Post-Extrasystolic Potentiation as a Predictor of Recovery of Left Ventricular Dysfunction After Radiofrequency Catheter Ablation

Balaji Krishnan, Ashwini Sankar, Inder Anand, Selcuk Adabag, Jian-Ming Li, Edward O McFalls, David G Benditt, Kalyanam Shivkumar, Venkatakrishna N Tholakanahalli

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)1283-1291
Number of pages9
JournalJACC: Clinical Electrophysiology
Volume3
Issue number11
DOIs
StatePublished - Nov 2017

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Ventricular Premature Complexes
Catheter Ablation
Left Ventricular Dysfunction
Odds Ratio
Confidence Intervals
Cardiomyopathies
Stroke Volume
Blood Pressure
Heart Ventricles
Multivariate Analysis
Retrospective Studies

Keywords

  • blood pressure
  • contractile reserve
  • hypertension
  • premature ventricular complex

Cite this

Post-Extrasystolic Potentiation as a Predictor of Recovery of Left Ventricular Dysfunction After Radiofrequency Catheter Ablation. / Krishnan, Balaji; Sankar, Ashwini; Anand, Inder; Adabag, Selcuk; Li, Jian-Ming; McFalls, Edward O; Benditt, David G; Shivkumar, Kalyanam; Tholakanahalli, Venkatakrishna N.

In: JACC: Clinical Electrophysiology, Vol. 3, No. 11, 11.2017, p. 1283-1291.

Research output: Contribution to journalArticle

Krishnan, Balaji ; Sankar, Ashwini ; Anand, Inder ; Adabag, Selcuk ; Li, Jian-Ming ; McFalls, Edward O ; Benditt, David G ; Shivkumar, Kalyanam ; Tholakanahalli, Venkatakrishna N. / Post-Extrasystolic Potentiation as a Predictor of Recovery of Left Ventricular Dysfunction After Radiofrequency Catheter Ablation. In: JACC: Clinical Electrophysiology. 2017 ; Vol. 3, No. 11. pp. 1283-1291.
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abstract = "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.",
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author = "Balaji Krishnan and Ashwini Sankar and Inder Anand and Selcuk Adabag and Jian-Ming Li and McFalls, {Edward O} and Benditt, {David G} and Kalyanam Shivkumar and Tholakanahalli, {Venkatakrishna N}",
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AU - Krishnan, Balaji

AU - Sankar, Ashwini

AU - Anand, Inder

AU - Adabag, Selcuk

AU - Li, Jian-Ming

AU - McFalls, Edward O

AU - Benditt, David G

AU - Shivkumar, Kalyanam

AU - Tholakanahalli, Venkatakrishna N

PY - 2017/11

Y1 - 2017/11

N2 - 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.

AB - 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.

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