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...
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| Vydané v: | Journal of cardiovascular development and disease Ročník 10; číslo 2; s. 89 |
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| Abstract | 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. |
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| AbstractList | 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. 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, VG[sub.p]→, of the ectopic beat, VG[sub.e]→, and of the VG difference vector, ΔVG[sub.ep]→, and compared their sizes. |VG[sub.e]→| of the SA and V ectopic beats were significantly larger than |VG[sub.p]→| (53.7 ± 25.0 vs. 47.8 ± 24.6 mV∙ms, respectively; p < 0.001). |ΔVG[sub.ep]→| were three times larger than the difference of |VG[sub.e]→| and |VG[sub.p]→| (19.94 ± 9.76 vs. 5.94 mV∙ms, respectively), demonstrating differences in the VG[sub.p]→ and VG[sub.e]→ spatial directions. The amount of ectopic prematurity was not correlated with |ΔVG[sub.ep]→|, 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. 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.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. 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; < 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. 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. |
| Audience | Academic |
| Author | Maan, Arie C. Schoonderwoerd, Resi M. Jukema, J. Wouter Man, Sumche Dik, Mariëlle Swenne, Cees A. |
| AuthorAffiliation | 1 Cardiology Department, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands 2 Netherlands Heart Institute, Moreelsepark 1, 3511 EP Utrecht, The Netherlands |
| AuthorAffiliation_xml | – name: 2 Netherlands Heart Institute, Moreelsepark 1, 3511 EP Utrecht, The Netherlands – name: 1 Cardiology Department, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands |
| Author_xml | – sequence: 1 givenname: Resi M. surname: Schoonderwoerd fullname: Schoonderwoerd, Resi M. – sequence: 2 givenname: Mariëlle surname: Dik fullname: Dik, Mariëlle – sequence: 3 givenname: Sumche surname: Man fullname: Man, Sumche – sequence: 4 givenname: Arie C. surname: Maan fullname: Maan, Arie C. – sequence: 5 givenname: J. Wouter surname: Jukema fullname: Jukema, J. Wouter – sequence: 6 givenname: Cees A. orcidid: 0000-0001-9801-2760 surname: Swenne fullname: Swenne, Cees A. |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/36826585$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1172/JCI113706 10.1046/j.1540.8167.90303.x 10.1109/TBME.1983.325172 10.1093/oxfordjournals.eurheartj.a059647 10.1161/01.RES.0000124605.03595.E4 10.1016/j.jelectrocard.2021.07.016 10.1161/01.RES.38.4.240 10.1161/01.CIR.31.4.551 10.1016/0002-8703(54)90221-5 10.1016/j.amjcard.2010.11.010 10.1161/01.CIR.1.2.264 10.1016/S0022-0736(79)80044-8 10.1016/0002-8703(66)90660-0 10.1016/j.jelectrocard.2008.07.006 10.1109/CIC.2005.1588151 10.1196/annals.1341.027 10.1016/0002-8703(57)90211-9 10.1378/chest.58.3.244 10.1016/j.jelectrocard.2015.05.002 10.1161/01.CIR.13.4.562 10.1161/01.RES.0000119322.87051.A9 10.1055/s-0038-1634799 10.1016/0002-8703(60)90516-0 10.1016/j.ihj.2020.09.006 10.1016/0002-8703(51)90017-8 10.1152/ajplegacy.1975.228.6.1717 10.1016/j.hrthm.2006.05.025 10.1016/j.jelectrocard.2016.07.025 10.1152/ajpheart.00542.2020 10.1016/S0002-8703(34)90303-3 10.1152/ajpheart.00159.2016 10.1159/000400423 10.1016/j.jelectrocard.2018.04.015 10.1161/01.CIR.9.3.381 10.1152/ajplegacy.1949.159.3.499 10.1016/0735-1097(89)90490-7 10.1016/j.jelectrocard.2013.10.010 10.1093/cvr/14.10.607 10.1109/CIC.2005.1588040 |
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| Keywords | action potential duration restitution intraventricular conduction vectorcardiogram extrasystoles spatial ventricular gradient |
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| SubjectTerms | 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 |
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| Title | Intra-Individual Comparison of Sinus and Ectopic Beats Probing the Ventricular Gradient’s Activation Dependence |
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