4.2 Article

Insight of electrocardiographic and electrophysiological parameters on the left ventricular function in patients with ventricular arrhythmia from left ventricular summit

Journal

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
Volume 34, Issue 5, Pages 1230-1240

Publisher

WILEY
DOI: 10.1111/jce.15904

Keywords

ablation; absolute earliest activation time discrepancy; left ventricular function; left ventricular summit; QRS duration; ventricular arrhythmia

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This study aimed to investigate the risk factors for left ventricular (LV) cardiomyopathy and the outcomes of patients with ventricular arrhythmia (VA) originating from the LV summit (LVS). The results showed that QRS duration (QRSd) and absolute earliest activation time discrepancy (AEAD) were independent factors associated with deteriorating LV systolic function in patients with VA, and catheter ablation could reverse LV remodeling. Narrower QRSd and better LV ejection fraction (LVEF) were associated with better recovery of LV function after ablation.
Introduction: Ventricular arrhythmia (VA) commonly originate from the left ventricular summit (LVS) and results in left ventricular (LV) dysfunction in some patients; however, factors related to LV cardiomyopathy have not been well elucidated. Therefore, this study aimed to investigate the risk factors for LV cardiomyopathy and the outcomes of patients with LVS VA. Methods: Between 2013 and 2018, a total of 139 patients (60.7% men; mean age 53.2 +/- 13.9 years old) underwent catheter ablation for LVS VA in two centers. Detailed patient demographics, electrocardiograms, electrophysiological characteristics, and clinical outcomes were analyzed. LV cardiomyopathy was defined as left ventricular ejection fraction (LVEF) <50%. Results: Acute procedural success was achieved in 92.8% of patients. There were 40 patients (28.8%) with LV cardiomyopathy, and the mean LVEF improved from 37.5 +/- 9.3% to 48.5 +/- 10.2% after ablation (p < .001). After multivariate analysis, the independent factors of LV dysfunction were wider QRS duration (QRSd) of the VA (odds ratio [OR] 1.02; 95% confidence interval [CI]: 1.00-1.04; p = .046) and the absolute earliest activation time discrepancy (AEAD) between epicardium and endocardium (OR 1.05; 95% CI: 1.00-1.09; p = .048). After ablation, the LV function was completely recovered in 20 patients (50%). The factors for LV dysfunction without recovery included wider premature ventricular complex (PVC) QRSd (OR 1.09; 95% CI: 1.02-1.17; p = .012) and poorer LVEF (OR 0.85; 95% CI: 0.74-0.97; p = .020). Conclusion: In patients with VA from the LVS, PVC QRSd and AEAD are factors associated with deteriorating LV systolic function. Catheter ablation can reverse LV remodeling. Narrower QRSd and better LVEF are associated with better recovery of LV function after ablation.

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