LEFT VENTRICULAR REMODELING AND ARRHYTHMOGENIC POTENTIAL IN ARTERIAL HYPERTENSION

Objective: To determine the rate of cardiac arrhythmias in hypertensive patients subject to left ventricular remodeling pattern (LVRP) in the absence of coronary artery disease. Design and Methods: The study cohort consisted of 79 patients with proved essential hypertension. The average age of patients was 50,2 ± 10,6 years. All patients were studied using mono- and two-dimensional echocardiography, 24-h dynamic Holter monitoring and exercise ECG testing in order to exclude coronary artery disease. Subject to LVRP the patients were divided into four groups. The first group (n = 5) consisted of the patients with normal geometry; the second group (n = 9) included the patients with concentric remodeling; the third group (n = 45) involved the patients with concentric left ventricular hypertrophy (LVH); the fourth group (n = 20) embraced the patients with eccentric LVH. Ventricular arrhythmias were categorized according to Lown-Wolf classification. Results: The average number (median) of premature atrial contructions (PAC) per hour was 0,4 ± 0,44 (0,29) in the first group; 2,15 ± 5,0. (0,25) in the second group; 13 ± 61,9 (2,2) in the third group and 12,4 ± 27,3 (3,1) in the fourth group. The frequency of PAC was different in the groups (p = 0,0038). The third group patient PAC occured more frequently than the same in the first (ð = 0,01) and in the second group (ð = 0,02). The frequency of complex atrial arrythmias (atrial couplets and runs of supraventricular tachycardia) was not different (p = 0,46; ð = 0,39). Average number (median) of ventricular premature complexes (VPC) per hour was 0,04 ± 0,05 (0,04) in the first group; 0,02 ± 0,03 (0) in the second group; 8 ± 21,8 (0,1) in the third group and 12,4 ± 27,3 (3,1) in the fourth group. The obtained data indicated intergroup differences in VPC frequency (p = 0,004). The third group patient VPC occured more frequently than the same in the second group (p = 0,0007) and the fourth group patients as compared to the second group (ð = 0,01). There were no intergroup differences in high gradation ventricular arrhythmias frequency (p = 0,08). Conclusions: The highest arrhythmogenic potential is detected in hypertensive patients with concentric and eccentric LVH.