Chicken-egg and Cardiomyopathy Ventricular Extrasystole Paradox

Abstract

Objectives: Left ventricular ejection fraction (LVEF) may decrease due to frequent ventricular extrasystoles (VESs). This study aimed to investigate whether the site of VES origin and other VES characteristics are associated with a decline in LVEF. Methods: The rhythm Holter records and follow-up files of 400 patients who presented to the outpatient clinic with complaints such as palpitations, presyncope, syncope, and dyspnea between January 2017 and March 2023 and who were prescribed a rhythm Holter as part of their evaluation were retrospectively reviewed. The relationship between reduced LVEF, defined as LVEF <50% on echocardiography, and VES characteristics was examined in patients with normal LVEF and a VES burden above 10%, utilizing 24- and 48-h electrophysiology studies. Results: The study comprised 34 patients with a mean age of 59.8±17.0 (range: 21–87) years. Among them, 55.9% (19 patients) were female, and the mean ejection fraction (EF) % was 49.5±11.3 (range: 25–67). Patients with EF % <50 (n=18) exhibited significantly higher diastolic diameter (5.3±0.5 vs. 4.7±0.5 cm, respectively; p=0.004), VES burden (32.3 vs. 16.7, respectively; p=0.0001), longer coupling interval (CI) measurements (p=0.018), and QRS duration (p=0.0001) compared to patients with EF % >50 (n=16). A positive correlation was observed between VES load and QRS duration in the group with EF <50% (r=0.664; p=0.002). In patients who developed VES-induced cardiomyopathy (CMP), VES originated from the mitral annulus (p<0.001), whereas VES originating from the right ventricular outflow tract was significantly associated with the non-CMP group (p<0.001). Conclusion: The burden of VESs may be associated with CMP, as well as longer QRS duration, CI, and exit location.