Hubert Delasnerie, Caroline Biendel, Meyer Elbaz, Franck Mandel, Maxime Beneyto, Guillaume Domain, Quentin Voglimacci-Stephanopoli, Pierre Mondoly, Clement Delmas, Vanina Bongard, Anne Rollin, Philippe Maury
Factors underlying clinical tolerance and hemodynamic consequences of monomorphic sustained ventricular tachycardia (VT) need to be clarified.
Intra-arterial pressures (IAP) during VT were collected in patients admitted for VT ablation and correlated to clinical, ECG and baseline echocardiographical parameters.
Clinical tolerance of sustained monomorphic ventricular tachycardia (VT) is variable and hemodynamical consequences of VT need to be clarified. Although VT rate is involved in hemodynamical tolerance, other mechanisms were described for explaining hemodynamical behavior during VT, such as atrio-ventricular dissociation [1, 2] and the uncoordinated ventricular contraction because of the ectopic pattern of ventricular activation [3–5]. Blurred or compensatory neuro-hormonal response to baroreceptor activation [2, 6] have been demonstrated. Finally, myocardial ischemia might explain some additional decrease in systolic function .
Materials and Methods
We performed a retrospective study of 114 VTs recorded in 58 successive patients referred for VT ablation at the University Hospital of Toulouse in the second half of 2019. Patients were referred for VT ablation either for an elective procedure (n = 37) or for electrical storm (n = 21). Patients with incessant or refractory VTs were not included, because hemodynamical behavior in this critical setting is not representative of stable balanced conditions, and any analysis would be furthermore precluded by the lack of stable baseline control conditions because of ongoing/incessant VTs. Patients with left ventricular assist techniques were not included.
For each patient, cardiac history, underlying cardiomyopathy, cardio-vascular risks factors, coronary status, medical therapy, symptoms and ECG were retrospectively collected.
We could distinguish two different patterns of hemodynamic profiles during VTs: a preserved regular 1:1 relationship between electrical (QRS) and mechanical (IAP) events and some dissociation between them (Fig 3). When the second pattern was identified, VT was more often untolerated compared to the first one (78% vs 29%, p<0.0001). In a few patients, the second pattern was transiently observed, but after a time of adaptation, the first pattern then occurred (Fig 3).
Moreover, we described two phases of time-dependent hemodynamical profiles during sustained VT, with an initial phase with rapid IAP drop followed by a delayed slow IAP increase. Of note, a few patients presented late IAP drop again. These profiles were somewhat different between well-tolerated and untolerated VTs, with larger IAP drop, lower IAP and lower delayed IAP increase in untolerated VTs. Interestingly, initial IAP drop was faster in well tolerated VTs.
Finally, we also could describe two hemodynamical patterns correlated to VT tolerance, depending on the 1:1 relationship between QRS and IAP waves.
This study helps to explain the large variability in clinical tolerance during VT, which is clearly related to intra-arterial pressures. VT tolerance was independently linked to VT rate, presence of resynchronization therapy, location of previous myocardial infarction, presence of concordant VT and QRS duration during VT.
Citation: Delasnerie H, Biendel C, Elbaz M, Mandel F, Beneyto M, Domain G, et al. (2023) Hemodynamical consequences and tolerance of sustained ventricular tachycardia. PLoS ONE 18(5): e0285802. https://doi.org/10.1371/journal.pone.0285802
Editor: Daniel M. Johnson, The Open University, UNITED KINGDOM
Received: December 28, 2022; Accepted: May 1, 2023; Published: May 17, 2023
Copyright: © 2023 Delasnerie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting Information files.
Funding: The authors received no specific funding for this work.
Competing interests : The authors have declared that no competing interests exist.