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[Correlation of stimulus-induced ventricular echo beats and left ventricular function in patients without ventricular
Abstract:
110 patients (105 male, 5 female, mean age +/- S.D.: 52.9 +/- 5.9 years) with and without coronary artery disease were prospectively studied by programmed right ventricular stimulation (single and double premature stimuli during sinus rhythm and a paced ventricular drive of rates of 120, 140, 160 and 180 b.p.m.). The incidence of ventricular echobeats (VE) was correlated with angiographic and electrocardiographic findings. The end of the stimulation protocol was reached as soon as four or more ventricular echobeats were initiated. 0 to 3 VE occurred in 61/110 patients, 4-9 VE in 31 patients (28%), and greater than or equal to 10 VE were induced in 16 patients. Four or more VE were initiated in 68% of cases up to a paced ventricular rhythm of 120 b.p.m. after one or two premature stimuli. Patients with abnormal results of stimulation showed a tendency to an increase in the frequency of ventricular extrasystoles and couplets during long-term ECG recording. 86% of the patients with normal angiographic findings had 0-3 VE and 14% greater than or equal to 4 VE. In 49% of the patients with abnormal left ventricular function, 0-3 VE and in 51%, greater than or equal to 4 VE could be induced. The type of left ventricular contraction abnormality was significantly correlated to the results of programmed ventricular stimulation. greater than or equal to 4 VE were observed in 74% of patients with anterior wall myocardial infarction. Patients with inferior wall myocardial infarction had greater than or equal to 4 VE in 54% of cases. Ventricular tachycardia was induced in 30% of patients with anterior and in only 12% of patients with inferior wall myocardial infarction (n.s.). To conclude, this prospective study has shown a correlation between the incidence of inducible ventricular echobeats in response to programmed ventricular stimulation and left ventricular function. The prognostic significance of these findings has to be assessed.