Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Heart Rhythm. 2012 Sep;9(9):1465-72. doi: 10.1016/j.hrthm.2012.05.019. Epub 2012 May 26.
Frequent ventricular premature depolarizations (VPDs) can cause reversible left ventricular (LV) dysfunction. However, not all patients normalize their LV function after VPD elimination.
To evaluate predictors of recovery of LV function following the elimination of frequent VPDs.
We identified patients with ≥10% VPDs/24 h and an LV ejection fraction of <50% who underwent successful ablation between 2007 and 2011. Subjects were classified as having reversible (≥10% increase to a final LV ejection fraction of ≥50%) or irreversible (≤10% increase or final LV ejection fraction <50%) LV dysfunction on the basis of echocardiographic follow-up. A reference group with ≥10% VPDs but normal LV function was identified.
One hundred fourteen patients with ≥10% VPDs were identified; 66 had preserved and 48 had impaired LV function. Over a median follow-up of 10.6 months, 24 of 48 were classified as reversible and 13 of 48 as irreversible and 11 of 44 were excluded. There was a gradient of VPD QRS duration between the control, reversible, and irreversible groups (mean VPD QRS 135, 158, and 173 ms, respectively; P < .001). This gradient persisted even for the same site of origin. In multivariate analysis, the only independent predictor of irreversible LV function was VPD QRS duration (odds ratio 5.07 [95% confidence interval 1.22-21.01] per 10-ms increase).
In patients with LV dysfunction and frequent VPDs, we identified VPD QRS duration as the only independent predictor for the recovery of LV function after ablation. This suggests that VPD QRS duration may be a marker for the severity of underlying substrate abnormality.
频发室性期前收缩(VPD)可导致左心室(LV)功能可逆性障碍。然而，并非所有患者在消除 VPD 后 LV 功能均能恢复正常。
评估频发 VPD 消除后 LV 功能恢复的预测因素。
我们确定了 2007 年至 2011 年期间接受成功消融术的 VPD 占 24 小时≥10%且 LV 射血分数<50%的患者。根据超声心动图随访结果，将患者分为 LV 功能可逆（最终 LV 射血分数≥50%，增加≥10%）或不可逆（最终 LV 射血分数<50%，增加≤10%）。确定 VPD 占 24 小时≥10%但 LV 功能正常的参考组。
共确定了 114 例 VPD 占 24 小时≥10%的患者，其中 66 例患者 LV 功能正常，48 例患者 LV 功能受损。中位随访时间为 10.6 个月时，48 例患者中有 24 例被分类为可逆性，13 例为不可逆性，44 例中有 11 例被排除。在对照组、可逆性组和不可逆性组之间，VPD QRS 持续时间存在梯度（平均 VPD QRS 分别为 135、158 和 173 ms；P<0.001）。即使起源于同一部位，这种梯度仍然存在。多变量分析中，不可逆性 LV 功能的唯一独立预测因素是 VPD QRS 持续时间（比值比 5.07[95%置信区间 1.22-21.01]，每增加 10 ms）。
在 LV 功能障碍和频发 VPD 的患者中，我们发现 VPD QRS 持续时间是消融术后 LV 功能恢复的唯一独立预测因素。这表明 VPD QRS 持续时间可能是潜在底物异常严重程度的标志物。
