Heart 1998;79:268-273 ( March )
Segmental wall motion abnormalities alter vulnerability to ventricular ectopic beats associated with acute increases in aortic pressure in patients with underlying coronary artery disease
Cardiology Department, Division of
Internal Medicine, University General Hospital, Leoforos
Panepistimiou, Ioannina, Greece
45500
Correspondence to: Dr Siogas.
Accepted for publication 3 November 1997
Objective
To evaluate whether patients with
coronary artery disease are susceptible to pressure related ventricular
arrhythmias, and if so to identify possible risk factors.
DesignInterventional study.
MethodsMetaraminol was given to 43 patients
undergoing coronary arteriography for ischaemic heart disease to
increase their aortic pressure, provided their systolic blood pressure
was < 160 mm Hg and they were in sinus rhythm, without any
ventricular ectopic activity (or with fewer than six ventricular
ectopic beats a minute) during a five minute control period.
ResultsDuring the metaraminol infusion,
systolic aortic pressure rose from 131 (15) to 199 (12) mm Hg (mean
(SD)). Ventricular ectopy appeared (or ventricular ectopic beats
increased by > 100%) in 13/43 patients. Ventricular ectopy was not
related to age, sex, presence of hypertension, history of myocardial
infarction, use of 
blockers, positive exercise test, number of
vessels diseased, or heart rate change during metaraminol infusion.
There was a strong relation between the appearance of ventricular
arrhythmia and segmental wall motion abnormalities: 1/19 (5.3%, 95%
confidence interval 0.1% to 26.0%) without abnormality; 2/12 (16.7%,
2.1% to 48.4%) with hypokinesia; and 10/12 (83.3%, 51.6% to 97.1%) with akinesia or dyskinesia, 
2 = 22.7, p < 0.001).
Ejection fraction was also a significant but not independent risk factor.
ConclusionsPatients with segmental
wall motion abnormalities are predisposed to ventricular ectopic beats
during an increase in systolic aortic pressure. This could be explained
by associated electrophysiological inhomogeneity. The presence of
mechanical inhomogeneity, as may occur in postinfarction akinesia or
dyskinesia, may affect the aortic pressure above which ventricular
arrhythmias appear.
© 1998 by Heart
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