Determinants of the incidence and severity of ventricular arrhythmias in aortic valve disease

Abstract

The incidence of ventricular arrhythmias in patients with aortic valve disease was investigated. Twenty-four-hour ambulatory electrocardiographic recordings were obtained in 93 patients without coronary artery disease (aortic stenosis [AS], n = 38; combined AS and aortic regurgitation [AR], n = 27; and AR only, n = 28). The arrhythmias were compared with the hemodynamic findings of cardiac catheterization. Ventricular premature beats (VPB) were noted in 78 patients (84%). They were rare (< 100 VPB/22 hours) in 40 patients (43%), moderately frequent (101 to 1,000 VPB/22 hours) in 23 patients (25%), and frequent (> 1,000 VPB/22 hours) in 15 patients (16%). Multiformity was found in 47 (51%), paired VPB in 32 (34%), and ventricular tachycardia in 17 (18%) of the 93 patients studied. The occurrence of ventricular arrhythmia was not related to the type of valve lesion, to the transvalvular gradient in patients with AS, or to the degree of regurgitation in patients with AR. In contrast, the grade of arrhythmia showed a negative correlation with left ventricular ejection fraction (AS, r s = −0.58; AS and AR, r s = −0.67; AR, r s = −0.78; all p < 0.001) and a positive correlation with peak systolic left ventricular wall stress (AS, r s = 0.56; AS and AR, r s = 0.56; AR, r s = 0.57; all p < 0.001). The frequency of VPB also showed a negative correlation with left ventricular ejection fraction (AS, r s = −0.63; AS and AR, r s = −0.65; AR, r s = −0.71; all p < 0.001). This study indicates that ventricular arrhythmias are present in a large number of patients with aortic valve disease. The severity of arrhythmias is strongly influenced by myocardial performance. Thus, severe arrhythmias are frequently a sign of impaired left ventricular function.