UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Left ventricular hypertrophy and arrhythmia

Author
Philip J Podrid, MD, FACC
Section Editor
George L Bakris, MD
Deputy Editor
Brian C Downey, MD, FACC

INTRODUCTION

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 [1]. 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 [2]. Nevertheless, if echocardiography is unavailable or too expensive, appropriate ECG criteria can be used to detect increased LV mass [3]. (See "Electrocardiographic diagnosis of left ventricular hypertrophy".)

LVH has been associated with both ventricular and supraventricular arrhythmias [4]. 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 [7], and other cardiovascular morbidity and mortality [8]. (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".)

              

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Mar 2016. | This topic last updated: Mar 4, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Elias MF, Sullivan LM, Elias PK, et al. Left ventricular mass, blood pressure, and lowered cognitive performance in the Framingham offspring. Hypertension 2007; 49:439.
  2. Barrios V, Escobar C, Calderon A, et al. Prevalence of left ventricular hypertrophy detected by Cornell voltage-duration product in a hypertensive population. Blood Press 2008; 17:110.
  3. Ang D, Lang C. The prognostic value of the ECG in hypertension: where are we now? J Hum Hypertens 2008; 22:460.
  4. Chatterjee S, Bavishi C, Sardar P, et al. Meta-analysis of left ventricular hypertrophy and sustained arrhythmias. Am J Cardiol 2014; 114:1049.
  5. Kannel WB, Gordon T, Offutt D. Left ventricular hypertrophy by electrocardiogram. Prevalence, incidence, and mortality in the Framingham study. Ann Intern Med 1969; 71:89.
  6. Kannel WB, Doyle JT, McNamara PM, et al. Precursors of sudden coronary death. Factors related to the incidence of sudden death. Circulation 1975; 51:606.
  7. Kannel WB, Gordon T, Castelli WP, Margolis JR. Electrocardiographic left ventricular hypertrophy and risk of coronary heart disease. The Framingham study. Ann Intern Med 1970; 72:813.
  8. Kannel WB, Castelli WP, McNamara PM, et al. Role of blood pressure in the development of congestive heart failure. The Framingham study. N Engl J Med 1972; 287:781.
  9. Fagard RH. Impact of different sports and training on cardiac structure and function. Cardiol Clin 1997; 15:397.
  10. Pluim BM, Zwinderman AH, van der Laarse A, van der Wall EE. The athlete's heart. A meta-analysis of cardiac structure and function. Circulation 2000; 101:336.
  11. Abernethy WB, Choo JK, Hutter AM Jr. Echocardiographic characteristics of professional football players. J Am Coll Cardiol 2003; 41:280.
  12. Cuspidi C, Lonati L, Sampieri L, et al. Similarities and differences in structural and functional changes of left ventricle and carotid arteries in young borderline hypertensives and in athletes. J Hypertens 1996; 14:759.
  13. Di Bello V, Pedrinelli R, Giorgi D, et al. Ultrasonic videodensitometric analysis of two different models of left ventricular hypertrophy. Athlete's heart and hypertension. Hypertension 1997; 29:937.
  14. Zehender M, Meinertz T, Keul J, Just H. ECG variants and cardiac arrhythmias in athletes: clinical relevance and prognostic importance. Am Heart J 1990; 119:1378.
  15. Biffi A, Maron BJ, Di Giacinto B, et al. Relation between training-induced left ventricular hypertrophy and risk for ventricular tachyarrhythmias in elite athletes. Am J Cardiol 2008; 101:1792.
  16. McLenachan JM, Henderson E, Morris KI, Dargie HJ. Ventricular arrhythmias in patients with hypertensive left ventricular hypertrophy. N Engl J Med 1987; 317:787.
  17. Levy D, Anderson KM, Savage DD, et al. Risk of ventricular arrhythmias in left ventricular hypertrophy: the Framingham Heart Study. Am J Cardiol 1987; 60:560.
  18. Siegel D, Cheitlin MD, Black DM, et al. Risk of ventricular arrhythmias in hypertensive men with left ventricular hypertrophy. Am J Cardiol 1990; 65:742.
  19. Vester EG, Kuhls S, Ochiulet-Vester J, et al. Electrophysiological and therapeutic implications of cardiac arrhythmias in hypertension. Eur Heart J 1992; 13 Suppl D:70.
  20. Ghali JK, Kadakia S, Cooper RS, Liao YL. Impact of left ventricular hypertrophy on ventricular arrhythmias in the absence of coronary artery disease. J Am Coll Cardiol 1991; 17:1277.
  21. Schmieder RE, Messerli FH. Determinants of ventricular ectopy in hypertensive cardiac hypertrophy. Am Heart J 1992; 123:89.
  22. Novo S, Barbagallo M, Abrignani MG, et al. Increased prevalence of cardiac arrhythmias and transient episodes of myocardial ischemia in hypertensives with left ventricular hypertrophy but without clinical history of coronary heart disease. Am J Hypertens 1997; 10:843.
  23. Mammarella A, Paradiso M, Basili S, et al. Morphologic left ventricular patterns and prevalence of high-grade ventricular arrhythmias in the normotensive and hypertensive elderly. Adv Ther 2000; 17:222.
  24. Palmiero P, Maiello M. Ventricular arrhythmias and left ventricular hypertrophy in essential hypertension. Minerva Cardioangiol 2000; 48:427.
  25. Narayanan K, Reinier K, Teodorescu C, et al. Electrocardiographic versus echocardiographic left ventricular hypertrophy and sudden cardiac arrest in the community. Heart Rhythm 2014; 11:1040.
  26. Bikkina M, Larson MG, Levy D. Asymptomatic ventricular arrhythmias and mortality risk in subjects with left ventricular hypertrophy. J Am Coll Cardiol 1993; 22:1111.
  27. Aronow WS, Epstein S, Koenigsberg M, Schwartz KS. Usefulness of echocardiographic left ventricular hypertrophy, ventricular tachycardia and complex ventricular arrhythmias in predicting ventricular fibrillation or sudden cardiac death in elderly patients. Am J Cardiol 1988; 62:1124.
  28. Saadehm Anm Joes JV. Predictors of sudden cardiac death in never previously treated patients with essential hypertension: long-term follow up. J Hum Hypertens 2001; 15:667.
  29. Panikkath R, Reinier K, Uy-Evanado A, et al. Electrocardiographic predictors of sudden cardiac death in patients with left ventricular hypertrophy. Ann Noninvasive Electrocardiol 2013; 18:225.
  30. Verdecchia P, Reboldi G, Gattobigio R, et al. Atrial fibrillation in hypertension: predictors and outcome. Hypertension 2003; 41:218.
  31. Chrispin J, Jain A, Soliman EZ, et al. Association of electrocardiographic and imaging surrogates of left ventricular hypertrophy with incident atrial fibrillation: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol 2014; 63:2007.
  32. Okin PM, Bang CN, Wachtell K, et al. Relationship of sudden cardiac death to new-onset atrial fibrillation in hypertensive patients with left ventricular hypertrophy. Circ Arrhythm Electrophysiol 2013; 6:243.
  33. Margey R, Roy A, Tobin S, et al. Sudden cardiac death in 14- to 35-year olds in Ireland from 2005 to 2007: a retrospective registry. Europace 2011; 13:1411.
  34. Haider AW, Larson MG, Benjamin EJ, Levy D. Increased left ventricular mass and hypertrophy are associated with increased risk for sudden death. J Am Coll Cardiol 1998; 32:1454.
  35. O'Gorman DJ, Sheridan DJ. Abnormalities of the coronary circulation associated with left ventricular hypertrophy. Clin Sci (Lond) 1991; 81:703.
  36. Houghton JL, Prisant LM, Carr AA, et al. Relationship of left ventricular mass to impairment of coronary vasodilator reserve in hypertensive heart disease. Am Heart J 1991; 121:1107.
  37. Lucarini AR, Picano E, Salvetti A. Coronary microvascular disease in hypertensives. Clin Exp Hypertens A 1992; 14:55.
  38. Houghton JL, Carr AA, Prisant LM, et al. Morphologic, hemodynamic and coronary perfusion characteristics in severe left ventricular hypertrophy secondary to systemic hypertension and evidence for nonatherosclerotic myocardial ischemia. Am J Cardiol 1992; 69:219.
  39. Harrison DG, Marcus ML, Dellsperger KC, et al. Pathophysiology of myocardial perfusion in hypertension. Circulation 1991; 83:III14.
  40. Koren MJ, Devereux RB, Casale PN, et al. Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med 1991; 114:345.
  41. Swynghedauw B, Chevalier B, Charlemagne D, et al. Cardiac hypertrophy, arrhythmogenicity and the new myocardial phenotype. II. The cellular adaptational process. Cardiovasc Res 1997; 35:6.
  42. Levy D, Anderson KM, Plehn J, et al. Echocardiographically determined left ventricular structural and functional correlates of complex or frequent ventricular arrhythmias on one-hour ambulatory electrocardiographic monitoring. Am J Cardiol 1987; 59:836.
  43. McLenachan JM, Dargie HJ. Ventricular arrhythmias in hypertensive left ventricular hypertrophy. Relationship to coronary artery disease, left ventricular dysfunction, and myocardial fibrosis. Am J Hypertens 1990; 3:735.
  44. Gillis AM, Mathison HJ, Kulisz E, Lester WM. Dispersion of ventricular repolarization and ventricular fibrillation in left ventricular hypertrophy: influence of selective potassium channel blockers. J Pharmacol Exp Ther 2000; 292:381.
  45. Hennersdorf MG, Niebch V, Perings C, Strauer BE. T wave alternans and ventricular arrhythmias in arterial hypertension. Hypertension 2001; 37:199.
  46. Yan GX, Rials SJ, Wu Y, et al. Ventricular hypertrophy amplifies transmural repolarization dispersion and induces early afterdepolarization. Am J Physiol Heart Circ Physiol 2001; 281:H1968.
  47. Toyoshima H, Park YD, Ishikawa Y, et al. Effect of ventricular hypertrophy on conduction velocity of activation front in the ventricular myocardium. Am J Cardiol 1982; 49:1938.
  48. Verdecchia P, Schillaci G, Guerrieri M, et al. Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension. Circulation 1990; 81:528.
  49. Schwartz PJ, La Rovere MT, Vanoli E. Autonomic nervous system and sudden cardiac death. Experimental basis and clinical observations for post-myocardial infarction risk stratification. Circulation 1992; 85:I77.
  50. Anderson JL, Rodier HE, Green LS. Comparative effects of beta-adrenergic blocking drugs on experimental ventricular fibrillation threshold. Am J Cardiol 1983; 51:1196.
  51. Hennersdorf MG, Schueller PO, Steiner S, Strauer BE. Prevalence of paroxysmal atrial fibrillation depending on the regression of left ventricular hypertrophy in arterial hypertension. Hypertens Res 2007; 30:535.
  52. Okin PM, Wachtell K, Devereux RB, et al. Regression of electrocardiographic left ventricular hypertrophy and decreased incidence of new-onset atrial fibrillation in patients with hypertension. JAMA 2006; 296:1242.
  53. Healey JS, Baranchuk A, Crystal E, et al. Prevention of atrial fibrillation with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: a meta-analysis. J Am Coll Cardiol 2005; 45:1832.
  54. Rials SJ, Wu Y, Ford N, et al. Effect of left ventricular hypertrophy and its regression on ventricular electrophysiology and vulnerability to inducible arrhythmia in the feline heart. Circulation 1995; 91:426.
  55. Rials SJ, Wu Y, Xu X, et al. Regression of left ventricular hypertrophy with captopril restores normal ventricular action potential duration, dispersion of refractoriness, and vulnerability to inducible ventricular fibrillation. Circulation 1997; 96:1330.
  56. Messerli FH, Nunez BD, Nunez MM, et al. Hypertension and sudden death. Disparate effects of calcium entry blocker and diuretic therapy on cardiac dysrhythmias. Arch Intern Med 1989; 149:1263.
  57. Novo S, Abrignani MG, Novo G, et al. Effects of drug therapy on cardiac arrhythmias and ischemia in hypertensives with LVH. Am J Hypertens 2001; 14:637.
  58. González-Fernández RA, Rivera M, Rodríguez PJ, et al. Prevalence of ectopic ventricular activity after left ventricular mass regression. Am J Hypertens 1993; 6:308.
  59. Manolis AJ, Beldekos D, Handanis S, et al. Comparison of spirapril, isradipine, or combination in hypertensive patients with left ventricular hypertrophy: effects on LVH regression and arrhythmogenic propensity. Am J Hypertens 1998; 11:640.
  60. Koren MJ, Devereux RB. Mechanism, effects, and reversal of left ventricular hypertrophy in hypertension. Curr Opin Nephrol Hypertens 1993; 2:87.
  61. Yurenev AP, Dyakonova HG, Novikov ID, et al. Management of essential hypertension in patients with different degrees of left ventricular hypertrophy. Multicenter trial. Am J Hypertens 1992; 5:182S.
  62. Levy D, Salomon M, D'Agostino RB, et al. Prognostic implications of baseline electrocardiographic features and their serial changes in subjects with left ventricular hypertrophy. Circulation 1994; 90:1786.
  63. Wachtell K, Okin PM, Olsen MH, et al. Regression of electrocardiographic left ventricular hypertrophy during antihypertensive therapy and reduction in sudden cardiac death: the LIFE Study. Circulation 2007; 116:700.
  64. Dahlöf B, Devereux RB, Kjeldsen SE, et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002; 359:995.