. 20) However, when the OT VPC occurs after a long CI, this will provide more time for ventricular filling, and the patient may feel the increased blood flow.…”

“…However, the understanding of the basis of the symptoms frequently observed in this disorder remains limited. Site of origin, 11) 12) 13) 14) 15) coupling interval (CI), 16) 17) 18) 19) 20) 21) 22) 23) and VPC burden 24) 25) 26) are important factors influencing the hemodynamic consequences of VPCs. We hypothesized that hemodynamic differences are correlated with the differences in VPC symptoms.…”

Association of premature ventricular complexes and risk of ischemic stroke: A systematic review and meta‐analysis

“…Moreover, the ventricular contraction from PVCs could not provide an effective cardiac output as a result of mechanical ventricular dyssynchrony. This leads to a transient decline in arterial blood pressure which could deteriorate the regionally and globally cerebral circulation 28‐30 …”