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
Hlavní autori:	Schoonderwoerd, Resi M., Dik, Mariëlle, Man, Sumche, Maan, Arie C., Jukema, J. Wouter, Swenne, Cees A.
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	Switzerland MDPI AG 01.02.2023 MDPI
Predmet:	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
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Popis
Shrnutí:	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.
Bibliografia:	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