Gurbuz Ahmet Seyfeddin, Ozturk Semi, Kilicgedik Alev, Akgun Taylan, Kalkan Mehmet Emin, Demir Serdar, Efe Suleyman Cagan, Acar Rezzan Deniz, Akcakoyun Mustafa, Kirma Cevat
Department of Cardiology, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey.
Department of Cardiology, Haseki Training and Research Hospital, Istanbul, Turkey.
Pacing Clin Electrophysiol. 2019 Mar;42(3):321-326. doi: 10.1111/pace.13606. Epub 2019 Jan 30.
The deterioration of left atrial and ventricular functions was demonstrated in patients with frequent ventricular extrasystole (fVES). The exact pathophysiology of left atrial dysfunction in patients with fVES is unclear. Retrograde ventriculoatrial conduction (VAC) often accompanies fVES, which may contribute to atrial dysfunction. We investigated whether atrial electromechanical delay and VAC are related to these atrial functions in patients with frequent right ventricular outflow tract (RVOT) VES and preserved ejection fraction (pEF).
This study included 21 patients with pEF (eight males, 48 ± 11 years), who had experienced more than 10 000 RVOT-VES during 24-h Holter monitoring and had undergone electrophysiological study/ablation. The study also included 20 healthy age- and sex-matched control subjects. Transthoracic echocardiography was performed on all of the subjects. Atrial conduction time was obtained by using tissue Doppler imaging. Strain analysis was performed with two-dimensional speckle tracking echocardiography.
The peak atrial longitudinal strain was significantly impaired in patients with fVES (P = 0.01). In addition, although the interatrial and left atrial conduction delay times were significantly different between each group (P < 0.001, P < 0.001), the right atrial conduction delay times were similar. When patients with fVES were divided into groups depending on the existence of retrograde VAC, atrial deformation parameters and conduction delay time did not significantly differ between either group.
Frequent RVOT-VES causes left atrial dysfunction. This information is obtained through strain analyses and recordings of left atrial conduction times in patients with pEF. Regardless, retrograde VAC is not related to atrial dysfunction.
频发室性期前收缩（fVES）患者存在左心房和心室功能恶化。fVES患者左心房功能障碍的确切病理生理学尚不清楚。室房逆向传导（VAC）常伴随fVES，这可能导致心房功能障碍。我们研究了心房机电延迟和VAC是否与频发右心室流出道（RVOT）室性期前收缩且射血分数保留（pEF）患者的这些心房功能相关。
本研究纳入21例pEF患者（8例男性，48±11岁），这些患者在24小时动态心电图监测期间经历了超过10000次RVOT室性期前收缩，并接受了电生理研究/消融治疗。研究还纳入了20名年龄和性别匹配的健康对照者。对所有受试者进行经胸超声心动图检查。通过组织多普勒成像获得心房传导时间。采用二维斑点追踪超声心动图进行应变分析。
fVES患者的心房纵向应变峰值明显受损（P = 0.01）。此外，尽管每组之间的房间隔和左心房传导延迟时间有显著差异（P < 0.001，P < 0.001），但右心房传导延迟时间相似。根据室房逆向传导的存在情况将fVES患者分组后，两组之间的心房变形参数和传导延迟时间无显著差异。
频发RVOT室性期前收缩导致左心房功能障碍。这一信息是通过对pEF患者进行应变分析和记录左心房传导时间获得的。无论如何，室房逆向传导与心房功能障碍无关。
