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[Correlations between arrhythmias and left ventricular function at rest and during stress in patients with
D Szymanski1, M Borggrefe, L Ulbricht
1Medizinische Klinik B, Universität Düsseldorf.
Insights
Left ventricular function is significantly impaired in patients with ventricular arrhythmias after heart attack. Arrhythmias, whether spontaneous or induced, worsen cardiac performance at rest and during exercise.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Cardiovascular Imaging
Context:
- Left ventricular anterior wall aneurysm is a complication of acute myocardial infarction.
- Assessing cardiac function post-infarction is crucial for patient management.
- Ventricular arrhythmias can significantly impact hemodynamic stability.
Purpose:
- To evaluate left ventricular (LV) function at rest and during exercise in patients with LV anterior wall aneurysm.
- To compare LV function between patients with and without a history of ventricular arrhythmias (VT+ vs. VT-).
- To investigate the impact of programmed right ventricular stimulation (RV+ vs. RV-) on LV function in patients without spontaneous arrhythmias.
Summary:
- Digital subtraction angiography and pulmonary artery pressure measurements were used to assess LV volumes and ejection fraction in 197 patients 6 months post-infarction.
- Patients with a history of ventricular arrhythmias (VT+) exhibited greater chamber volumes and reduced ejection fraction compared to those without (VT-).
- In the VT- group, patients with positive right ventricular stimulation (RV+) showed impaired function at rest (similar to VT+) and during exercise (similar to RV-), indicating significant cardiac dysfunction.
Impact:
- Left ventricular function is demonstrably more compromised in patients experiencing spontaneous or induced arrhythmias.
- Findings suggest that arrhythmias, even those induced by stimulation, are associated with significant left ventricular dysfunction.
- Further long-term studies are needed to clarify clinical implications, including the prophylactic use of antiarrhythmic therapies.
Abstract:
The results (clinical, hemodynamic, and angiographic data) of 197 patients with left ventricular anterior wall aneurysm were evaluated at rest and during exercise (bicycle ergometer) 6 months after the acute infarction. Using the technique of digital subtraction angiography, left ventricular volumes were estimated after injection of contrast medium into the pulmonary artery and measuring of pulmonary artery pressure. In 136 patients a programmed right ventricular stimulation was performed additionally. The patients were divided into the following groups: patients with (VT+) and without (VT-) ventricular arrhythmias in history. Group VT- was subdivided in patients with positive (RV+) or negative (RV-) result of right ventricular stimulation. In group VT+ chamber volumes were greater and ejection fraction was smaller than in group VT-. At rest the results of subgroup RV+ were similar to group VT+, but during exercise similar to group RV-. These results show that left ventricular function at rest and during exercise is much more impaired in patients with spontaneous and by stimulation-induced arrhythmias than in patients without these arrhythmias. The conclusions for clinical practice of these findings are not yet clear, concerning, for example, the prophylactic use of antiarrhythmic measurements in patients without spontaneous but with induced arrhythmias. Further investigations (long-term follow-ups of these patients) will be necessary.