Systolic, diastolic, and pulse blood pressure during premature ventricular contractions: relationship with characteristics of ectopic beats

The aim is to assess the relationship between systolic, diastolic, and pulse blood pressure (SBP, DBP, PBP) during ventricular extrasystoles (VE) and the individual characteristics of ectopic beats.

Methods. The primary method of investigation was BP measurement for each heartbeat. Inclusion criteria were the presence of ≥10000 monomorphic VE per day. A total of 53 patients were included, either without structural heart changes or with minimal structural alterations. The mean of systolic, diastolic, and pulse BP (SBP, DBP, and PBP) during VE (SBP VE, DBP VE, PBP VE) and during post-extrasystolic sinus contraction (post VE SBP, post VE DBP, post VE PBP) were calculated for each patient as fractions of 1.0.

Results. The QRS complex width in VE originating from the right ventricular outflow tract is greater than from the left ventricular outflow tract; fragmentation of the QRS complex is more commonly observed in these VE. Significant correlations were observed between SBP VE and mean coupling interval (CI), PBP VE and CI, and SBP VE and PBP VE, though not between DBP VE and CI. DBP VE was significantly associated with VE count and daily VE percentage, while PBP VE was associated with left ventricular ejection fraction. It has been shown that post-VE SBP and post VE DBP are lower, while post VE PBP is higher compared to the corresponding parameters of sinus beats preceding the VE. Significant relationships were found between post VE SBP and post VE PBP, the duration of the post-extrasystolic pause, and the presence of paired VE; between post VE DBP and post VE PBP, DBP VE, CI VE, the presence of non-sustained ventricular tachycardia, and daily VE percentage; between post VE PBP and DBP VE, the presence of non-sustained ventricular tachycardia, daily VE percentage, and post-extrasystolic pause duration. Post VE PBP was equally determined by values of post VE SBP and DBP.

Conclusion. With the shortening of the VE coupling interval, its SBP decreases, while DBP increases slightly, which may determine its hemodynamic significance. In post-extrasystolic sinus beats, both SBP and DBP decrease.

1. Ying Du, Shanshan Ma, Pan Yue, et al. Comparing the effects of pulsed and radiofrequency catheter ablation on quality of life, anxiety, and depression of patients with paroxysmal supraventricular tachycardia: a single-center, randomized, single-blind, standard-controlled trial. Trials. 2024;25(1): 146. https://doi.org/10.1186/s13063-024-07971-8.

2. Medi C, Kalman JM, Freedman SB. Supraventricular tachycardia. Med J Aust. 2009;190(5): 255-60. https://doi.org/10.5694/j.1326-5377.2009.tb02388.x.

3. Lomper K, Ross C, Uchmanowicz I. Anxiety and Depressive Symptoms, Frailty and Quality of Life in Atrial Fibrillation. Int J Environ Res Public Health. 2023;20(2): 1066. https://doi.org/10.3390/ijerph20021066.

4. Thrall G, Lip GY, Carroll D, Lane D. Depression, anxiety, and quality of life in patients with atrial fibrillation. Chest. 2007;132(4): 1259-64. https://doi.org/10.1378/chest.07-0036.

5. Yakovenko TV, Shubik YuV, Kostyuk GP, Kryatova TV. Structure and dynamics of nosogenic psychic reactions in patients with different forms of atrial fibrillation. Journal of arrhythmology. 2006;44: 26-29 (In Russ.).

6. Yakovenko TV, Shubik YuV, Kostyuk GP, Kryatova TV. The quality of life of patients with various forms of atrial fibrillation and the effect on it of treatment of nosogenic psychic reactions. Journal of arrhythmology. 2008;51: 36-39 (In Russ.).

7. Mikhaylov AY, Yumashev AV, Kolpak E. Quality of life, anxiety and depressive disorders in patients with extrasystolic arrhythmia. Arch Med Sci. 2020;18(2): 328-335. https://doi.org/10.5114/aoms.2020.101359.

8. Sandhu U, Kovacs AH, Nazer B. Psychosocial symptoms of ventricular arrhythmias: Integrating patient-reported outcomes into clinical care. Heart Rhythm O2. 2021;2(6Part B): 832-839. https://doi.org/10.1016/j.hroo.2021.09.011.

9. Sandhu U, Nguyen AT, Dornblaser J, et al. Patient-Reported Outcomes in a Multidisciplinary Electrophysiology-Psychology Ventricular Arrhythmia Clinic. J Am Heart Assoc. 2022;11(15): e025301. https://doi.org/10.1161/JAHA.122.025301.

10. Marazzato J, Angeli F, De Ponti R, et al. Atrial fibrillation and sudden cardiac death: a mystery to unravel? G Ital Cardiol (Rome). 2021;22(7): 544-553. https://doi.org/10.1714/3629.36105.

11. Waldmann V, Jouven X, Narayanan K, et al. Association Between Atrial Fibrillation and Sudden Cardiac Death: Pathophysiological and Epidemiological Insights. Circ Res. 2020;127(2): 301-309. https://doi.org/10.1161/CIRCRESAHA.120.316756.

12. Obeyesekere MN, Leong-Sit P, Massel D, et al. Risk of arrhythmia and sudden death in patients with asymptomatic preexcitation: a meta-analysis. Circulation. 2015;125(19): 2308- 15. https://doi.org/10.1161/CIRCULATIONAHA.111.055350.

13. Tang PT, Shenasa M, Boyle NG. Ventricular Arrhythmias and Sudden Cardiac Death. Card Electrophysiol Clin. 2017;9(4): 693-708. https://doi.org/10.1016/j.ccep.2017.08.004.

14. Krummen DE, Ho G, Villongco CT, et al. Ventricular fibrillation: triggers, mechanisms and therapies. Future Cardiol. 2016;12(3): 373-90. https://doi.org/10.2217/fca-2016-0001.

15. Boudoulas H, Dervenagas S, Schaal SF, et al. Malignant premature ventricular beats in ambulatory patients. Ann Intern Med. 1979 Nov;91(5): 723-6. https://doi.org/10.7326/0003-4819-91-5-723.

16. Von Olshausen K, Treese N, Pop T, et al. Sudden cardiac death in long-term electrocardiography. Dtsch Med Wochenschr. 1985 Aug 2;110(31-32): 1195-201.

17. Zeppenfeld K, Tfelt-Hansen J, De Riva M, et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. European Heart Journal. 2022);00:1-130 https://doi.org/10.1093/eurheartj/ehac262.

18. Lebedev DS, Mikhailov EN, Neminuschiy NM, et al. Ventricular arrhythmias. Ventricular tachycardias and sudden cardiac death. 2020 Clinical guidelines. Russian Journal of Cardiology. 2021;26(7): 4600. (In Russ.) https://doi.org/10.15829/1560-4071-2021-4600.

19. Dan G-A, Martinez-Rubio A, Agewall S, et al. Antiarrhythmic drugs-clinical use and clinical decision making: a consensus document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology (ESC) Working Group on Cardiovascular Pharmacology, endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS) and International Society of Cardiovascular Pharmacotherapy (ISCP). Europace. 2018;20(5): 731-732an. https://doi.org/10.1093/europace/eux373.

20. Agesen FN, Lynge TH, Blanche P, et al. Temporal trends and sex differences in sudden cardiac death in the Copenhagen City Heart Study. Heart. 2021;107: 1303-1309. https://doi.org/10.1136/heartjnl-2020-318881.

21. Shkolnikova MA, Shubik YuV, Shalnova SA, et al. Cardiac Arrhythmias in Elderly Patients and Their Correlation with Health Indices and Mortality. Journal of arrhythmology. 2007;49: 5-13 (In Russ.).

22. Wilde AAM, Amin AS. Clinical Spectrum of SCN5A Mutations: Long QT Syndrome, Brugada Syndrome, and Cardiomyopathy. JACC Clin Electrophysiol. 2018;4(5): 569- 579. https://doi.org/10.1016/j.jacep.2018.03.006.

23. Skinner JR, Winbo A, Abrams D, et al. Channelopathies That Lead to Sudden Cardiac Death: Clinical and Genetic Aspects. Heart Lung Circ. 2019;28(1): 22-30. https://doi.org/10.1016/j.hlc.2018.09.007.

24. Schimpf R, Veltmann C, Wolpert C, Borggrefe M. Arrhythmogenic hereditary syndromes: Brugada Syndrome, long QT syndrome, short QT syndrome and CPVT. Minerva Cardioangiol. 2010;58(6): 623-36.

25. Collis R, Elliott PM. Sudden cardiac death in inherited cardiomyopathy. Int J Cardiol. 2017;237: 56-59. https://doi.org/10.1016/j.ijcard.2017.04.006.

26. Gordeeva MV, Veleslavova OE, Baturova MA, et al. Sudden non-violent death in young adults (retrospective analysis). Journal of arrhythmology. 2011;65: 25-32 (In Russ.)

27. Gordeeva MV, Mitrofanova LB, Pahomov AV, et al. Arrhythmogenic right ventricular cardiomyopathy/dysplasia as the cause of sudden cardiac death in young adults. Journal of arrhythmology. 2012;69: 38-48 (In Russ.)

28. Sedov VM, Yashin SM, Shubik YuV. Arrhythmogenic right ventricular dysplasia/cardiomyopathy. Journal of arrhythmology. 2000;20: 23-30 (In Russ.)

29. Ryabkova VA, Churilov LP, Shoenfeld Y, et al. Lethal immunoglobulins: auto antibodies and sudden cardiac death. Autoimmunity Reviews. 2019;18(4): 415-425.

30. Arakelyan MG, Bockeria LA, Vasilieva EYu, et al. 2020 Clinical guidelines for Atrial fibrillation and atrial flutter. Russian Journal of Cardiology. 2021;26(7): 4594. (In Russ.). https://doi.org/10.15829/1560-4071-2021-4594

31. Bokeria LA, Golukhova EZ, Popov SV, et al. 2020 Clinical practice guidelines for Supraventricular tachycardia in adults. Russian Journal of Cardiology. 2021;26(5): 4484. (In Russ.).

32. Shubik YuV, Korneev AB, Morozov AN. Number of ventricular premature beats and other causes of cardiomyopathy associated with arrhythmia: case reports.. Journal of arrhythmology. 2023;30(4): e11-e15. https://doi.org/10.35336/VA-1237.

33. Latchamsetty R, Bogun F. Premature Ventricular Complex-Induced Cardiomyopathy. JACC Clin Electrophysiol. 2019;5(5): 537-550. https://doi.org/10.1016/j.jacep.2019.03.013.

34. Saurav A, Smer A, Abuzaid A, et al. Premature ventricular contraction-induced cardiomyopathy. Clin Cardiol. 2015;38(4): 251-8. https://doi.org/10.1002/clc.22371.

35. Treshkur TV, Tulintseva TE, Tatarinova AA, et al. Ventricular arrhythmias and holter monitoring - principles of formation of the conclusion on the results of the study. Journal of arrhythmology. 2018; 93: 53-63. (In Russ.). https://doi.org/10.25760/VA-2018-93-53-63.

36. Steger A, Sinnecker D, Barthel P, et al. Post-extrasystolic Blood Pressure Potentiation as a Risk Predictor in Cardiac Patients. Arrhythmia & Electrophysiology Review. 2016;5(1): 27-30. https://doi.org/10.15420/aer.2016.14.2.

37. Kuijer PJ, Van der Werf T, Meijler FL. Post-extrasystolic potentiation without a compensatory pause in normal and diseased hearts. Br Heart J. 1990;63(5): 284-6. https://doi.org/10.1136/hrt.63.5.284.

38. Mulpuru SK, Witt CM. Post-Extrasystolic Potentiation for Individualizing Care of Premature Ventricular Contraction-Induced Cardiomyopathy. JACC Clin Electrophysiol. 2017;3(11): 1292-1295. https://doi.org/10.1016/j.jacep.2017.07.010.

39. Sprenkeler DJ, Vos MA. Post-extrasystolic Potentiation: Link between Ca(2+) Homeostasis and Heart Failure? Arrhythm Electrophysiol Rev. 2016;5(1): 20-6. https://doi. org/10.15420/aer.2015.29.2.

40. Brignole M, Moya A, Frederik J. de Lange FJ, et al. Practical Instructions for the 2018 ESC Guidelines for the diagnosis and management of syncope. European Heart Journal. 2018;39: e43-e80. https://doi.org/10.1093/eurheartj/ehy071.

41. Thijs RD, Brignole M, FalupPecurariu C, et al. Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness. Clinical Autonomic Research. 2021. https://doi.org/10.1007/s10286-020-00738-6.

42. Shubik YuV, Pivovarov VV, Zaytsev GK, et al. Blood pressure measuring at every heartbeat in atrial fibrillation patients: the next step towards the personalization of treatment strategy. Journal of arrhythmology. 2021;28(1): 23-32. (In Russ.). https://doi.org/10.35336/VA-2021-1-23-32.

43. Shubik YuV, Korneev AB, Medvedev MM, Morozov AN. Hemodynamic features of different variants of the premature ventricular constractions. Vestnik of Saint Petersburg University. Medicine. 2023;18(3): 258-273 (In Russ.)]. https://doi.org/10.21638/spbu11.2023.303

44. Vainshtein AB, Yashin SM, Dumpis YaYu, Shubik YuV. Electrocardiographic topical diagnostics of non-coronary right ventricular arrhythmias. Journal of arrhythmology. 2004;34: 11-17. (In Russ.).

45. Revishvili Ash, Noskova MV, Rzaev FG, Artyuchina EV. Noninvasive topical diagnostics of non-coronary ventricular arrhythmias. Journal of arrhythmology. 2004;35: 5-15. (In Russ.).

46. Budanova MA, Chmelevsky MP, Treshkur TV, Tikhonenko VM. Еlectrocardiographic criteria and algorithms for differential diagnosis of wide QRS complexes arrhythmias. Journal of arrhythmology. 2020;27(4): 24-32. https://doi.org/10.35336/VA-2020-4-24-32. (In Russ.).

47. Taymasova IA, Yashkov MV, Dedukh EV, et al. History of development of ventricular arrhythmias diagnostics. Kardiologiia. 2021;61(12): 108-116. (In Russ.).