Eccentric hypertrophy in an animal model of mid- and long-term premature ventricular contraction–induced cardiomyopathy

• Main Authors: Juan Torrado, MD, PhD, Gurukripa N. Kowlgi, MD, Rafael J. Ramirez, PhD, Jaime Balderas-Villalobos, PhD, Daniel Jovin, BS, Chandler Parker, BS, Evani Om, BS, Sergei Airapetov, DO, Karoly Kaszala, MD, PhD, FHRS, Alex Y. Tan, MD, FHRS, Kenneth A. Ellenbogen, MD, FHRS, Jose F. Huizar, MD, FHRS
• Format: Article
• Language: English
• Published: Elsevier 2021-02-01
• Series: Heart Rhythm O2
• Subjects: Cardiomyopathy; Eccentric hypertrophy; Heart rate irregularity; LV dyssynchrony; Premature atrial contraction; Premature ventricular contraction
• Online Access: http://www.sciencedirect.com/science/article/pii/S2666501821000027

Background: Tachycardia and heart rate irregularity are proposed triggers of premature ventricular contraction–induced cardiomyopathy (PVC-cardiomyopathy). Bigeminal premature atrial and ventricular contractions (PACs and PVCs) increase heart rate and result in rhythm irregularities but differ in their effects on ventricular synchrony. Comparing chronic bigeminal PACs with PVCs would provide insights into mechanisms of PVC-cardiomyopathy. Objective: To compare the impact of chronic PACs and PVCs on ventricular hemodynamics, structure, and function. Methods: Pacemakers were implanted in 27 canines to reproduce atrial (PACs, n = 7) or ventricular bigeminy (PVCs, n = 11) for 12 weeks, and compared to sham-operated animals (n = 9). Four additional animals were exposed to long-term bigeminal PVCs (48 weeks). Hemodynamic changes were assessed using a pressure-transducing catheter at baseline and 12 weeks. Cardiac remodeling was monitored by transthoracic echocardiography throughout the 12- and 48-week protocols in the respective groups. Results: PVC group demonstrated a significant decrease in left ventricular (LV) ejection fraction and contractility (max dP/dt), impaired LV lusitropy (min dP/dt), and increase in LV dimensions and LV mass at 12 weeks without further deterioration beyond 16 weeks. Despite increased LV mass, relative wall thickness decreased, consistent with eccentric hypertrophy. No significant cardiac remodeling was noted in either sham or PAC groups at 12 weeks. Conclusion: In contrast to bigeminal PACs, PVCs result in a cardiomyopathy characterized by reduced LV ejection fraction, LV dilation, and eccentric hypertrophy that plateaus between 12 and 16 weeks. The lack of remodeling in chronic PACs suggests that tachycardia and heart rate irregularity do not play a significant role on the development of PVC-cardiomyopathy.