Author + information
- Received January 27, 2017
- Revision received April 28, 2017
- Accepted May 26, 2017
- Published online November 20, 2017.
- Balaji Krishnan, MD, MS,
- Ashwini Sankar, MA,
- Inder Anand, MD, DPhil,
- Selcuk Adabag, MD, MS,
- Jian-Ming Li, MD, PhD,
- Edward O. McFalls, MD, PhD,
- David G. Benditt, MD,
- Kalyanam Shivkumar, MD, PhD and
- Venkatakrishna N. Tholakanahalli, MD∗ ()
- Cardiac Arrhythmia Center and Cardiovascular Division, University of Minnesota and Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
- ↵∗Address for correspondence:
Dr. Venkatakrishna N. Tholakanahalli, University of Minnesota, Minneapolis Veterans Affairs Medical Center, 1 Veterans Drive, Minneapolis, Minnesota 55417.
Objectives This study hypothesizes that post-extrasystolic potentiation reflects left ventricle contractile reserve and therefore may predict an improvement of premature ventricular contraction (PVC)-induced cardiomyopathy after PVC ablation.
Background Post-extrasystolic potentiation is a physiologic phenomenon of blood pressure accentuation after a PVC beat.
Methods We performed a retrospective study of patients with a PVC burden of ≥10% PVC/24 h and left ventricular ejection fraction (LVEF) of <50% who underwent successful ablation between January 1, 2009, to June 30, 2015. Subjects were classified as having reversible (a final LVEF ≥50%) or irreversible (final LVEF <50%) LV dysfunction on a follow-up echocardiogram. A reference (control) group with ≥10% PVC but normal LV function was also identified.
Results Sixty-one patients (age 68 ± 11 years, 98% male) were studied: 30 with preserved and 31 with reduced LVEF. During median follow-up of 9.4 months, the LVEF of 17 of 31 reduced EF patients improved (reversible) but 14 did not (irreversible). The post-PVC beat systolic blood pressure (SBP) (mm Hg) increase ranged from 12.1 in control subjects (LVEF >50%) to 11.5 in reversible patients to 5 in irreversible patients. In multivariate analysis, the independent predictors of reversible LV function were post-PVC SBP rise (odds ratio [OR]: 4.61; 95% confidence interval [CI]: 1.45 to 15.83 per 5-mm Hg increase; p < 0.001), post-PVC pulse pressure change (OR: 5.2; 95% CI: 2.3 to 18.6 per 5-mm Hg increase; p < 0.001), and PVC QRS duration (OR: 2.78; 95% CI: 1.63 to 10.94 per 10-ms increase; p < 0.001).
Conclusions In patients with LV dysfunction and frequent PVC, post-PVC SBP accentuation may be a marker for subsequent recovery of LVEF after ablation in presumed PVC-induced cardiomyopathy.
Dr. Adabag has received a research grant from Medtronic. Dr. Benditt is supported in part by a grant from the Dr. Earl E Bakken family in support of Heart-Brain research. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received January 27, 2017.
- Revision received April 28, 2017.
- Accepted May 26, 2017.