Left ventricular hypertrophy and arrhythmia
- Philip J Podrid, MD, FACC
Philip J Podrid, MD, FACC
- Professor of Medicine, Professor of Pharmacology and Experimental Therapeutics
- Boston University School of Medicine
- Lecturer, Harvard Medical School
Left ventricular hypertrophy (LVH) is a common finding in patients with cardiovascular disease (CVD) and CVD risk factors, and it can be diagnosed either by electrocardiogram (ECG) or by echocardiography . Echocardiography is generally preferred for confirming the presence of LVH since the sensitivity of the different ECG criteria may be as low as 7 to 35 percent with mild LVH and only 10 to 50 percent with moderate to severe disease . Nevertheless, if echocardiography is unavailable or too expensive, appropriate ECG criteria can be used to detect increased LV mass . (See "Electrocardiographic diagnosis of left ventricular hypertrophy".)
LVH has been associated with both ventricular and supraventricular arrhythmias . Data, primarily from the Framingham Heart Study, have identified electrocardiographic LVH as a blood pressure-independent risk for sudden cardiac death (SCD) [5,6], acute myocardial infarction , and other cardiovascular morbidity and mortality . (See "Clinical implications and treatment of left ventricular hypertrophy in hypertension" and "Electrocardiographic diagnosis of left ventricular hypertrophy".)
This topic will review the association between LVH and arrhythmias (both ventricular and supraventricular) as well as sudden cardiac death. The pathogenesis of LVH in hypertension is discussed separately. (See "Definition and pathogenesis of left ventricular hypertrophy in hypertension".)
DEFINITION AND ETIOLOGIES OF LVH
Left ventricular hypertrophy (LVH) is defined as an increase in the mass of the left ventricle, which can be secondary to an increase in wall thickness, an increase in cavity size, or both. This increase in mass predominantly results from a chronic increase in left ventricular afterload, although there is also a genetic component.
LV mass can be estimated using various imaging techniques, including echocardiography and cardiac magnetic resonance (CMR) imaging. The standards for normal and increased LV mass are gender-specific. (See "Definition and pathogenesis of left ventricular hypertrophy in hypertension", section on 'Definition' and "Clinical utility of cardiovascular magnetic resonance imaging".)
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- DEFINITION AND ETIOLOGIES OF LVH
- MAKING THE DIAGNOSIS OF LVH
- LVH AND VENTRICULAR ARRHYTHMIAS
- LVH AND SUPRAVENTRICULAR ARRHYTHMIAS
- LVH AND RISK OF SUDDEN CARDIAC DEATH
- MECHANISMS OF ARRHYTHMIAS IN LVH
- Electrophysiologic abnormalities
- Abnormalities of the hypertrophied myocardial cell
- Increased sympathetic activity
- REGRESSION OF LVH
- Effect on atrial fibrillation
- Effect on ventricular arrhythmias
- Effect on sudden cardiac death