CARDIOVASCULAR MEDICINE

Physiological changes in ventricular filling alter cardiac electrophysiology in patients with abnormal ventricular function

P R James, S M C Hardman, P Taggart

University College London, Whittington and UCL Hospitals NHS Trust, London, UK

Correspondence to:
Correspondence to:
Dr P Rachael James, Cardiothoracic Centre, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK;
rachael.james{at}virgin.net

Objective: To explore the hypothesis that patients with abnormal ventricular function have an altered electrophysiological response to physiological changes in ventricular filling which is not evident in people with normal ventricles.

Design: The influence of an acute alteration in ventricular filling on dispersion of repolarisation, measured as QT dispersion, was examined in subjects with normal (n = 9) and abnormal ventricles (n = 9). A physiological reduction in ventricular filling was achieved using dual chamber atrioventricular (AV) pacing in two different modes—AV pacing: atrial activation 120 ms before ventricular activation such that atrial contraction occurred normally in late diastole; and VA (ventriculoatrial) pacing: atrial activation 50 ms after ventricular activation, such that atrial contraction occurred after closure of the AV valves. The absence of effective atrial contraction was confirmed by echocardiography. Ventricular cycle length and sequence of excitation through the ventricle was constant throughout both VA and AV sequences within each patient.

Results: During AV pacing (normal ventricular filling) there was no significant difference in QT dispersion between the two groups. In contrast during VA pacing, when the atrial component to ventricular filling was abolished, there was an immediate and consistent increase in QT dispersion compared with baseline in subjects with abnormal ventricular function (p < 0.001) but not in those with normal ventricles.

Conclusions: An abrupt change in ventricular filling, within the physiological range, increased QT dispersion in subjects with abnormal ventricular function but not in subjects with normal ventricles. The findings suggest an altered electrophysiological response to ventricular load in patients with abnormal ventricular function.

Keywords: QT dispersion; ventricular function; dispersion of repolarisation; mechanoelectric feedback

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