Prevalence and Prognostic Value of Concealed Structural Abnormalities in Patients With Apparently Idiopathic Ventricular Arrhythmias of Left Versus Right Ventricular Origin

Nucifora, Gaetano; Muser, Daniele; Masci, Pier Giorgio; Barison, Andrea; Rebellato, Luca; Piccoli, Gianluca; Daleffe, Elisabetta; Toniolo, Mauro; Zanuttini, Davide; Facchin, Domenico; Lombardi, Massimo; Proclemer, Alessandro

doi:10.1161/circep.113.001172

Cited by 63 publications

(60 citation statements)

References 32 publications

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“…Therefore, the increased sensitivity of cardiac tests in the future will likely reclassify many ‘idiopathic’ VA. In one study of VT patients with no structural abnormalities detected on usual cardiac investigations, cardiac magnetic resonance imaging (MRI) demonstrated structural abnormalities in approximately 5% of patients with idiopathic VA of right ventricular origin and 40% of left ventricular origin 27 . Given the current prohibitive cost of widespread MRI, in our opinion the definition of idiopathic VA should ideally consist of the following: absence of clinically significant coronary artery and structural heart disease, EF ≥50% (unless low EF is secondary to idiopathic VA), absence of ECG evidence of scar (for example, a fractionated QRS 28 ) and a normal signal averaged ECG 29 , Certainly, the ability to detect myocardial fibrosis is important as this has been associated with an increased vulnerability for arrhythmias 30, 31 .…”

Section: Discussionmentioning

confidence: 99%

Incidence of Idiopathic Ventricular Arrhythmias

Sirichand

Killu

Padmanabhan

et al. 2017

Circ: Arrhythmia and Electrophysiology

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Background Ventricular tachycardia (VT) and premature ventricular complexes (PVC) most frequently occur in the context of structural heart disease. However, the burden of idiopathic ventricular arrhythmias (VA) in the general population is unknown. Methods and Results We identified incident cases of idiopathic VA between 2005and 2013 from Olmsted County, MN using the Rochester Epidemiology Project database. For PVC cohorts, we included those with frequent (defined as ≥100 PVC/24 hours) symptomatic PVCs. We defined idiopathic VA-associated cardiomyopathy as an EF drop of ≥10% from baseline. Between 2005 and 2013, we identified 614 individuals with incident idiopathic VA. (229 [37.3%] were male, average age was 52.1 ± 17.2 years). Of these, 177 (28.8%) had idiopathic VT, 408 (66.5%) had symptomatic PVCs and 29 (4.7%) had idiopathic VA-associated cardiomyopathy. The age- and sex- adjusted incidence rates in 2005–2007, 2008–2010 and 2011–2013 were 44.9 per 100,000 (95% CI 38.0–51.8), 47.6 per 100,000 (95% CI 40.8–54.5) and 62.0 per 100,000 (95% CI 54.4–69.6), respectively. In idiopathic VT, there was an increase in incidence rate with age s (P<0.001) but not between sexes (P=0.12). The age-adjusted incidence of symptomatic PVC was higher in females than males (46.2 per 100,000 [95% CI 40.9–51.6] versus 20.5 per 100,000 [95% CI 16.8–24.3], p<0.001). The small number of individuals with idiopathic VA-associated cardiomyopathy precluded any formal testing. Conclusions The incidence of idiopathic VA is increasing. Furthermore, overall incidence increases with age. While the rate of idiopathic VT is similar across genders, women have a higher incidence of symptomatic PVC.

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Section: Discussionmentioning

confidence: 99%

Incidence of Idiopathic Ventricular Arrhythmias

Sirichand

Killu

Padmanabhan

et al. 2017

Circ: Arrhythmia and Electrophysiology

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“…Idiopathic PVCs are typically related to triggered activity due to cyclic adenosine monophosphate‐mediated afterdepolarizations, are frequently monomorphic and originate from the right and left ventricular outflow tracts in up to 70% of the cases, thus presenting with a LBBB QRS morphology and an inferiorly directed frontal axis . Conversely, PVCs related to SHD typically have a re‐entry mechanism, are more frequently multifocal and often present a RBBB QRS morphology with a superiorly directed axis . At least in some cases ECG depolarization and repolarization abnormalities such as inverted T waves are present and consistent with presence of wall motion abnormalities on TTE .…”

Section: Diagnostic Workup Of Patients With Frequent Pvcsmentioning

confidence: 99%

Detection of concealed structural heart disease by imaging in patients with apparently idiopathic premature ventricular complexes: A review of current literature

Sassone

Muser

Casella

et al. 2019

Clinical Cardiology

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Background Premature ventricular complexes (PVCs) are the most common form of ventricular arrhythmia in the general population. While in most cases PVCs represent a primitive phenomenon with benign behavior, in a non‐negligible proportion of subjects frequent PVCs may be epiphenomenon of underlying occult heart diseases, requiring special medical attention since they have been resulted linked to increased total and cardiac mortality. Nevertheless, PVCs themselves, when incessantly frequent, may be responsible for left ventricular dysfunction in otherwise normal heart. Aim of this narrative review is to update current knowledge on the general approach to patients with frequent PVCs on the basis of available data, with a special focus on the value of imaging. Hypothesis Routine diagnostic work‐up not infrequently miss subtle concealed arrhythmic substrate, leading to erroneously refer to such arrhythmias as to “idiopathic”. Methods Literature search of PVCs articles was conducted in PubMed and Scopus electronic database. Results Conflicting data arise from literature about the true clinical significance of idiopathic PVCs. There is growing body of data providing evidence that more advanced non‐invasive imaging modalities, such as cardiac magnetic resonance, have an incremental diagnostic and prognostic value. On the other hand, in some cases the prognostic significance of isolated subtle myocardial structural abnormalities in patients with PVCs, still remains area of uncertainty. Conclusion In selected subjects with PVCs and high‐risk features for concealed arrhythmic substrate, traditional assessment to rule out the presence of heart disease, including surface ECG and transthoracic echocardiography, should be implemented with more advanced cardiovascular imaging modalities.

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“…Cardiac MRI provides an accurate assessment of both left and right ventricular size, function, and wall motion and is able to provide comprehensive myocardial tissue characterization and particularly to identify and quantify myocardial fibrosis. Cardiac MRI was able to detect structural abnormalities in a non‐negligible proportion of patients with apparently idiopathic ventricular arrhythmias of LV origin (Nucifora et al., ) and to identify subepicardial delayed gadolinium enhancement and non‐ischemic myocardial scars in athletes with pathological ECG findings (Muser et al., ; Schnell et al., ). Accordingly, this imaging technique may be particularly useful in athletes presenting with unexplained ventricular arrhythmias, particularly with a RBBB morphology and wide QRS, suggesting a LV origin.…”

Section: Imaging In Athletes With Ventricular Arrhythmias: Findings Fmentioning

confidence: 99%

The prevalence and clinical significance of premature ventricular beats in the athlete

D’Ascenzi

Zorzi

Alvino

et al. 2016

Scandinavian Med Sci Sports

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Adolescents and adults with cardiovascular disease who are engaged in sports activity have an increased risk of sudden cardiac death (SCD) that is three times greater than that of their non-athletic counterparts. Sport acts as a trigger for cardiac arrest in the presence of underlying cardiovascular diseases predisposing to life-threatening ventricular arrhythmias. Frequent and complex premature ventricular beats (PVBs) detected during the cardiovascular screening of the athletic population may be a sign of an underlying cardiovascular disease at risk of SCD, but are also often recorded in trained athletes without cardiovascular abnormalities. Thus, the interpretation of PVBs could represent a clinical dilemma, particularly in the athlete. However, while some characteristics of PVBs can be considered common and benign, others occur uncommonly in the athletic population and raise the suspicion of an underlying cardiovascular disease. This review discusses the prevalence and clinical significance of PVBs in the athlete, with a focus on exercise-induced PVBs, on the analysis of PVB's morphology at 12-lead ECG, and on the morphological substrates identified by imaging techniques. The implications on eligibility for competitive sports participation are also discussed, according to the relevance of PVB detection for disqualifying athletes from competitions.

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Prevalence and Prognostic Value of Concealed Structural Abnormalities in Patients With Apparently Idiopathic Ventricular Arrhythmias of Left Versus Right Ventricular Origin

Cited by 63 publications

References 32 publications

Incidence of Idiopathic Ventricular Arrhythmias

Incidence of Idiopathic Ventricular Arrhythmias

Detection of concealed structural heart disease by imaging in patients with apparently idiopathic premature ventricular complexes: A review of current literature

The prevalence and clinical significance of premature ventricular beats in the athlete

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