Subclinical Coronary Atherosclerosis in Patients Undergoing Catheter Ablation for Idiopathic Premature Ventricular Complexes
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Keywords:Coronary artery disease, premature ventricular complex, radiofrequency ablation
Objective: Idiopathic premature ventricular complexes (PVC) occur in the absence of clinically apparent structural heart disease (SHD) and are treated effectively with catheter ablation. We aimed to evaluate the association of PVC characteristics with subclinical coronary artery disease (CAD) during catheter ablation.
Methods: A total of 116 patients (age: median 55 years; sex: 58.6% men), without SHD, in whom PVC ablation and coronary angiography had been performed simultaneously were enrolled. PVC localizations were categorized into 4 groups as; right ventricular outflow tract (RVOT), left ventricular outflow tract (LVOT), left ventricle (LV)-body, and right ventricle (RV)-body. PVC frequency was also classified as moderate (5,000–10,000 PVCs/day) and frequent (≥10,000 PVCs/day). Coronary artery stenoses were categorized as normal, non-critical (<50%), and critical (≥50%).
Results: Co-incidental CAD was more frequent among patients with LV-body originated PVCs (non-critical, 51.6 % and critical, 22.6 %); while most of the patients with LVOT, RVOT, and RV-body originated PVCs had normal coronary arteries (58.8%, 56%, and 55.6%, respectively; p=0.019). There was no significant association between PVC frequency and coronary artery lesion severity (p=0.080) or between PVC recurrence and PVC frequency (p=0.748), PVC localization (p=0.188), coronary artery lesion severity (p=0.080), number of involved coronary artery segments (p=0.566), and number of involved coronary artery vessels (p=0.729).
Conclusion: Subclinical CAD was more frequent among patients with LV-body originated idiopathic PVCs. Thus, its routine pre-procedural assessment may be considered for LV-body originated PVCs.
Ng GA. Treating patients with ventricular ectopic beats. Heart 2006; 92: 1707-12.
Enriquez A, Frankel DS, Baranchuk A. Pathophysiology of ventricular tachyarrhythmias : From automaticity to reentry. Herzschrittmacherther Elektrophysiol 2017; 28: 149-56.
Lerman BB. Ventricular tachycardia: mechanistic insights derived from adenosine. Circ Arrhythm Electrophysiol 2015; 8: 483-91.
Ahn MS. Current Concepts of Premature Ventricular Contractions. J Lifestyle Med 2013; 3: 26-33.
Maggioni AP, Zuanetti G, Franzosi MG, Rovelli F, Santoro E, Staszewsky L, et al. Prevalence and prognostic significance of ventricular arrhythmias after acute myocardial infarction in the fibrinolytic era.GISSI-2 results. Circulation 1993; 87: 312-22.
Moss AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter
Automatic Defibrillator Implantation Trial Investigators. N Engl J Med 1996; 335: 1933-40.
Priori SG, Blomstrom-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the
European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J 2015; 36: 2793-867.
Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, et al. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. J Arrhythm 2019; 35: 323-484.
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39: 3021-104.
American Diabetes A. Diagnosis and classification of diabetes mellitus. Diabetes care 2011; 34: S62-9.
Engstrom G, Hedblad B, Janzon L, Juul-Moller S. Ventricular arrhythmias during 24-h ambulatory ECG recording: incidence, risk factors and prognosis in men with and without a history of cardiovascular disease. J Intern Med 1999; 246: 363-72.
Kennedy HL, Whitlock JA, Sprague MK, Kennedy LJ, Buckingham TA, Goldberg RJ. Long-term follow-up of asymptomatic healthy subjects with frequent and complex ventricular ectopy. N Engl J Med 1985; 312: 193-7.
Chiang BN, Perlman LV, Ostrander Jr LD, Epstein FH. Relationship of premature systoles to coronary heart disease and sudden death in the Tecumseh epidemiologic study. Ann Intern Med 1969; 70: 1159-66.
Niwano S, Wakisaka Y, Niwano H, Fukaya H, Kurokawa S, Kiryu M, et al. Prognostic significance of frequent premature ventricular contractions originating from the ventricular outflow tract in patients with normal left ventricular function. Heart 2009; 95: 1230-7.
Kanei Y, Friedman M, Ogawa N, Hanon S, Lam P, Schweitzer P. Frequent premature ventricular complexes originating from the right ventricular outflow tract are associated with left ventricular dysfunction. Ann Noninvasive Electrocardiol 2008; 13: 81-5.
Ling Z, Liu Z, Su L, Zipunnikov V, Wu J, Du H, et al. Radiofrequency ablation versus antiarrhythmic medication for treatment of ventricular premature beats from the right ventricular outflow tract: prospective randomized study. Circ Arrhythm Electrophysiol 2014; 7: 237-43.
Yamada T, Murakami Y, Yoshida N, Okada T, Toyama J, Yoshida Y, et al. Efficacy of electroanatomic mapping in the catheter ablation of premature ventricular contractions originating from the right ventricular outflow tract. J Interv Card Electrophysiol 2007; 19: 187-94.
Latchamsetty R, Yokokawa M, Morady F, Kim HM, Mathew S, Tilz R, et al. Multicenter Outcomes for Catheter Ablation of Idiopathic Premature Ventricular Complexes. JACC Clin Electrophysiol 2015; 1: 116-23.
Morady F, Kadish AH, DiCarlo L, Kou WH, Winston S, deBuitlier M, et al. Long-term results of catheter ablation of idiopathic right ventricular tachycardia. Circulation 1990; 82: 2093-9.
Tada H, Hiratsuji T, Naito S, Kurosaki K, Ueda M, Ito S, et al. Prevalence and characteristics of idiopathic outflow tract tachycardia with QRS alteration following catheter ablation requiring additional radiofrequency ablation at a different point in the outflow tract. Pacing Clin Electrophysiol 2004; 27: 1240-9.
Yamada T, McElderry HT, Doppalapudi H, Murakami Y, Yoshida Y, Yoshida N, et al. Idiopathic ventricular arrhythmias originating from the aortic root prevalence, electrocardiographic and electrophysiologic characteristics, and results of radiofrequency catheter ablation. J Am Coll Cardiol 2008; 52: 139-47.
Biere L, Mezdad TH, Dupuis JM, Vervueren L, Rakotonirina H, Prunier F, et al. Long-term prognostic significance of right bundle-branch morphology ventricular ectopy induced during stress test in patients with intermediate to high probability of coronary artery disease. Europace 2018; 20: 528-34.
Lee V, Perera D, Lambiase P. Prognostic significance of exercise-induced premature ventricular complexes: a systematic review and meta-analysis of observational studies. Heart Asia 2017; 9: 14-24.
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