January 1, 2003Pacing and Clinical Electrophysiology
Heart Rate Turbulence After Atrial and Ventricular Premature Beats: Relation to Left Ventricular Function and Coupling Intervals
Key result
APBs induce heart rate turbulence but generate a ~53% lower turbulence slope than VPBs.
- P<0.008
- n=37
Why the study?
The presence of heart rate turbulence after atrial premature beats and the effects of coupling intervals on HRT in patients with and without left ventricular dysfunction were unclear.
Does the type of premature beat (atrial vs ventricular) and coupling interval affect heart rate turbulence in patients with and without left ventricular dysfunction?
Population
37 subjects referred for electrophysiologic evaluation for ventricular tachycardia, including patients with and without left ventricular dysfunction
Comparison
HRT after atrial premature beats vs ventricular premature beats; normal ejection fraction vs left ventricular dysfunction
Design
Observational study with stimulation protocol of atrial and ventricular extrastimuli
Authors
Discussion
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Implication
Heart rate turbulence measurement requires distinguishing premature beat type; extends prior observations but leaves open effects on risk stratification.
Study Design
Type
Observational (n=37)
Structured PICO
Does the type of premature beat (atrial vs ventricular) and coupling interval affect heart rate turbulence in patients with and without left ventricular dysfunction?
P
Population
37 subjects (mean age 54 years, 13.5% female) referred for electrophysiologic evaluation for ventricular tachycardia who underwent a stimulation protocol.
E
Exposure
Stimulation protocol consisting of 3 series of single atrial and ventricular extrastimuli with coupling intervals decremented from 750 to 400 ms at a 50 ms-step.
C
Comparator
Comparison between atrial premature beats (APB) and ventricular premature beats (VPB), as well as between patients with normal ejection fraction and left ventricular dysfunction.
O
Outcome
Turbulence onset (TO) and turbulence slope (TS) after an APB and a VPB.surrogate
Main Result
Absolute Event Rate: 3.95% vs 8.32%
p-value: p=<0.008
An atrial premature beat induces heart rate turbulence, but the response is substantially attenuated compared to a ventricular premature beat and is not influenced by the coupling interval.
Cite This Study
Savelieva et al. (2003) conducted an observational in Ventricular tachycardia evaluation (n=37). Atrial premature beat (APB) vs. Ventricular premature beat (VPB) was evaluated on Turbulence slope (TS) (p=<0.008). An atrial premature beat induces heart rate turbulence, but compared to a ventricular premature beat, turbulence slope is significantly attenuated (3.95 vs 8.32 ms/RR, P<0.008).