Hypertension, Obesity, Left Ventricular Hypertrophy, Complex Ventricular Ectopic Activity, and Increased Risk for Sudden Death Review of Ochsner Studies and the Literature

Abstract

Hypertension, obesity, and left ventricular hypertrophy (LVH) are associated with increased risk of sudden death. The authors reviewed clinical, echocardiographic, and Holter data from 179 patients enrolled in studies at Ochsner Medical Institutions and the medical literature to determine the prevalence and complexity of ventricular arrhythmias in hypertensive patients with concentric and isolated septal hypertrophy (ISH), as well as obese patients with or without eccentric LVH. The prevalence and complexity of ventricular arrhythmias was not significantly increased in hypertensive patients without LVH or with only minimal echocardiographic evidence of concentric LVH. However, ventricular ectopic activity was increased 30-fold in ISH, 40-fold in mild concentric LVH that was evident on the electrocardiogram, and 60-fold in patients with moderate concentric LVH. In obese patients without LVH, ventricular ectopy was increased 40-fold, and by more than 80-fold in obese patients with eccentric LVH. The complexity of ventricular ectopic activity, as defined by higher Lown class, was also significantly increased in these groups. Several recent reports from other institutions also demonstrated the increased prevalence and complexity of ventricular arrhythmias in patients with LVH. These data indicated that all types of LVH, including concentric, eccentric, and ISH, are associated with increased prevalence and complexity of ventricular arrhythmias, suggesting a potential electrophysiologic mechanism that may partly account for the increased risk of sudden death in patients with hypertension, obesity, and LVH. Efforts at preventing and reducing LVH with nonpharmacologic and drug therapies seems warranted.