Skip to main content
PMC home page
Heart logoLink to Heart
. 1998 Mar;79(3):268–273. doi: 10.1136/hrt.79.3.268

Segmental wall motion abnormalities alter vulnerability to ventricular ectopic beats associated with acute increases in aortic pressure in patients with underlying coronary artery disease

K Siogas 1, S Pappas 1, G Graekas 1, J Goudevenos 1, G Liapi 1, D Sideris 1
PMCID: PMC1728643  PMID: 9602661

Abstract

Objective—To evaluate whether patients with coronary artery disease are susceptible to pressure related ventricular arrhythmias, and if so to identify possible risk factors.
Design—Interventional study.
Methods—Metaraminol was given to 43 patients undergoing coronary arteriography for ischaemic heart disease to increase their aortic pressure, provided their systolic blood pressure was < 160 mm Hg and they were in sinus rhythm, without any ventricular ectopic activity (or with fewer than six ventricular ectopic beats a minute) during a five minute control period.
Results—During the metaraminol infusion, systolic aortic pressure rose from 131 (15) to 199 (12) mm Hg (mean (SD)). Ventricular ectopy appeared (or ventricular ectopic beats increased by > 100%) in 13/43 patients. Ventricular ectopy was not related to age, sex, presence of hypertension, history of myocardial infarction, use of β blockers, positive exercise test, number of vessels diseased, or heart rate change during metaraminol infusion. There was a strong relation between the appearance of ventricular arrhythmia and segmental wall motion abnormalities: 1/19 (5.3%, 95% confidence interval 0.1% to 26.0%) without abnormality; 2/12 (16.7%, 2.1% to 48.4%) with hypokinesia; and 10/12 (83.3%, 51.6% to 97.1%) with akinesia or dyskinesia, χ2 = 22.7, p < 0.001). Ejection fraction was also a significant but not independent risk factor. 
Conclusions—Patients with segmental wall motion abnormalities are predisposed to ventricular ectopic beats during an increase in systolic aortic pressure. This could be explained by associated electrophysiological inhomogeneity. The presence of mechanical inhomogeneity, as may occur in postinfarction akinesia or dyskinesia, may affect the aortic pressure above which ventricular arrhythmias appear.

 Keywords: mechanoelectrical feedback;  segmental wall motion;  akinesia;  dyskinesia;  ventricular ectopic beats;  arrhythmias

Full Text

The Full Text of this article is available as a PDF (134.8 KB).

Figure 1  .

Figure 1  

Open in a new tab

Incidence of pressure related arrhythmias as a function of regional kinetic abnormalities.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Antoniou A., Milonas D., Kanakakis J., Rokas S., Sideris D. A. Contraction-excitation feedback in human atrial fibrillation. Clin Cardiol. 1997 May;20(5):473–476. doi: 10.1002/clc.4960200514. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bigger J. T., Jr, Fleiss J. L., Kleiger R., Miller J. P., Rolnitzky L. M. The relationships among ventricular arrhythmias, left ventricular dysfunction, and mortality in the 2 years after myocardial infarction. Circulation. 1984 Feb;69(2):250–258. doi: 10.1161/01.cir.69.2.250. [DOI] [PubMed] [Google Scholar]
  3. Calkins H., Maughan W. L., Weisman H. F., Sugiura S., Sagawa K., Levine J. H. Effect of acute volume load on refractoriness and arrhythmia development in isolated, chronically infarcted canine hearts. Circulation. 1989 Mar;79(3):687–697. doi: 10.1161/01.cir.79.3.687. [DOI] [PubMed] [Google Scholar]
  4. Cleland J. G., Dargie H. J., Hodsman G. P., Ball S. G., Robertson J. I., Morton J. J., East B. W., Robertson I., Murray G. D., Gillen G. Captopril in heart failure. A double blind controlled trial. Br Heart J. 1984 Nov;52(5):530–535. doi: 10.1136/hrt.52.5.530. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Coulshed D. S., Cowan J. C., Drinkhill M. J., Hainsworth R. The effects of ventricular end-diastolic and systolic pressures on action potential and duration in anaesthetized dogs. J Physiol. 1992 Nov;457:75–91. doi: 10.1113/jphysiol.1992.sp019365. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Dean J. W., Lab M. J. Arrhythmia in heart failure: role of mechanically induced changes in electrophysiology. Lancet. 1989 Jun 10;1(8650):1309–1312. doi: 10.1016/s0140-6736(89)92697-4. [DOI] [PubMed] [Google Scholar]
  7. Dean J. W., Lab M. J. Regional changes in ventricular excitability during load manipulation of the in situ pig heart. J Physiol. 1990 Oct;429:387–400. doi: 10.1113/jphysiol.1990.sp018263. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Denardo S. J., Stevenson W. G. Is the adaptation of right ventricular refractoriness to an abrupt increase in heart rate impaired in chronic heart failure? Am Heart J. 1989 Mar;117(3):585–589. doi: 10.1016/0002-8703(89)90732-1. [DOI] [PubMed] [Google Scholar]
  9. Dodge H. T., Sheehan F. H. Quantitative contrast angiography for assessment of ventricular performance in heart disease. J Am Coll Cardiol. 1983 Jan;1(1):73–81. doi: 10.1016/s0735-1097(83)80012-6. [DOI] [PubMed] [Google Scholar]
  10. Dominguez G., Fozzard H. A. Effect of stretch on conduction velocity and cable properties of cardiac Purkinje fibers. Am J Physiol. 1979 Sep;237(3):C119–C124. doi: 10.1152/ajpcell.1979.237.3.C119. [DOI] [PubMed] [Google Scholar]
  11. El-Sherif N., Smith R. A., Evans K. Canine ventricular arrhythmias in the late myocardial infarction period. 8. Epicardial mapping of reentrant circuits. Circ Res. 1981 Jul;49(1):255–265. doi: 10.1161/01.res.49.1.255. [DOI] [PubMed] [Google Scholar]
  12. Gornick C. C., Tobler H. G., Pritzker M. C., Tuna I. C., Almquist A., Benditt D. G. Electrophysiologic effects of papillary muscle traction in the intact heart. Circulation. 1986 May;73(5):1013–1021. doi: 10.1161/01.cir.73.5.1013. [DOI] [PubMed] [Google Scholar]
  13. Hansen D. E., Craig C. S., Hondeghem L. M. Stretch-induced arrhythmias in the isolated canine ventricle. Evidence for the importance of mechanoelectrical feedback. Circulation. 1990 Mar;81(3):1094–1105. doi: 10.1161/01.cir.81.3.1094. [DOI] [PubMed] [Google Scholar]
  14. Klein L. S., Miles W. M., Zipes D. P. Effect of atrioventricular interval during pacing or reciprocating tachycardia on atrial size, pressure, and refractory period. Contraction-excitation feedback in human atrium. Circulation. 1990 Jul;82(1):60–68. doi: 10.1161/01.cir.82.1.60. [DOI] [PubMed] [Google Scholar]
  15. Kostis J. B., Byington R., Friedman L. M., Goldstein S., Furberg C. Prognostic significance of ventricular ectopic activity in survivors of acute myocardial infarction. J Am Coll Cardiol. 1987 Aug;10(2):231–242. doi: 10.1016/s0735-1097(87)80001-3. [DOI] [PubMed] [Google Scholar]
  16. Lab M. J. Contraction-excitation feedback in myocardium. Physiological basis and clinical relevance. Circ Res. 1982 Jun;50(6):757–766. doi: 10.1161/01.res.50.6.757. [DOI] [PubMed] [Google Scholar]
  17. Lab M. J. Mechanically dependent changes in action potentials recorded from the intact frog ventricle. Circ Res. 1978 Apr;42(4):519–528. doi: 10.1161/01.res.42.4.519. [DOI] [PubMed] [Google Scholar]
  18. Lab M. J. Transient depolarisation and action potential alterations following mechanical changes in isolated myocardium. Cardiovasc Res. 1980 Dec;14(11):624–637. doi: 10.1093/cvr/14.11.624. [DOI] [PubMed] [Google Scholar]
  19. Lerman B. B., Burkhoff D., Yue D. T., Franz M. R., Sagawa K. Mechanoelectrical feedback: independent role of preload and contractility in modulation of canine ventricular excitability. J Clin Invest. 1985 Nov;76(5):1843–1850. doi: 10.1172/JCI112177. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Levine J. H., Guarnieri T., Kadish A. H., White R. I., Calkins H., Kan J. S. Changes in myocardial repolarization in patients undergoing balloon valvuloplasty for congenital pulmonary stenosis: evidence for contraction-excitation feedback in humans. Circulation. 1988 Jan;77(1):70–77. doi: 10.1161/01.cir.77.1.70. [DOI] [PubMed] [Google Scholar]
  21. Martin G. R., Stanger P. Transient prolongation of the QTc interval after balloon valvuloplasty and angioplasty in children. Am J Cardiol. 1986 Dec 1;58(13):1233–1235. doi: 10.1016/0002-9149(86)90388-7. [DOI] [PubMed] [Google Scholar]
  22. Mehra R., Zeiler R. H., Gough W. B., El-Sherif N. Reentrant ventricular arrhythmias in the late myocardial infarction period. 9. Electrophysiologic-anatomic correlation of reentrant circuits. Circulation. 1983 Jan;67(1):11–24. doi: 10.1161/01.cir.67.1.11. [DOI] [PubMed] [Google Scholar]
  23. Minisi A. J., Mukharji J., Rehr R. B., Lewis S. A., Richardson D. W., Romhilt D. W., Vetrovec G. W. Association between extent of coronary artery disease and ventricular premature beat frequency after myocardial infarction. Am Heart J. 1988 Jun;115(6):1198–1201. doi: 10.1016/0002-8703(88)90008-7. [DOI] [PubMed] [Google Scholar]
  24. Packer M., Gottlieb S. S., Blum M. A. Immediate and long-term pathophysiologic mechanisms underlying the genesis of sudden cardiac death in patients with congestive heart failure. Am J Med. 1987 Mar 20;82(3A):4–10. doi: 10.1016/0002-9343(87)90126-4. [DOI] [PubMed] [Google Scholar]
  25. Pfeffer M. A., Braunwald E., Moyé L. A., Basta L., Brown E. J., Jr, Cuddy T. E., Davis B. R., Geltman E. M., Goldman S., Flaker G. C. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators. N Engl J Med. 1992 Sep 3;327(10):669–677. doi: 10.1056/NEJM199209033271001. [DOI] [PubMed] [Google Scholar]
  26. Reiter M. J., Synhorst D. P., Mann D. E. Electrophysiological effects of acute ventricular dilatation in the isolated rabbit heart. Circ Res. 1988 Mar;62(3):554–562. doi: 10.1161/01.res.62.3.554. [DOI] [PubMed] [Google Scholar]
  27. Ruberman W., Weinblatt E., Goldberg J. D., Frank C. W., Shapiro S. Ventricular premature beats and mortality after myocardial infarction. N Engl J Med. 1977 Oct 6;297(14):750–757. doi: 10.1056/NEJM197710062971404. [DOI] [PubMed] [Google Scholar]
  28. Schulze R. A., Jr, Strauss H. W., Pitt B. Sudden death in the year following myocardial infarction. Relation to ventricular premature contractions in the late hospitals phase and left ventricular ejection fraction. Am J Med. 1977 Feb;62(2):192–199. doi: 10.1016/0002-9343(77)90314-x. [DOI] [PubMed] [Google Scholar]
  29. Sideris D. A., Chrysos D. N., Maliaras G. K., Michalis L. K., Moulopoulos S. D. Effect of acute hypertension on the cardiac rhythm. Experimental observations. J Electrocardiol. 1988 Apr;21(2):183–191. doi: 10.1016/s0022-0736(88)80015-3. [DOI] [PubMed] [Google Scholar]
  30. Sideris D. A. High blood pressure and ventricular arrhythmias. Eur Heart J. 1993 Nov;14(11):1548–1553. doi: 10.1093/eurheartj/14.11.1548. [DOI] [PubMed] [Google Scholar]
  31. Sideris D. A., Kontoyannis D. A., Michalis L., Adractas A., Moulopoulos S. D. Acute changes in blood pressure as a cause of cardiac arrhythmias. Eur Heart J. 1987 Jan;8(1):45–52. doi: 10.1093/oxfordjournals.eurheartj.a062158. [DOI] [PubMed] [Google Scholar]
  32. Sideris D. A., Pappas S., Siongas K., Grekas G., Argyri-Greka O., Koundouris E., Foussas S. Effect of preload and afterload on ventricular arrhythmogenesis. J Electrocardiol. 1995 Apr;28(2):147–152. doi: 10.1016/s0022-0736(05)80285-7. [DOI] [PubMed] [Google Scholar]
  33. Sideris D. A., Toumanidis S. T., Kostis E. B., Diakos A., Moulopoulos S. D. Arrhythmogenic effect of high blood pressure: some observations on its mechanism. Cardiovasc Res. 1989 Nov;23(11):983–992. doi: 10.1093/cvr/23.11.983. [DOI] [PubMed] [Google Scholar]
  34. Sniderman A. D., Marpole D., Fallen E. L. Regional contraction patterns in the normal and ischemic left ventricle in man. Am J Cardiol. 1973 Apr;31(4):484–489. doi: 10.1016/0002-9149(73)90299-3. [DOI] [PubMed] [Google Scholar]
  35. Spear J. F., More E. N. Stretch-induced excitation and conduction disturbances in the isolated rat myocardium. J Electrocardiol. 1972;5(1):15–24. doi: 10.1016/s0022-0736(72)80058-x. [DOI] [PubMed] [Google Scholar]
  36. Stewart D. E., Ikram H., Espiner E. A., Nicholls M. G. Arrhythmogenic potential of diuretic induced hypokalaemia in patients with mild hypertension and ischaemic heart disease. Br Heart J. 1985 Sep;54(3):290–297. doi: 10.1136/hrt.54.3.290. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Taggart P., Sutton P. M., Treasure T., Lab M., O'Brien W., Runnalls M., Swanton R. H., Emanuel R. W. Monophasic action potentials at discontinuation of cardiopulmonary bypass: evidence for contraction-excitation feedback in man. Circulation. 1988 Jun;77(6):1266–1275. doi: 10.1161/01.cir.77.6.1266. [DOI] [PubMed] [Google Scholar]
  38. Taggart P., Sutton P., John R., Lab M., Swanton H. Monophasic action potential recordings during acute changes in ventricular loading induced by the Valsalva manoeuvre. Br Heart J. 1992 Mar;67(3):221–229. doi: 10.1136/hrt.67.3.221. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Weaver W. D., Lorch G. S., Alvarez H. A., Cobb L. A. Angiographic findigs and prognostic indicators in patients resuscitated from sudden cardiac death. Circulation. 1976 Dec;54(6):895–900. doi: 10.1161/01.cir.54.6.895. [DOI] [PubMed] [Google Scholar]
  40. Webster M. W., Fitzpatrick M. A., Nicholls M. G., Ikram H., Wells J. E. Effect of enalapril on ventricular arrhythmias in congestive heart failure. Am J Cardiol. 1985 Sep 15;56(8):566–569. doi: 10.1016/0002-9149(85)91186-5. [DOI] [PubMed] [Google Scholar]
  41. White H. D., Norris R. M., Brown M. A., Brandt P. W., Whitlock R. M., Wild C. J. Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction. Circulation. 1987 Jul;76(1):44–51. doi: 10.1161/01.cir.76.1.44. [DOI] [PubMed] [Google Scholar]
  42. Yamashita T., Inoue H., Usui M., Kuo T., Saihara S., Nozaki A., Momomura S., Serizawa T., Iizuka M., Sugimoto T. Acute effect of percutaneous transluminal mitral commissurotomy on QT interval: possible role of afterload in contraction-excitation feedback. Am Heart J. 1991 Jun;121(6 Pt 1):1634–1639. doi: 10.1016/0002-8703(91)90006-4. [DOI] [PubMed] [Google Scholar]
  43. de Bakker J. M., van Capelle F. J., Janse M. J., Wilde A. A., Coronel R., Becker A. E., Dingemans K. P., van Hemel N. M., Hauer R. N. Reentry as a cause of ventricular tachycardia in patients with chronic ischemic heart disease: electrophysiologic and anatomic correlation. Circulation. 1988 Mar;77(3):589–606. doi: 10.1161/01.cir.77.3.589. [DOI] [PubMed] [Google Scholar]
  44. de Bono D. P. What is the role of invasive intervention after coronary thrombolysis? Eur Heart J. 1991 Dec;12 (Suppl G):43–46. [PubMed] [Google Scholar]

Articles from Heart are provided here courtesy of BMJ Publishing Group

RESOURCES