Abstract
The aim of this opinion paper is to point out the knowledge gap between evidence on the molecular level and clinical diagnostic possibilities in left ventricular hypertrophy (LVH) regarding the prediction of ventricular arrhythmias and monitoring the effect of therapy. LVH is defined as an increase in left ventricular size and is associated with increased occurrence of ventricular arrhythmia. Hypertrophic rebuilding of myocardium comprises interrelated processes on molecular, subcellular, cellular, tissue, and organ levels affecting electrogenesis, creating a substrate for triggering and maintaining arrhythmias. The knowledge of these processes serves as a basis for developing targeted therapy to prevent and treat arrhythmias. In the clinical practice, the method for recording electrical phenomena of the heart is electrocardiography. The recognized clinical electrocardiogram (ECG) predictors of ventricular arrhythmias are related to alterations in electrical impulse propagation, such as QRS complex duration, QT interval, early repolarization, late potentials, and fragmented QRS, and they are not specific for LVH. However, the simulation studies have shown that the QRS complex patterns documented in patients with LVH are also conditioned remarkably by the alterations in impulse propagation. These QRS complex patterns in LVH could be potentially recognized for predicting ventricular arrhythmia and for monitoring the effect of therapy.
Highlights
Ventricular arrhythmias, especially ventricular tachycardia and ventricular fibrillation, are life-threatening arrhythmias, frequently leading to sudden cardiac deaths
Fragmented QRS complex is frequently seen in patients with left ventricular hypertrophy (LVH), and it was reported to be associated with ventricular arrhythmia [114,115,116]
LVH is associated with higher prevalence of these non-specific predictors of ventricular arrhythmia resulting from significant rebuilding of myocardium-affecting electrogenesis that is potentially arrhythmogenic
Summary
Ventricular arrhythmias, especially ventricular tachycardia and ventricular fibrillation, are life-threatening arrhythmias, frequently leading to sudden cardiac deaths. There are several ECG findings that are recognized as ventricular arrhythmia predictors, and their interpretation is related to altered electrophysiological processes and to our understanding of ventricular arrhythmias mechanism They are not specific for a certain clinical diagnosis and include, e.g., prolonged QRS complex duration, prolonged QT interval/corrected QT interval (QTc), early repolarization, and the fragmented QRS complex (fQRS). The progress and detailed knowledge in terms of electrogenesis are not reflected in the interpretation of P-QRS-T waveforms analysis, where the traditional interpretation still persists The aim of this opinion paper is to discuss possible links between QRS complex morphology and ventricular arrhythmias based on molecular and electrophysiological processes and to discuss ECG patterns that could potentially indicate abnormal electrical substrate pertinent to conditions necessary for re-entry to occur. The links between ECG diagnostic criteria based on underlying processes affecting electrogenesis are demonstrated using an example of left ventricular hypertrophy (LVH)
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