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Percutaneous Pulmonary Valve Implantation Alters Electrophysiologic Substrate

View Article: PubMed Central - PubMed

ABSTRACT

Background: Percutaneous pulmonary valve implantation (PPVI) is first‐line therapy for some congenital heart disease patients with right ventricular outflow tract dysfunction. The hemodynamics improvements after PPVI are well documented, but little is known about its effects on the electrophysiologic substrate. The objective of this study is to assess the short‐ and medium‐term electrophysiologic substrate changes and elucidate postprocedure arrhythmias.

Methods and results: A retrospective chart review of patients undergoing PPVI from May 2010 to April 2015 was performed. A total of 106 patients underwent PPVI; most commonly these patients had tetralogy of Fallot (n=59, 55%) and pulmonary insufficiency (n=60, 57%). The median follow‐up time was 28 months (7‐63 months). Pre‐PPVI, 25 patients (24%) had documented arrhythmias: nonsustained ventricular tachycardia (NSVT) (n=9, 8%), frequent premature ventricular contractions (PVCs) (n=6, 6%), and atrial fibrillation/flutter (AF/AFL) (n=10, 9%). Post‐PPVI, arrhythmias resolved in 4 patients who had NSVT (44%) and 5 patients who had PVCs (83%). New arrhythmias were seen in 16 patients (15%): 7 NSVT, 8 PVCs, and 1 AF/AFL. There was resolution at medium‐term follow‐up in 6 (86%) patients with new‐onset NSVT and 7 (88%) patients with new‐onset PVCs. There was no difference in QRS duration pre‐PPVI, post‐PPVI, and at medium‐term follow‐up (P=0.6). The median corrected QT lengthened immediately post‐PPVI but shortened significantly at midterm follow‐up (P<0.01).

Conclusions: PPVI reduced the prevalence of NSVT. The majority of postimplant arrhythmias resolve by 6 months of follow‐up.

No MeSH data available.


Related in: MedlinePlus

Isolated premature ventricular contractions (PVCs). Six patients had documented frequent isolated PVCs pre‐PPVI. Immediately postprocedure, there was resolution of PVCs in 4 (64%) patients, while 1 (17%) patient continued to have persistent PVCs, and 1 (17%) patient had nonsustained ventricular tachycardia (NSVT). Additionally, 8 patients had new‐onset PVCs immediately postprocedure. Seven out of 8 patients with new‐onset PVCs and both of the persistent PVCs postprocedure no longer had any arrhythmia at follow‐up. One patient with new‐onset PVCs and the patient with persistent PVCs immediately postprocedure continued to have PVCs at follow‐up. The patient with persistent PVCs throughout had an out‐of‐hospital sudden cardiac arrest. NSVT indicates nonsustained ventricular tachycardia; PPVI, percutaneous pulmonary valve implantation; PVCs, premature ventricular contractions.
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jah31812-fig-0007: Isolated premature ventricular contractions (PVCs). Six patients had documented frequent isolated PVCs pre‐PPVI. Immediately postprocedure, there was resolution of PVCs in 4 (64%) patients, while 1 (17%) patient continued to have persistent PVCs, and 1 (17%) patient had nonsustained ventricular tachycardia (NSVT). Additionally, 8 patients had new‐onset PVCs immediately postprocedure. Seven out of 8 patients with new‐onset PVCs and both of the persistent PVCs postprocedure no longer had any arrhythmia at follow‐up. One patient with new‐onset PVCs and the patient with persistent PVCs immediately postprocedure continued to have PVCs at follow‐up. The patient with persistent PVCs throughout had an out‐of‐hospital sudden cardiac arrest. NSVT indicates nonsustained ventricular tachycardia; PPVI, percutaneous pulmonary valve implantation; PVCs, premature ventricular contractions.

Mentions: Pre‐PPVI, 27/106 patients (25%) had documented arrhythmias. Nine patients (8%) had NSVT, 6 patients (6%) had frequent PVCs, 10 patients (10%) had atrial AF/AFL, and 2 patients (2%) had supraventricular tachycardia. Only 2/8 (25%) patients with pre‐PPVI VT, and no patient with pre‐PPVI AF/AFL was in the PS group. New‐onset arrhythmias immediately post‐PPVI include 7 patients with NSVT, 8 patients with PVCs, and 1 patient with AF/AFL. These arrhythmias were recorded on overnight telemetry. Once again, there were very few PS‐only patients (3/16, 19%) in this cohort. At follow‐up, these new‐onset arrhythmias resolved in 86% of NSVT cases and 88% of PVCs cases. Two out of 8 patients with new‐onset PVCs were started on β‐blockers, which were discontinued at their 6‐month follow‐up. Two out of 7 patients with new‐onset NSVT were started on amiodarone. One of these patients was taken off the amiodarone at 6 months of follow‐up. The second patient continued to be maintained on amiodarone without documented recurrence of NSVT. One patient was started on a β‐blocker and continued to be on this medication because he had persistent documented PVCs. Overall, 12/16 (75%) patients no longer had documented NSVT, and 12/14 (86%) patients no longer had PVCs. One patient with PVCs prior to the procedure continued to have PVCs postprocedure. This patient also developed endocarditis of the Melody valve. He had an out‐of‐hospital sudden cardiac arrest. Finally, AF/AFL resolved in 6/11 (55%) cases (Figures 6, 7 through 8; Figures S2 and S3). Arrhythmia burden was determined by Holter monitoring, internal rhythm devices reports, and telemetry during subsequent hospitalizations.


Percutaneous Pulmonary Valve Implantation Alters Electrophysiologic Substrate
Isolated premature ventricular contractions (PVCs). Six patients had documented frequent isolated PVCs pre‐PPVI. Immediately postprocedure, there was resolution of PVCs in 4 (64%) patients, while 1 (17%) patient continued to have persistent PVCs, and 1 (17%) patient had nonsustained ventricular tachycardia (NSVT). Additionally, 8 patients had new‐onset PVCs immediately postprocedure. Seven out of 8 patients with new‐onset PVCs and both of the persistent PVCs postprocedure no longer had any arrhythmia at follow‐up. One patient with new‐onset PVCs and the patient with persistent PVCs immediately postprocedure continued to have PVCs at follow‐up. The patient with persistent PVCs throughout had an out‐of‐hospital sudden cardiac arrest. NSVT indicates nonsustained ventricular tachycardia; PPVI, percutaneous pulmonary valve implantation; PVCs, premature ventricular contractions.
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getmorefigures.php?uid=PMC5121524&req=5

jah31812-fig-0007: Isolated premature ventricular contractions (PVCs). Six patients had documented frequent isolated PVCs pre‐PPVI. Immediately postprocedure, there was resolution of PVCs in 4 (64%) patients, while 1 (17%) patient continued to have persistent PVCs, and 1 (17%) patient had nonsustained ventricular tachycardia (NSVT). Additionally, 8 patients had new‐onset PVCs immediately postprocedure. Seven out of 8 patients with new‐onset PVCs and both of the persistent PVCs postprocedure no longer had any arrhythmia at follow‐up. One patient with new‐onset PVCs and the patient with persistent PVCs immediately postprocedure continued to have PVCs at follow‐up. The patient with persistent PVCs throughout had an out‐of‐hospital sudden cardiac arrest. NSVT indicates nonsustained ventricular tachycardia; PPVI, percutaneous pulmonary valve implantation; PVCs, premature ventricular contractions.
Mentions: Pre‐PPVI, 27/106 patients (25%) had documented arrhythmias. Nine patients (8%) had NSVT, 6 patients (6%) had frequent PVCs, 10 patients (10%) had atrial AF/AFL, and 2 patients (2%) had supraventricular tachycardia. Only 2/8 (25%) patients with pre‐PPVI VT, and no patient with pre‐PPVI AF/AFL was in the PS group. New‐onset arrhythmias immediately post‐PPVI include 7 patients with NSVT, 8 patients with PVCs, and 1 patient with AF/AFL. These arrhythmias were recorded on overnight telemetry. Once again, there were very few PS‐only patients (3/16, 19%) in this cohort. At follow‐up, these new‐onset arrhythmias resolved in 86% of NSVT cases and 88% of PVCs cases. Two out of 8 patients with new‐onset PVCs were started on β‐blockers, which were discontinued at their 6‐month follow‐up. Two out of 7 patients with new‐onset NSVT were started on amiodarone. One of these patients was taken off the amiodarone at 6 months of follow‐up. The second patient continued to be maintained on amiodarone without documented recurrence of NSVT. One patient was started on a β‐blocker and continued to be on this medication because he had persistent documented PVCs. Overall, 12/16 (75%) patients no longer had documented NSVT, and 12/14 (86%) patients no longer had PVCs. One patient with PVCs prior to the procedure continued to have PVCs postprocedure. This patient also developed endocarditis of the Melody valve. He had an out‐of‐hospital sudden cardiac arrest. Finally, AF/AFL resolved in 6/11 (55%) cases (Figures 6, 7 through 8; Figures S2 and S3). Arrhythmia burden was determined by Holter monitoring, internal rhythm devices reports, and telemetry during subsequent hospitalizations.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Percutaneous pulmonary valve implantation (PPVI) is first‐line therapy for some congenital heart disease patients with right ventricular outflow tract dysfunction. The hemodynamics improvements after PPVI are well documented, but little is known about its effects on the electrophysiologic substrate. The objective of this study is to assess the short‐ and medium‐term electrophysiologic substrate changes and elucidate postprocedure arrhythmias.

Methods and results: A retrospective chart review of patients undergoing PPVI from May 2010 to April 2015 was performed. A total of 106 patients underwent PPVI; most commonly these patients had tetralogy of Fallot (n=59, 55%) and pulmonary insufficiency (n=60, 57%). The median follow‐up time was 28 months (7‐63 months). Pre‐PPVI, 25 patients (24%) had documented arrhythmias: nonsustained ventricular tachycardia (NSVT) (n=9, 8%), frequent premature ventricular contractions (PVCs) (n=6, 6%), and atrial fibrillation/flutter (AF/AFL) (n=10, 9%). Post‐PPVI, arrhythmias resolved in 4 patients who had NSVT (44%) and 5 patients who had PVCs (83%). New arrhythmias were seen in 16 patients (15%): 7 NSVT, 8 PVCs, and 1 AF/AFL. There was resolution at medium‐term follow‐up in 6 (86%) patients with new‐onset NSVT and 7 (88%) patients with new‐onset PVCs. There was no difference in QRS duration pre‐PPVI, post‐PPVI, and at medium‐term follow‐up (P=0.6). The median corrected QT lengthened immediately post‐PPVI but shortened significantly at midterm follow‐up (P<0.01).

Conclusions: PPVI reduced the prevalence of NSVT. The majority of postimplant arrhythmias resolve by 6 months of follow‐up.

No MeSH data available.


Related in: MedlinePlus