Strong modulation of ectopic focus as a mechanism of repetitive interpolated ventricular bigeminy with heart rate doubling

Takayanagi, Kunio; Toratani, Noritaka; Chida, Ryuji; Kobayashi, Shigeto; Sakai, Yoshihiko; Takeuchi, Akihiro; Ikeda, Noriaki

doi:10.1016/j.hrthm.2013.06.013

Cited by 6 publications

(10 citation statements)

References 17 publications

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“…PVCs from the RV/LV outflow (below the valve) or body with extensive surrounding myocardium (and without localized fibrosis) would not be expected to behave in this manner. This relative isolation may decrease the modulation of the PVC focus by the sinus rhythm focus as described recently by Takayanagi et al (21). …”

Section: Discussionmentioning

confidence: 71%

Coupling Interval Variability Differentiates Ventricular Ectopic Complexes Arising in the Aortic Sinus of Valsalva and Great Cardiac Vein From Other Sources

Bradfield¹,

Homsi

Shivkumar³

et al. 2014

Journal of the American College of Cardiology

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Objectives The objective of this study was to determine whether premature ventricular contractions (PVCs) arising from the aortic sinuses of Valsalva (SOV) and great cardiac vein (GCV) have coupling interval (CI) characteristics that differentiate them from other ectopic foci. Background PVCs occur at relatively fixed CI from the preceding normal QRS complex in most patients. However, we observed patients with PVCs originating in unusual areas (SOV and GCV) in whom the PVC CI was highly variable. We hypothesized that PVCs from these areas occur seemingly randomly because of the lack of electrotonic effects of the surrounding myocardium. Methods Seventy-three consecutive patients referred for PVC ablation were assessed. Twelve consecutive PVC CIs were recorded. The ΔCI (maximum – minimum CI) was measured. Results We studied 73 patients (age 50 ± 16 years, 47% male). The PVC origin was right ventricular (RV) in 29 (40%), left ventricular (LV) in 17 (23%), SOV in 21 (29%), and GCV in 6 (8%). There was a significant difference between the mean ΔCI of RV/LV PVCs compared with SOV/GCV PVCs (33 ± 15 ms vs. 116 ± 52 ms, p < 0.0001). A ΔCI of >60 ms demonstrated a sensitivity of 89%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 94%. Cardiac events were more common in the SOV/GCV group versus the RV/LV group (7 of 27 [26%] vs. 2 of 46 [4%], p < 0.02). Conclusions ΔCI is more pronounced in PVCs originating from the SOV or GCV. A ΔCI of 60 ms helps discriminate the origin of PVCs before diagnostic electrophysiological study and may be associated with increased frequency of cardiac events.

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Section: Discussionmentioning

confidence: 71%

Coupling Interval Variability Differentiates Ventricular Ectopic Complexes Arising in the Aortic Sinus of Valsalva and Great Cardiac Vein From Other Sources

Bradfield¹,

Homsi

Shivkumar³

et al. 2014

Journal of the American College of Cardiology

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“…To the best of our knowledge, this innovative study is the first to directly investigate ECL from the quantified ratio for the distribution pattern, T/B-PEI, in VPCs by developing our previous logics. 8,9,[13][14][15] The most important finding is that T/B-PEI determines T/B-IEI and ECL. These 2 ratios, instead of the 4 location parameters for bigeminy and trigeminy, show the relative location of trigeminy viewed from the center of bigeminy.…”

Section: Discussionmentioning

confidence: 99%

“…Interpolated trigeminy or more constituted other regression lines with flexion, while interpolated and compensatory bigeminy constituted a single regression line on PIC. 15 In Figure 5A (46-year-old man with no heart disease), compensatory trigeminy and quadrigeminy overlapped on the dominant bigeminy (n 5 29,934). Traces of interpolated trigeminy and quadrigeminy were observed at PEI of 300 ms.…”

Section: Intermediate Typementioning

confidence: 98%

“…We also found its special form showing repetitive interpolation, where strong modulation was suspected. 15 These patterns, expressed by 4 parameters for abscissa and ordinate each for bigeminy and trigeminy, were recognized 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 by visual inspection of the PIC and have not yet been quantified. 16,17…”

Section: Introductionmentioning

confidence: 99%

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Ectopic cycle length estimation from the quantified distribution patterns of ventricular bigeminy and trigeminy

Takayanagi¹,

Hori

Sakai

et al. 2021

Heart Rhythm O2

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BACKGROUND Ectopic cycle length (ECL) and the distribution patterns of ventricular bigeminy and trigeminy, expressed as their postextrasystolic intervals (PEIs) and interectopic intervals (IEIs), have been poorly pursued. OBJECTIVE Based on modulation theory, we hypothesized that the PEIs of bigeminy and trigeminy determine their IEIs and ECL. METHODS Ambulatory electrocardiograms of 1290 patients with ventricular premature complexes (3000/day) were studied. To quantify their distribution pattern on the PEI vs IEI curve (PIC), we introduced the following 2 ratios: PEI of trigeminy to PEI of bigeminy ratio (T/B-PEI) and IEI of trigeminy to IEI of bigeminy ratio (T/B-IEI). Distribution patterns were divided into 3 types by T/ B-PEI: standard type (,0.90), intermediate type (between 0.90 and 1.20), and reverse type (.1.20). ECL was defined as the average of the bigeminy and trigeminy intervals in the standard type, and bigeminy intervals in the other 2 types. RESULTS T/B-IEI disclosed significant linear relationship with T/B-PEI (P , .0001). ECLs were longest in the standard type (1905 6 347 ms; n 5 426), followed by the intermediate type (1520 6 239 ms; n 5 607) and reverse type (1317 6 227 ms; n 5 227) (P , .0001). Trigeminy PEI/ECL in the standard type (0.450 6 0.074) was significantly shorter than that of the other 2 types (P , .0001). CONCLUSION We confirmed that T/B-PEI determines T/B-IEI and ECL by discriminating the 3 distribution patterns. Among them, trigeminy PEI/ECL decided the 2 types of modulation by the first sinus QRS, starting at the early delay phase or the later acceleration phase.

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“…Extension is more common in the right (54% in 1 autopsy study) than the left cusp (24%) 2 . Lack of inhibitive electrotonic interactions from surrounding and remote cardiomyocytes owing to scarcity of muscle bundles above the semilunar valves may promote ventricular ectopy 6, 7. Intervening regions of fibrosis, for example, in bicuspid valves may further inhibit this electrotonic interaction.…”

Section: Discussionmentioning

confidence: 99%

Bicuspid aortic valve supporting supravalvular “substrate” for multiple ventricular tachycardias

Kumar

Stevenson

Tedrow

2017

HeartRhythm Case Reports

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Strong modulation of ectopic focus as a mechanism of repetitive interpolated ventricular bigeminy with heart rate doubling

Cited by 6 publications

References 17 publications

Coupling Interval Variability Differentiates Ventricular Ectopic Complexes Arising in the Aortic Sinus of Valsalva and Great Cardiac Vein From Other Sources

Coupling Interval Variability Differentiates Ventricular Ectopic Complexes Arising in the Aortic Sinus of Valsalva and Great Cardiac Vein From Other Sources

Ectopic cycle length estimation from the quantified distribution patterns of ventricular bigeminy and trigeminy

Bicuspid aortic valve supporting supravalvular “substrate” for multiple ventricular tachycardias

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