Journal Article

15. Ventricular Arrhythmias

P.E. Bloch Thomsen, J.K. Kanters and K. Saermark

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 7, issue s3, pages S23-S23
Published in print October 2005 | ISSN: 1099-5129
Published online October 2005 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1016/j.eupc.2005.08.217
15. Ventricular Arrhythmias

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Background

Ventricular extrasystoles are characterized by a fixed coupling interval to the last QRST-complex preceding it. We hypothesized that this QRST-complex differed from QRST-complexes of other sinus beats not followed by ventricular extrasystoles. Further, we investigated whether phase-2 reentry, demonstrated recently in animal experiments to initiate ventricular extrasystoles, ventricular tachycardia and ventricular fibrillation, also could play a role in humans.

Methods and Results

We examined 18 patients with ventricular extrasystoles and/or ventricular tachycardia by signal averaging of the ECG (group A) or by single beat analysis of intracardiac electrograms (group B).

Group A consisted of 6 patients without structural heart disease and one patient with the Brugada syndrome. Six of the 7 patients had right ventricular outflow tract ventricular extrasystoles. In 6 of the 7 patients we demonstrated significant ST-elevation and/or T-wave changes in the sinus beat preceding ventricular extrasystoles compared to the second last sinus beat in one or more of the three orthogonal leads X, Y and Z.

Group B consisted of 11 patients undergoing radiofrequency ablation. Eight of the 11 patients had right ventricular outflow tract extrasystoles. In 9 of the 11 patients, single beat analysis of unipolar and bipolar electrograms recorded close to successful ablation sites demonstrated similar changes i.e. ST-elevation (median peak voltage gradient 150 microvolt (range 0-1700) and T-wave changes in the sinus beat prior to ventricular ectopy. In addition J-point elevation was demonstrated in several cases. In total, significant changes were demonstrated in 15 of the 18 patients studied (83%).

Conclusion

The J-point elevation, the ST-elevation and the T-wave changes documented in the last sinus beat prior to ventricular extrasystoles are in agreement with phase-2 reentry suggesting that this may be the responsible mechanism for ventricular extrasystoles and/or ventricular tachycardia/fibrillation The phenomenon has hitherto been demonstrated in animal experiments only.

Journal Article.  0 words. 

Subjects: Cardiovascular Medicine

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