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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| Format: | Article |
| Language: | English |
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MDPI AG
2023-02-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/10/2/89 |
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| author | Resi M. Schoonderwoerd Mariëlle Dik Sumche Man Arie C. Maan J. Wouter Jukema Cees A. Swenne |
| author_facet | Resi M. Schoonderwoerd Mariëlle Dik Sumche Man Arie C. Maan J. Wouter Jukema Cees A. Swenne |
| author_sort | Resi M. Schoonderwoerd |
| collection | DOAJ |
| description | 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, <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mover accent="true"><mrow><mi>V</mi><msub><mi>G</mi><mi>p</mi></msub></mrow><mo stretchy="true">→</mo></mover></mrow></semantics></math></inline-formula>, of the ectopic beat, <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mover accent="true"><mrow><mi>V</mi><msub><mi>G</mi><mi>e</mi></msub></mrow><mo stretchy="true">→</mo></mover></mrow></semantics></math></inline-formula>, and of the VG difference vector, <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mover accent="true"><mrow><mo>Δ</mo><mi>V</mi><msub><mi>G</mi><mrow><mi>e</mi><mi>p</mi></mrow></msub></mrow><mo stretchy="true">→</mo></mover></mrow></semantics></math></inline-formula>, and compared their sizes. <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mfenced close="|" open="|"><mrow><mover accent="true"><mrow><mi>V</mi><msub><mi>G</mi><mi>e</mi></msub></mrow><mo stretchy="true">→</mo></mover></mrow></mfenced></mrow></semantics></math></inline-formula> of the SA and V ectopic beats were significantly larger than <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mfenced close="|" open="|"><mrow><mover accent="true"><mrow><mi>V</mi><msub><mi>G</mi><mi>p</mi></msub></mrow><mo stretchy="true">→</mo></mover></mrow></mfenced></mrow></semantics></math></inline-formula> (53.7 ± 25.0 vs. 47.8 ± 24.6 mV∙ms, respectively; <i>p</i> < 0.001). <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mfenced close="|" open="|"><mrow><mover accent="true"><mrow><mo>Δ</mo><mi>V</mi><msub><mi>G</mi><mrow><mi>e</mi><mi>p</mi></mrow></msub></mrow><mo stretchy="true">→</mo></mover></mrow></mfenced></mrow></semantics></math></inline-formula> were three times larger than the difference of <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mfenced close="|" open="|"><mrow><mover accent="true"><mrow><mi>V</mi><msub><mi>G</mi><mi>e</mi></msub></mrow><mo stretchy="true">→</mo></mover></mrow></mfenced></mrow></semantics></math></inline-formula> and <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mfenced close="|" open="|"><mrow><mover accent="true"><mrow><mi>V</mi><msub><mi>G</mi><mi>p</mi></msub></mrow><mo stretchy="true">→</mo></mover></mrow></mfenced></mrow></semantics></math></inline-formula> (19.94 ± 9.76 vs. 5.94 mV∙ms, respectively), demonstrating differences in the <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mover accent="true"><mrow><mi>V</mi><msub><mi>G</mi><mi>p</mi></msub></mrow><mo stretchy="true">→</mo></mover></mrow></semantics></math></inline-formula> and <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mover accent="true"><mrow><mi>V</mi><msub><mi>G</mi><mi>e</mi></msub></mrow><mo stretchy="true">→</mo></mover></mrow></semantics></math></inline-formula> spatial directions. The amount of ectopic prematurity was not correlated with <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mfenced close="|" open="|"><mrow><mover accent="true"><mrow><mo>Δ</mo><mi>V</mi><msub><mi>G</mi><mrow><mi>e</mi><mi>p</mi></mrow></msub></mrow><mo stretchy="true">→</mo></mover></mrow></mfenced></mrow></semantics></math></inline-formula>, 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. |
| first_indexed | 2024-03-11T08:39:08Z |
| format | Article |
| id | doaj.art-dda6af5514b8429a8e17bf3eab654d2b |
| institution | Directory Open Access Journal |
| issn | 2308-3425 |
| language | English |
| last_indexed | 2024-03-11T08:39:08Z |
| publishDate | 2023-02-01 |
| publisher | MDPI AG |
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| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj.art-dda6af5514b8429a8e17bf3eab654d2b2023-11-16T21:16:52ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252023-02-011028910.3390/jcdd10020089Intra-Individual Comparison of Sinus and Ectopic Beats Probing the Ventricular Gradient’s Activation DependenceResi M. Schoonderwoerd0Mariëlle Dik1Sumche Man2Arie C. Maan3J. Wouter Jukema4Cees A. Swenne5Cardiology Department, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The NetherlandsCardiology Department, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The NetherlandsCardiology Department, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The NetherlandsCardiology Department, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The NetherlandsCardiology Department, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The NetherlandsCardiology Department, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The NetherlandsWilson 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, <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mover accent="true"><mrow><mi>V</mi><msub><mi>G</mi><mi>p</mi></msub></mrow><mo stretchy="true">→</mo></mover></mrow></semantics></math></inline-formula>, of the ectopic beat, <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mover accent="true"><mrow><mi>V</mi><msub><mi>G</mi><mi>e</mi></msub></mrow><mo stretchy="true">→</mo></mover></mrow></semantics></math></inline-formula>, and of the VG difference vector, <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mover accent="true"><mrow><mo>Δ</mo><mi>V</mi><msub><mi>G</mi><mrow><mi>e</mi><mi>p</mi></mrow></msub></mrow><mo stretchy="true">→</mo></mover></mrow></semantics></math></inline-formula>, and compared their sizes. <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mfenced close="|" open="|"><mrow><mover accent="true"><mrow><mi>V</mi><msub><mi>G</mi><mi>e</mi></msub></mrow><mo stretchy="true">→</mo></mover></mrow></mfenced></mrow></semantics></math></inline-formula> of the SA and V ectopic beats were significantly larger than <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mfenced close="|" open="|"><mrow><mover accent="true"><mrow><mi>V</mi><msub><mi>G</mi><mi>p</mi></msub></mrow><mo stretchy="true">→</mo></mover></mrow></mfenced></mrow></semantics></math></inline-formula> (53.7 ± 25.0 vs. 47.8 ± 24.6 mV∙ms, respectively; <i>p</i> < 0.001). <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mfenced close="|" open="|"><mrow><mover accent="true"><mrow><mo>Δ</mo><mi>V</mi><msub><mi>G</mi><mrow><mi>e</mi><mi>p</mi></mrow></msub></mrow><mo stretchy="true">→</mo></mover></mrow></mfenced></mrow></semantics></math></inline-formula> were three times larger than the difference of <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mfenced close="|" open="|"><mrow><mover accent="true"><mrow><mi>V</mi><msub><mi>G</mi><mi>e</mi></msub></mrow><mo stretchy="true">→</mo></mover></mrow></mfenced></mrow></semantics></math></inline-formula> and <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mfenced close="|" open="|"><mrow><mover accent="true"><mrow><mi>V</mi><msub><mi>G</mi><mi>p</mi></msub></mrow><mo stretchy="true">→</mo></mover></mrow></mfenced></mrow></semantics></math></inline-formula> (19.94 ± 9.76 vs. 5.94 mV∙ms, respectively), demonstrating differences in the <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mover accent="true"><mrow><mi>V</mi><msub><mi>G</mi><mi>p</mi></msub></mrow><mo stretchy="true">→</mo></mover></mrow></semantics></math></inline-formula> and <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mover accent="true"><mrow><mi>V</mi><msub><mi>G</mi><mi>e</mi></msub></mrow><mo stretchy="true">→</mo></mover></mrow></semantics></math></inline-formula> spatial directions. The amount of ectopic prematurity was not correlated with <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mfenced close="|" open="|"><mrow><mover accent="true"><mrow><mo>Δ</mo><mi>V</mi><msub><mi>G</mi><mrow><mi>e</mi><mi>p</mi></mrow></msub></mrow><mo stretchy="true">→</mo></mover></mrow></mfenced></mrow></semantics></math></inline-formula>, 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.https://www.mdpi.com/2308-3425/10/2/89action potential duration restitutionextrasystolesintraventricular conductionspatial ventricular gradientvectorcardiogram |
| spellingShingle | Resi M. Schoonderwoerd Mariëlle Dik Sumche Man Arie C. Maan J. Wouter Jukema Cees A. Swenne Intra-Individual Comparison of Sinus and Ectopic Beats Probing the Ventricular Gradient’s Activation Dependence Journal of Cardiovascular Development and Disease action potential duration restitution extrasystoles intraventricular conduction spatial ventricular gradient vectorcardiogram |
| title | Intra-Individual Comparison of Sinus and Ectopic Beats Probing the Ventricular Gradient’s Activation Dependence |
| title_full | Intra-Individual Comparison of Sinus and Ectopic Beats Probing the Ventricular Gradient’s Activation Dependence |
| title_fullStr | Intra-Individual Comparison of Sinus and Ectopic Beats Probing the Ventricular Gradient’s Activation Dependence |
| title_full_unstemmed | Intra-Individual Comparison of Sinus and Ectopic Beats Probing the Ventricular Gradient’s Activation Dependence |
| title_short | Intra-Individual Comparison of Sinus and Ectopic Beats Probing the Ventricular Gradient’s Activation Dependence |
| title_sort | intra individual comparison of sinus and ectopic beats probing the ventricular gradient s activation dependence |
| topic | action potential duration restitution extrasystoles intraventricular conduction spatial ventricular gradient vectorcardiogram |
| url | https://www.mdpi.com/2308-3425/10/2/89 |
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