Intra-Individual Comparison of Sinus and Ectopic Beats Probing the Ventricular Gradient’s Activation Dependence

Wilson assumed that the ventricular gradient (VG) is independent of the ventricular activation order. This paradigm has often been refuted and was never convincingly corroborated. We sought to validate Wilson’s concept by intra-individual comparison of the VG of sinus beats and ectopic beats, thus a...

Full description

Saved in:
Bibliographic Details
Published in:Journal of cardiovascular development and disease Vol. 10; no. 2; p. 89
Main Authors: Schoonderwoerd, Resi M., Dik, Mariëlle, Man, Sumche, Maan, Arie C., Jukema, J. Wouter, Swenne, Cees A.
Format: Journal Article
Language:English
Published: Switzerland MDPI AG 01.02.2023
MDPI
Subjects:
action potential duration restitution
Arrhythmia
Comparative analysis
Electrocardiogram
Electrocardiography
Experiments
extrasystoles
Heart
Heart beat
Integrals
intraventricular conduction
Investigations
Ischemia
Morphology
Restitution
spatial ventricular gradient
vectorcardiogram
United Kingdom
action potential duration restitution
intraventricular conduction
vectorcardiogram
extrasystoles
spatial ventricular gradient
ISSN:2308-3425, 2308-3425
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Wilson assumed that the ventricular gradient (VG) is independent of the ventricular activation order. This paradigm has often been refuted and was never convincingly corroborated. We sought to validate Wilson’s concept by intra-individual comparison of the VG of sinus beats and ectopic beats, thus assessing the effects of both altered ventricular conduction (caused by the ectopic focus) and restitution (caused by ectopic prematurity). We studied standard diagnostic ECGs of 118 patients with accidental extrasystoles: normally conducted supraventricular ectopic beats (SN, N = 6) and aberrantly conducted supraventricular ectopic beats (SA, N = 20) or ventricular ectopic beats (V, N = 92). In each patient, we computed the VG vectors of the predominant beat, VGp→, of the ectopic beat, VGe→, and of the VG difference vector, ΔVGep→, and compared their sizes. VGe→ of the SA and V ectopic beats were significantly larger than VGp→ (53.7 ± 25.0 vs. 47.8 ± 24.6 mV∙ms, respectively; p < 0.001). ΔVGep→ were three times larger than the difference of VGe→ and VGp→ (19.94 ± 9.76 vs. 5.94 mV∙ms, respectively), demonstrating differences in the VGp→ and VGe→ spatial directions. The amount of ectopic prematurity was not correlated with ΔVGep→, although the larger VG difference vectors were observed for the more premature (<80%) extrasystoles. Electrical restitution properties and electrotonic interactions likely explain our findings. We conclude that the concept of a conduction-independent VG should be tested at equal heart rates and without including premature extrasystoles.
Bibliography:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 14
content type line 23
These authors contributed equally to this work.
ISSN:2308-3425
2308-3425
DOI:10.3390/jcdd10020089