Circulation: Arrhythmia and Electrophysiology HAE Abnormal Left Ventricular Mechanics of Ventricular Ectopic Beats: Insights into Origin and Coupling Interval in Premature Ventricular Contraction-Induced Cardiomyopathy LV Dyssynchrony during PVCs CIRCAE/2015/003047 CIRCAE/2015/003047 10.1161/CIRCEP.115.003047 8 10/20/15 5 Sine Kristina 617-542-5100 617-542-6539 Hindricks, Gerhard Heart Center, University of Leipzig Dr. Jose Francisco Huizar jfhuizar@gmail.com Dr. McGuire VA Medical Center 1201 Broad Rock Blvd (4A-100) Richmond Virginia 23249 UNITED STATES 804-6755466 804-6755467 60751 Jonathan Potfay Richmond VA Medical Center jonathan.potfay@va.gov 104861 Karoly Kaszala Hunter Holmes McGuire VA Medical Center Karoly.Kaszala@va.gov 131778 Alex Y Tan VCU School of Mediicne alextan787@gmail.com 205517 Adam P. Sima Virginia Commonwealth University simaa@vcu.edu 94386 John Gorcsan III University of Pittsburgh gorcsanj@upmc.edu 25942 Kenneth A. Ellenbogen Medical College of Virginia ken.ellenbogen@gmail.com 60001 Jose Francisco Huizar McGuire VA Medical Center jfhuizar@gmail.com 60751 03/31/2015 03/31/2015 07/18/2015 08/03/2015 08/21/2015 10/20/2015 Original Articles <P><B><I>Background</I></B>—Left ventricular (LV) dyssynchrony caused by premature ventricular contractions (PVCs) has been proposed as a mechanism of PVC-induced cardiomyopathy (CM). We sought to understand the impact of different PVC locations and coupling intervals (prematurity) on LV regional mechanics and global function of the PVC beat itself. </P><P><B><I>Methods and Results</I></B>—Using our premature pacing algorithm, pentageminal PVCs at coupling intervals of 200-375ms were delivered from the epicardial right ventricular (RV) apex, RV outflow tract (RVOT), and LV free wall, as well as premature atrial contractions (PACs) from the left atrial (LA) appendage at a coupling interval of 200ms in seven healthy canines. LV short axis echocardiographic images, LV stroke volume (SV) and dP/dt_max were obtained during all ectopic beats and VP. LV dyssynchrony was assessed by dispersion of QRS-to-peak strain (earliest - last QRS-to-peak strain) between 6 different LV segments during each of the aforementioned beats (GE, EchoPac). LV dyssynchrony was greater during long- rather than short-coupled PVCs and PVCs at 375ms compared with rapid VP at 400ms (P<0.0001), whereas, no difference was found between PVC locations. Longer PVC coupling intervals were associated with greater SV and dP/dt_max despite more pronounced dyssynchrony (P<0.001). </P><P><B><I>Conclusions</I></B>—PVCs with longer coupling intervals demonstrate more pronounced LV dyssynchrony, whereas PVC location has minimal impact. LV dyssynchrony cannot be attributed to prematurity or abnormal ventricular activation alone, but rather to a combination of both. This study suggests that late-coupled PVCs may cause a more severe cardiomyopathy if dyssynchrony is the leading mechanism responsible for PVC-induced CM.</P> 1 0 0 3 3 yes CircAE_CIRCAE-2015-003047.xml CircAE_CIRCAE-2015-003047_file1.docx

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CircAE_CIRCAE-2015-003047_supp1.pdf CircAE_CIRCAE-2015-003047_supp2.avi CircAE_CIRCAE-2015-003047_supp3.avi CircAE_CIRCAE-2015-003047_supp4.avi CircAE_CIRCAE-2015-003047_supp5.avi CircAE_CIRCAE-2015-003047_supp6.docx CircAE_CIRCAE-2015-003047_supp7.pdf CircAE_CIRCAE-2015-003047_merge.pdf CircAE_CIRCAE-2015-003047_Huizar_60751_disclosure.pdf CircAE_CIRCAE-2015-003047_Huizar_60751_copyright.pdf CircAE_CIRCAE-2015-003047_Sima_94386_disclosure.pdf CircAE_CIRCAE-2015-003047_Sima_94386_copyright.pdf CircAE_CIRCAE-2015-003047_Gorcsan_III_25942_disclosure.pdf CircAE_CIRCAE-2015-003047_Gorcsan_III_25942_copyright.pdf CircAE_CIRCAE-2015-003047_Kaszala_131778_disclosure.pdf CircAE_CIRCAE-2015-003047_Kaszala_131778_copyright.pdf CircAE_CIRCAE-2015-003047_Potfay_104861_disclosure.pdf CircAE_CIRCAE-2015-003047_Potfay_104861_copyright.pdf CircAE_CIRCAE-2015-003047_Tan_205517_disclosure.pdf CircAE_CIRCAE-2015-003047_Tan_205517_copyright.pdf CircAE_CIRCAE-2015-003047_Ellenbogen_60001_disclosure.pdf CircAE_CIRCAE-2015-003047_Ellenbogen_60001_copyright.pdf Bill authors $70 per pg.; no excess pgs. Article has supplemental material (1 PDF & 4 Videos) and bullet points. Guest Editor for this article was Gerhard Hindricks, MD. Rec'd 3/31/15 Subject Codes: [130] Animal models of human disease [132] Arrhythmias - basic studies [31] Echocardiography [11] Other heart failure ksine