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Significance of ventricular arrhythmias in systemic hypertension with left ventricular hypertrophy
S D Pringle1, F G Dunn, P W Macfarlane
1Department of Medical Cardiology, Glasgow Royal Infirmary, Scotland, United Kingdom.
Insights
Hypertensive patients with left ventricular hypertrophy often experience ventricular arrhythmias. However, this study found little evidence of an arrhythmogenic substrate, suggesting their significance remains unclear.
Area of Science:
- Cardiology
- Electrophysiology
- Hypertension Research
Background:
- Hypertension-induced left ventricular (LV) hypertrophy and strain are linked to sudden cardiac death risk.
- Ventricular arrhythmias are suspected as a contributing factor to this increased risk.
Purpose of the Study:
- To investigate the prevalence and significance of ventricular arrhythmias in hypertensive patients with LV hypertrophy and strain.
- To determine if an arrhythmogenic substrate is present in these patients.
Main Methods:
- 48-hour ambulatory ECG monitoring in 90 hypertensive patients with LV hypertrophy and strain.
- ECG signal-averaging and programmed ventricular stimulation were employed.
- Ventricular arrhythmias were assessed using Lown grading and detection of ventricular tachycardia.
Main Results:
- Complex ventricular ectopic activity (Lown grade ≥3) was found in 66% of patients.
- Nonsustained ventricular tachycardia occurred in 12% of patients.
- No sustained arrhythmias were detected, and only one patient showed ventricular late potentials.
Conclusions:
- Ventricular arrhythmias are common in hypertensive patients with LV hypertrophy and strain.
- The study found minimal evidence of an underlying arrhythmogenic substrate.
- The clinical significance of these arrhythmias in this patient population requires further investigation.
Abstract:
Hypertensive patients with the electrocardiographic (ECG) pattern of left ventricular (LV) hypertrophy and strain are at increased risk of sudden death. It has been suggested that ventricular arrhythmias may be responsible. The prevalence and significance of ventricular arrhythmias was therefore studied in 90 hypertensive patients with LV hypertrophy and strain by undertaking 48-hour ambulatory ECG monitoring, ECG signal-averaging and programmed ventricular stimulation. Complex ventricular ectopic activity (Lown grade greater than or equal to 3) was detected in 59 patients (66%). Eleven patients (12%) had episodes of nonsustained ventricular tachycardia. There were no sustained arrhythmias either on ambulatory ECG monitoring or induced by programmed ventricular stimulation. Only 1 patient had ventricular late potentials recorded by the signal-averaged electrocardiogram. Therefore, there was little to suggest an underlying arrhythmogenic substrate in these patients. In conclusion, whereas ventricular arrhythmias occur often in patients with LV hypertrophy associated with systemic hypertension, their significance, if any, remains to be established.