Clinical and translational insights on premature ventricular contractions and PVC-induced cardiomyopathy

Jose F Huizar, Alex Y Tan, Karoly Kaszala, Kenneth A Ellenbogen, Jose F Huizar, Alex Y Tan, Karoly Kaszala, Kenneth A Ellenbogen

Abstract

The medical community's understanding of the consequences of premature ventricular contractions (PVCs) and PVC-induced cardiomyopathy has been derived mostly from observational and large population-based studies. Due to the difficulty of predicting the development of PVC-cardiomyopathy, the acute and chronic cardiac effects of PVCs and the mechanism of PVC-cardiomyopathy have been derived from pre-clinical studies with large animal models. Recently, these studies have described myocardial substrates that could potentially increase morbidity and mortality in patients with frequent PVCs and PVC-cardiomyopathy. In this paper, we provide an up-to-date comprehensive review of these pre-clinical and clinical studies.

Keywords: Eccentric hypertrophy; Heart rate irregularity; LV dyssynchrony; Premature atrial contraction; Premature ventricular contraction.

Published by Elsevier Inc.

Figures

Figure 1.
Figure 1.
Potential triggers of PVCs and substrate and outcomes of PVC-cardiomyopathy.
Figure 2.
Figure 2.
Linear decline of LVEF appears proportional to PVC burden in (A) clinical and (B) translational animal model (reproduced with permission, Tan et.al [15, 52]).
Figure 3.
Figure 3.
Comparison of event-free survival (death and resuscitated cardiac arrest) in patients with diagnosis of PVC-cardiomyopathy from the CHF-STAT study (A) overall population (n=421) and (B) amiodarone-only treated group (n=203) (reproduced with permission, Huizar et.al.[5]).
Figure 4.
Figure 4.
Substrate for the development of ventricular arrhythmias in PVC-cardiomyopathy (reproduced with permission, Huizar et.al.[60]).

References

    1. Agarwal SK, Simpson RJ Jr., Rautaharju P, Alonso A, Shahar E, Massing M, Saba S, Heiss G: Relation of ventricular premature complexes to heart failure (from the Atherosclerosis Risk In Communities [ARIC] Study). Am J Cardiol 2012, 109(1):105–109.
    1. Agarwal V, Vittinghoff E, Whitman IR, Dewland TA, Dukes JW, Marcus GM: Relation Between Ventricular Premature Complexes and Incident Heart Failure. Am J Cardiol 2017, 119(8):1238–1242.
    1. Dukes JW, Dewland TA, Vittinghoff E, Mandyam MC, Heckbert SR, Siscovick DS, Stein PK, Psaty BM, Sotoodehnia N, Gottdiener JS et al.: Ventricular Ectopy as a Predictor of Heart Failure and Death. J Am Coll Cardiol 2015, 66(2):101–109.
    1. Huizar JF, Ellenbogen KA, Tan AY, Kaszala K: Arrhythmia-Induced Cardiomyopathy: JACC State-of-the-Art Review. J Am Coll Cardiol 2019, 73(18):2328–2344.
    1. Huizar JF, Fisher SG, Ramsey FV, Kaszala K, Tan AY, Moore H, Koneru JN, Kron J, Padala SK, Ellenbogen KA et al.: Outcomes of Premature Ventricular Contraction–Cardiomyopathy in the Veteran Population: A Secondary Analysis of the CHF-STAT Study. J Am Coll Cardiol Clin Electrophysiol 2020, (In Press)(In Press).
    1. Knecht S, Sacher F, Wright M, Hocini M, Nogami A, Arentz T, Petit B, Franck R, De Chillou C, Lamaison D et al.: Long-term follow-up of idiopathic ventricular fibrillation ablation: a multicenter study. J Am Coll Cardiol 2009, 54(6):522–528.
    1. Parreira L, Marinheiro R, Amador P, Mesquita D, Farinha J, Lopes A, Fonseca M, Chambel D, Venancio J, Lopes C et al.: Frequent premature ventricular contractions. Association of burden and complexity with prognosis according to the presence of structural heart disease. Ann Noninvasive Electrocardiol 2020:e12800.
    1. Huizar JF, Kaszala K, Potfay J, Minisi AJ, Lesnefsky EJ, Abbate A, Mezzaroma E, Chen Q, Kukreja RC, Hoke NN et al.: Left ventricular systolic dysfunction induced by ventricular ectopy: a novel model for premature ventricular contraction-induced cardiomyopathy. Circ Arrhythm Electrophysiol 2011, 4(4):543–549.
    1. Walters TE, Rahmutula D, Szilagyi J, Alhede C, Sievers R, Fang Q, Olgin J, Gerstenfeld EP: Left Ventricular Dyssynchrony Predicts the Cardiomyopathy Associated With Premature Ventricular Contractions. J Am Coll Cardiol 2018, 72(23 Pt A):2870–2882.
    1. Bozkurt B, Colvin M, Cook J, Cooper LT, Deswal A, Fonarow GC, Francis GS, Lenihan D, Lewis EF, McNamara DM et al.: Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association. Circulation 2016, 134(23):e579–e646.
    1. Engel G, Cho S, Ghayoumi A, Yamazaki T, Chun S, Fearon WF, Froelicher VF: Prognostic significance of PVCs and resting heart rate. Ann Noninvasive Electrocardiol 2007, 12(2):121–129.
    1. Baman TS, Lange DC, Ilg KJ, Gupta SK, Liu TY, Alguire C, Armstrong W, Good E, Chugh A, Jongnarangsin K et al.: Relationship between burden of premature ventricular complexes and left ventricular function. Heart Rhythm 2010, 7(7):865–869.
    1. Hasdemir C, Ulucan C, Yavuzgil O, Yuksel A, Kartal Y, Simsek E, Musayev O, Kayikcioglu M, Payzin S, Kultursay H et al.: Tachycardia-induced cardiomyopathy in patients with idiopathic ventricular arrhythmias: the incidence, clinical and electrophysiologic characteristics, and the predictors. J Cardiovasc Electrophysiol 2011, 22(6):663–668.
    1. Latchamsetty R, Yokokawa M, Morady F, Kim HM, Mathew S, Tilz R, Kuck KH, Nagashima K, Tedrow U, Stevenson WG et al.: Multicenter Outcomes for Catheter Ablation of Idiopathic Premature Ventricular Complexes. JACC Clin Electrophysiol 2015, 1(3):116–123.
    1. Tan AY, Hu YL, Potfay J, Kaszala K, Howren M, Sima AP, Shultz M, Koneru JN, Ellenbogen KA, Huizar JF: Impact of ventricular ectopic burden in a premature ventricular contraction-induced cardiomyopathy animal model. Heart Rhythm 2016, 13(3):755–761.
    1. Potfay J, Kaszala K, Tan AY, Sima AP, Gorcsan J 3rd, Ellenbogen KA, Huizar JF: Abnormal Left Ventricular Mechanics of Ventricular Ectopic Beats: Insights Into Origin and Coupling Interval in Premature Ventricular Contraction-Induced Cardiomyopathy. Circ Arrhythm Electrophysiol 2015, 8(5):1194–1200.
    1. Hamon D, Blaye-Felice MS, Bradfield JS, Chaachoui N, Tung R, Elayi CS, Vaseghi M, Dhanjal TS, Boyle NG, Maury P et al.: A New Combined Parameter to Predict Premature Ventricular Complexes Induced Cardiomyopathy: Impact and Recognition of Epicardial Origin. J Cardiovasc Electrophysiol 2016, 27(6):709–717.
    1. Sadron Blaye-Felice M, Hamon D, Sacher F, Pascale P, Rollin A, Duparc A, Mondoly P, Derval N, Denis A, Cardin C et al.: Premature ventricular contraction-induced cardiomyopathy: Related clinical and electrophysiologic parameters. Heart Rhythm 2016, 13(1):103–110.
    1. Cooper MW: Postextrasystolic potentiation. Do we really know what it means and how to use it? Circulation 1993, 88(6):2962–2971.
    1. Gunda S, Akyeampong D, Gomez-Arroyo J, Jovin DG, Kowlgi NG, Kaszala K, Tan AY, Koneru JN, Kron J, Ellenbogen KA et al.: Consequences of chronic frequent premature atrial contractions: Association with cardiac arrhythmias and cardiac structural changes. J Cardiovasc Electrophysiol 2019, 30(10):1952–1959.
    1. Kowgli NG, Jovin D, O’Quinn M, Kaszala K, Ellenbogen KA, Tan AY, Huizar JF: Neither Irregularity nor Tachycardia are Triggers of PVC-cardiomyopathy: Comparing Persistent Atrial and Ventricular Ectopy in an Animal Model. Heart Rhythm 2018, 15(5):S594.
    1. Kuroki K, Tada H, Seo Y, Ishizu T, Igawa M, Yamasaki H, Igarashi M, Machino T, Naruse Y, Sekiguchi Y et al.: Prediction and mechanism of frequent ventricular premature contractions related to haemodynamic deterioration. Eur J Heart Fail 2012, 14(10):1112–1120.
    1. Takada H, Takeuchi S, Ando K, Kaito A, Yoshida S: Experimental studies on myocardial contractility and hemodynamics in extrasystoles. Jpn Circ J 1970, 34(5):419–430.
    1. Hamon D, Rajendran PS, Chui RW, Ajijola OA, Irie T, Talebi R, Salavatian S, Vaseghi M, Bradfield JS, Armour JA et al.: Premature Ventricular Contraction Coupling Interval Variability Destabilizes Cardiac Neuronal and Electrophysiological Control: Insights From Simultaneous Cardioneural Mapping. Circ Arrhythm Electrophysiol 2017, 10(4).
    1. Salavatian S, Yamaguchi N, Hoang J, Lin N, Patel S, Ardell JL, Armour JA, Vaseghi M: Premature ventricular contractions activate vagal afferents and alter autonomic tone: implications for premature ventricular contraction-induced cardiomyopathy. Am J Physiol Heart Circ Physiol 2019, 317(3):H607–H616.
    1. Smith ML, Hamdan MH, Wasmund SL, Kneip CF, Joglar JA, Page RL: High-frequency ventricular ectopy can increase sympathetic neural activity in humans. Heart Rhythm 2010, 7(4):497–503.
    1. Tan AY, Elharrif K, Cardona-Guarache R, Mankad P, Ayers O, Joslyn M, Das A, Kaszala K, Lin SF, Ellenbogen KA et al.: Persistent Proarrhythmic Neural Remodeling Despite Recovery From Premature Ventricular Contraction-Induced Cardiomyopathy. J Am Coll Cardiol 2020, 75(1):1–13.
    1. Yamada S, Lo LW, Chou YH, Lin WL, Chang SL, Lin YJ, Liu SH, Cheng WH, Tsai TY, Chen SA: Beneficial Effect of Renal Denervation on Ventricular Premature Complex Induced Cardiomyopathy. J Am Heart Assoc 2017, 6(3).
    1. Elharrif K, O’Quinn MP, Lee P, Minisi AJ, Kaszala K, Ellenbogen KA, Huizar JF, Tan AY: Left Cardiac Sympathetic Efferent Denervation is Protective Against Premature Ventricular Contraction-Induced Cardiomyopathy (Abstract). Circulation 2018, 138:A14434.
    1. Gomez-Arroyo JG, Eltit JM, Samso M, Evani O, Tan AY, Kaszala K, Huizar JF: Transcriptomic Profiling Reveals Key Molecular Pathways Associated With Premature ventricular Contraction-induced Cardiomyopathy. Circulation 2018, 136:A19002.
    1. Walters T, Szilagyi J, Alhede C, Sievers R, Fang Q, Olgin J, Gerstenfeld E: Dyssynchrony and Fibrosis Persist after Resolution of Cardiomyopathy in a Swine Premature Ventricular Contraction Model. JACC Clin Electrophysiol 2020, In Press.
    1. Hasdemir C, Yuksel A, Camli D, Kartal Y, Simsek E, Musayev O, Isayev E, Aydin M, Can LH: Late gadolinium enhancement CMR in patients with tachycardia-induced cardiomyopathy caused by idiopathic ventricular arrhythmias. Pacing Clin Electrophysiol 2012, 35(4):465–470.
    1. Penela D, Martinez M, Fernandez-Armenta J, Aguinaga L, Tercedor L, Ordonez A, Acosta J, Marti-Almor J, Bisbal F, Rossi L et al.: Influence of myocardial scar on the response to frequent premature ventricular complex ablation. Heart 2019, 105(5):378–383.
    1. Jiang M, Zhang M, Howren M, Wang Y, Tan A, Balijepalli RC, Huizar JF, Tseng GN: JPH-2 interacts with Cai-handling proteins and ion channels in dyads: Contribution to premature ventricular contraction-induced cardiomyopathy. Heart Rhythm 2016, 13(3):743–752.
    1. Hong T, Yang H, Zhang SS, Cho HC, Kalashnikova M, Sun B, Zhang H, Bhargava A, Grabe M, Olgin J et al.: Cardiac BIN1 folds T-tubule membrane, controlling ion flux and limiting arrhythmia. Nat Med 2014, 20(6):624–632.
    1. Wang Y, Eltit JM, Kaszala K, Tan A, Jiang M, Zhang M, Tseng GN, Huizar JF: Cellular mechanism of premature ventricular contraction-induced cardiomyopathy. Heart Rhythm 2014, 11(11):2064–2072.
    1. Zhong L, Lee YH, Huang XM, Asirvatham SJ, Shen WK, Friedman PA, Hodge DO, Slusser JP, Song ZY, Packer DL et al.: Relative efficacy of catheter ablation vs antiarrhythmic drugs in treating premature ventricular contractions: a single-center retrospective study. Heart Rhythm 2014, 11(2):187–193.
    1. Shanmugam N, Chua TP, Ward D: ‘Frequent’ ventricular bigeminy--a reversible cause of dilated cardiomyopathy. How frequent is ‘frequent’? Eur J Heart Fail 2006, 8(8):869–873.
    1. Shariff N, Makowski D, Levin V: Radiofrequency ablation improving LV function in cardiomyopathy secondary to low burden of premature ventricular complexes. Anadolu Kardiyol Derg 2013, 13(8):812–814.
    1. Loring Z, Hanna P, Pellegrini CN: Longer Ambulatory ECG Monitoring Increases Identification of Clinically Significant Ectopy. Pacing Clin Electrophysiol 2016, 39(6):592–597.
    1. Park KM, Im SI, Park SJ, Kim JS, On YK: Risk factor algorithm used to predict frequent premature ventricular contraction-induced cardiomyopathy. Int J Cardiol 2017, 233:37–42.
    1. Yokokawa M, Kim HM, Good E, Crawford T, Chugh A, Pelosi F Jr., Jongnarangsin K, Latchamsetty R, Armstrong W, Alguire C et al. Impact of QRS duration of frequent premature ventricular complexes on the development of cardiomyopathy. Heart Rhythm 2012, 9(9):1460–1464.
    1. Del Carpio Munoz F, Syed FF, Noheria A, Cha YM, Friedman PA, Hammill SC, Munger TM, Venkatachalam KL, Shen WK, Packer DL et al.: Characteristics of premature ventricular complexes as correlates of reduced left ventricular systolic function: study of the burden, duration, coupling interval, morphology and site of origin of PVCs. J Cardiovasc Electrophysiol 2011, 22(7):791–798.
    1. Yokokawa M, Kim HM, Good E, Chugh A, Pelosi F Jr., Alguire C, Armstrong W, Crawford T, Jongnarangsin K, Oral H et al.: Relation of symptoms and symptom duration to premature ventricular complex-induced cardiomyopathy. Heart Rhythm 2012, 9(1):92–95.
    1. Kawamura M, Badhwar N, Vedantham V, Tseng ZH, Lee BK, Lee RJ, Marcus GM, Olgin JE, Gerstenfeld EP, Scheinman MM: Coupling interval dispersion and body mass index are independent predictors of idiopathic premature ventricular complex-induced cardiomyopathy. J Cardiovasc Electrophysiol 2014, 25(7):756–762.
    1. Olgun H, Yokokawa M, Baman T, Kim HM, Armstrong W, Good E, Chugh A, Pelosi F Jr., Crawford T, Oral H et al.: The role of interpolation in PVC-induced cardiomyopathy. Heart Rhythm 2011, 8(7):1046–1049.
    1. Krishnan B, Sankar A, Anand I, Adabag S, Li JM, McFalls EO, Benditt DG, Shivkumar K, Tholakanahalli VN: Post-Extrasystolic Potentiation as a Predictor of Recovery of Left Ventricular Dysfunction After Radiofrequency Catheter Ablation. JACC Clin Electrophysiol 2017, 3(11):1283–1291.
    1. Kowlgi GN, Ramirez RJ, Kaszala K, Joslyn M, Koneru JN, Ellenbogen KA, Tan AY, Huizar JF: Post-extrasystolic potentiation as a predictor of premature ventricular contraction-cardiomyopathy in an animal model. Europace 2020.
    1. Ban JE, Park HC, Park JS, Nagamoto Y, Choi JI, Lim HE, Park SW, Kim YH: Electrocardiographic and electrophysiological characteristics of premature ventricular complexes associated with left ventricular dysfunction in patients without structural heart disease. Europace 2013, 15(5):735–741.
    1. Penela D, Acosta J, Aguinaga L, Tercedor L, Ordonez A, Fernandez-Armenta J, Andreu D, Sanchez-Millan PJ, Cabanelas N, Tolosana JM et al.: Ablation of frequent PVC in patients meeting criteria for primary prevention ICD implant: Safety of withholding the implant. Heart Rhythm 2015, 12(12):2434–2442.
    1. Wijnmaalen AP, Delgado V, Schalij MJ, van Huls van Taxis CF, Holman ER, Bax JJ, Zeppenfeld K: Beneficial effects of catheter ablation on left ventricular and right ventricular function in patients with frequent premature ventricular contractions and preserved ejection fraction. Heart 2010, 96(16):1275–1280.
    1. Altintas B, Ozkalayci F, Cinier G, Kaya I, Aktan A, Kup A, Onuk R, Ozcan S, Uslu A, Akyuz A et al.: The effect of idiopathic premature ventricular complexes on left ventricular ejection fraction. Ann Noninvasive Electrocardiol 2020, 25(2):e12702.
    1. Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC et al.: 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2018, 138(13):e272–e391.
    1. Ling Z, Liu Z, Su L, Zipunnikov V, Wu J, Du H, Woo K, Chen S, Zhong B, Lan X et al.: Radiofrequency ablation versus antiarrhythmic medication for treatment of ventricular premature beats from the right ventricular outflow tract: prospective randomized study. Circ Arrhythm Electrophysiol 2014, 7(2):237–243.
    1. Hyman MC, Mustin D, Supple G, Schaller RD, Santangeli P, Arkles J, Lin D, Muser D, Dixit S, Nazarian S et al.: Class IC antiarrhythmic drugs for suspected premature ventricular contraction-induced cardiomyopathy. Heart Rhythm 2018, 15(2):159–163.
    1. Rivera S, de la Paz Ricapito M, Espinoza J, Belardi D, Albina G, Giniger A, Roux JF, Ayala-Paredes F, Scazzuso F: Cryoablation for Ventricular Arrhythmias Arising From the Papillary Muscles of the Left Ventricle Guided by Intracardiac Echocardiography and Image Integration. JACC Clin Electrophysiol 2015, 1(6):509–516.
    1. Kaszala K, Huizar JF, Tan AY, Ellenbogen KA: Cryoablation Achieves More Consistent Deeper Lesions With Improved Safety Compared to Radiofrequency Energy: An Experimental Model (Abstract 16035). Circulation 2015, 132:A16035.
    1. Chen X, Sun L, Chen Q, Kojodjojo P, Chen H, Ju W, Zhu W, Zhu Y, Zhao P, Zhang F et al.: Contact-versus noncontact-guided ablation of the right ventricular outflow tract arrhythmias: A propensity score matched analysis. Pacing Clin Electrophysiol 2020.
    1. Maeda S, Chik WW, Liang JJ, Kelesidis I, Arroyo RC, D’Souza B, Sadek MM, Muser D, Squara F, Venugopal D et al.: Recovery of renal dysfunction after catheter ablation of outflow tract ventricular arrhythmias in patients with ventricular premature depolarization-mediated cardiomyopathy. J Interv Card Electrophysiol 2017, 48(1):43–50.
    1. Huizar JF, Ellenbogen KA: Is PVC-Induced Cardiomyopathy Truly Reversible?: A Deep Dive Into Questions That Remain Unanswered. JACC Clin Electrophysiol 2020, 6(11):1377–1380.
    1. Yokokawa M, Good E, Crawford T, Chugh A, Pelosi F Jr., Latchamsetty R, Jongnarangsin K, Armstrong W, Ghanbari H, Oral H et al.: Recovery from left ventricular dysfunction after ablation of frequent premature ventricular complexes. Heart Rhythm 2013, 10(2):172–175.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj