Incidence, reproducibility and prognostic significance of ventricular echo beats in patients with and without coronary heart disease
Abendroth, R.R.; Breithardt, G.; Bleses, H.P.; Yeh, H.L.; Seipel, L.
Zeitschrift für Kardiologie 70(12): 889-894
1981
ISSN/ISBN: 0300-5860 PMID: 6171940 Document Number: 169067
A controversy developed regarding the prognostic significance of postextrastimulus ventricular repetitive beating in humans. The incidence, and the prognostic significance of repetitive ventricular beating in response to programmed ventricular stimulation were studied. The prospective study was done in 237 patients (185 female, 55 male, mean age .+-. SD: 50.4 .+-. 7.6 yr). Programmed right ventricular stimulation was done during spontaneous rhythm using 1 or 2 premature stimuli. The incidence of ventricular echo beats in response to programmed single or double ventricular extrastimuli delivered during spontaneous rhythm was correlated with angiographic and clinical findings of the patients as well as the natural history of the illness. To determine the reproducibility of ventricular echo beats, the programmed ventricular stimulation in the apex of the right ventricle was repeated up to 5 times. A repetitive ventricular response was observed in 52/237 patients (21.9%) after 1, and 150/237 patients (63.2%) after 2 premature stimuli. In patients with normal left ventricular function, ventricular echo beats occurred in 9.5% with abnormal left ventricular function and in 26.4% (.ltoreq. 0.01) after 1 premature stimuli. After 2 permature stimuli there was no difference in the incidence of repetitive beating in patients with normal or abnormal left ventricular function (60.3 vs. 64.3%). The incidence of ventricular echo beats could be reproduced in a small number of patients. During an average patient follow-up period of 9.1 mo. (1-16 mo.) 231 patients were alive and was lost of follow-up. Three of 5 patients who died were classified as sudden death patients. All sudden death patients had abnormal left ventricular function. Of these 3 patients, 1 had ventricular echo beats. Fifty-seven underwent an aortocoronary bypass operation. This prospective study showed a correlation between the incidence of ventricular echo beats in response to programmed single ventricular extrastimuli delivered during spontaneous rhythm and left ventricular function. This correlation could not be evaluated after 2 premature stimuli. At this time of mean follow-up period, the incidence of ventricular echo beats induced during sinus rhythm in patients with chronic coronary heart disease is not a prognostic indicator to predict sudden death.