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Published on: February 26, 2013
Acute changes in left atrial appendage function with premature ventricular complexes
Suresh Kumar Sukumaran1, Anish Bhargav1, Sridhar Balaguru1
1Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
Insights
Frequent premature ventricular complexes (PVCs) acutely reduce left atrial appendage (LAA) diastolic emptying velocity. This dysfunction may explain the link between frequent PVCs and stroke risk.
Area of Science:
- Cardiology
- Electrophysiology
- Stroke Prevention
Background:
- Left atrial appendage (LAA) dysfunction is a known risk factor for embolic stroke.
- Frequent premature ventricular complexes (PVCs) are also associated with an increased risk of stroke.
Purpose of the Study:
- To investigate whether left atrial dysfunction serves as a link between frequent PVCs and stroke.
- To assess the acute effect of simulated frequent PVCs on LAA function.
Main Methods:
- Ten patients with structurally normal hearts undergoing electrophysiology study were included.
- Transesophageal echocardiography measured LAA flow velocities.
- PVCs were simulated using right ventricular pacing in a bigeminal pattern for 5 minutes.
Main Results:
- A significant decrease in LAA late diastolic emptying velocity was observed after 5 minutes of simulated PVCs (p=0.01).
- LAA filling velocity showed a non-significant trend toward decrease.
- LAA velocities largely returned to baseline after a 5-minute rest period.
Conclusions:
- Simulated frequent PVCs in a bigeminal pattern acutely impair LAA diastolic emptying velocity.
- This acute LAA dysfunction represents a potential mechanism contributing to the increased stroke risk associated with frequent PVCs.
Objectives:
Left atrial appendage (LAA) dysfunction is a risk factor for stroke. Evidence shows that frequent premature ventricular complexes (PVCs) are associated with embolic stroke. Whether left atrial dysfunction is the bridging link between frequent premature ventricular complexes and stroke is unknown.
Materials And Methods:
Patients with a structurally normal heart undergoing elective electrophysiology study were included. Transoesophageal echo was used to measure LAA flow velocities. To simulate PVCs in bigeminal rhythm, single paced beats were delivered from the right ventricle with a coupling interval of QT + 10 % RR interval after each sinus beat. LAA flow doppler velocities were acquired at baseline, after 5 min of pacing and again 5 min after cessation of pacing.
Results:
Ten patients were included in the study. Late diastolic emptying velocity decreased significantly after 5 min of PVCs (55.68 ± 16.33 cm/s, p = 0.01) compared to baseline (68.01 ± 10.34 cm/s). This almost returned to baseline after a rest period of 5 min (63.13 ± 16.16 cm/s, p = 0.277). The left atrial appendage filling velocity exhibited a statistically non-significant trend toward a decrease after 5 min of PVCs (45.70 ± 10.85 cm/s, p = 0.129), compared to the baseline value of 51.31 ± 14.11 cm/s.
Conclusions:
Premature ventricular complexes in bigeminal pattern for 5 min resulted in an acute decrease in the late diastolic emptying velocity. This is a possible mechanism for the increased risk of strokes in patients with frequent PVCs.
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