24-Hour QT variability in heart failure

Dobson, Craig P; Rovere, Maria Teresa La; Olsen, Cara; Berardinangeli, Marino; Veniani, Marco; Midi, Paolo; Tavazzi, Luigi; Haigney, Mark C.

doi:10.1016/j.jelectrocard.2009.06.021

Cited by 25 publications

(14 citation statements)

References 8 publications

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“…Patients with heart failure have a higher QTV compared to age matched controls (Piccirillo et al, 2013). Heart failure patients show a marked circadian variation with an increase in QTV during the daytime (Dobson et al, 2009). Enhanced sympathetic activity by tilt table testing in heart failure patients is associated with an increased QTV although the increase may be impaired in comparison to normal subjects (Desai et al, 2004; Piccirillo et al, 2006).…”

Section: Discussionmentioning

confidence: 99%

Autonomic Modulation in Patients with Heart Failure Increases Beat-to-Beat Variability of Ventricular Action Potential Duration

et al. 2017

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Background: Exaggerated beat-to-beat variability of ventricular action potential duration (APD) is linked to arrhythmogenesis. Sympathetic stimulation has been shown to increase QT interval variability, but its effect on ventricular APD in humans has not been determined.Methods and Results: Eleven heart failure patients with implanted bi-ventricular pacing devices had activation–recovery intervals (ARI, surrogate for APD) recorded from LV epicardial electrodes under constant RV pacing. Sympathetic activity was increased using a standard autonomic challenge (Valsalva) and baroreceptor indices were applied to determine changes in sympathetic stimulation. Two Valsalvas were performed for each study and were repeated, both off and on bisoprolol. In addition sympathetic nerve activity (SNA) was measured from skin electrodes on the thorax using a novel validated method. Autonomic modulation significantly increased mean short-term variability in ARI; off bisoprolol mean STV increased from 3.73 ± 1.3 to 5.27 ± 1.04 ms (p = 0.01), on bisoprolol mean STV of ARI increased from 4.15 ± 1.14 to 4.62 ± 1 ms (p = 0.14). Adrenergic indices of the Valsalva demonstrated significantly reduced beta-adrenergic function when on bisoprolol (Δ pressure recovery time, p = 0.04; Δ systolic overshoot in Phase IV, p = 0.05). Corresponding increases in SNA from rest both off (1.4 uV, p < 0.01) and on (0.7 uV, p < 0.01) bisoprolol were also seen.Conclusions: Beat-to-beat variability of ventricular APD increases during brief periods of increased sympathetic activity in patients with heart failure. Bisoprolol reduces, but does not eliminate, these effects. This may be important in the genesis of ventricular arrhythmias in heart failure patients.

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Section: Discussionmentioning

confidence: 99%

Autonomic Modulation in Patients with Heart Failure Increases Beat-to-Beat Variability of Ventricular Action Potential Duration

et al. 2017

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“…Shusterman et al (2006) described an upsurge of alternating and non-alternating RL 10 min before the onset of VT/VF in HF patients. Analysis of 24-h Holter ECG revealed pronounced diurnal variations in QTVI (higher QT variability in the morning and during the day, and lower QT variability during the night) in HF patients (Dobson et al, 2009). At the same time, no significant changes in the mean QTVI trend was detected during 12 h of ECG monitoring before the onset of spontaneous VT/VF in the acute intensive cardiac care unit patients (Sachdev et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

Longitudinal changes in intracardiac repolarization lability in patients with implantable cardioverter-defibrillator

Guduru¹,

Lansdown²,

Chernichenko³

et al. 2013

Front. Physiol.

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Background: While it is known that elevated baseline intracardiac repolarization lability is associated with the risk of fast ventricular tachycardia (FVT)/ventricular fibrillation (VF), the effect of its longitudinal changes on the risk of FVT/VF is unknown.Methods and Results: Near-field (NF) right ventricular (RV) intracardiac electrograms (EGMs) were recorded every 3–6 months at rest in 248 patients with structural heart disease [mean age 61.2 ± 13.3; 185(75%) male; 162(65.3%) ischemic cardiomyopathy] and implanted cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) [201 (81%) primary prevention]. Intracardiac beat-to-beat QT variability index (QTVINF) was measured on NF RV EGM. During the first study phase (median 18 months), participants made on average 2.4 visits. Then remote follow-up was continued for an additional median period of 3 years. Average QTVINF did not change during the first year after ICD implantation (−0.342 ± 0.603 at baseline vs. −0.262 ± 0.552 at 6 months vs. −0.334 ± 0.603 at 12 months); however, it decreased thereafter (−0.510 ± 0.603 at 18 months; P = 0.042). Adjusted population-averaged GEE model showed that the odds of developing FVT/VF increased by 75% for each 1 unit increase in QTVINF. (OR 1.75 [95%CI 1.05–2.92]; P = 0.031). However, individual patient–specific QTVINF trends (increasing, decreasing, flat) varied from patient to patient. For a given patient, the odds of developing FVT/VF were not associated with increasing or decreasing QTVINF over time [OR 1.27; (95%CI 0.05–30.10); P = 0.881].Conclusion: While on average the odds of FVT/VF increased with an increase in QTVINF, patient-specific longitudinal trends in QTVINF did not affect the odds of FVT/VF.

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“…44 Other methods include heart rate variability, late potentials on signalaveraged ECG, QT dispersion, T-wave alternans, time to inscribe the second half of the T wave (T peak -T end ), and beat-to-beat variability of repolarization. 45,46,47,48,49,50 Although these tests have the potential to provide a more comprehensive assessment of repolarization reserve, validation is essential. A common failing of currently existing noninvasive assays of electric stability is high specificity for predicting fatal arrhythmias but low sensitivity.…”

Section: Limitations Of the Tqt And Future Directions For Proarrhythmmentioning

confidence: 99%

Evaluation of Toxicity for Heart Failure Therapeutics

Link

Yan

Kowey

2010

Circ: Heart Failure

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24-Hour QT variability in heart failure

Cited by 25 publications

References 8 publications

Autonomic Modulation in Patients with Heart Failure Increases Beat-to-Beat Variability of Ventricular Action Potential Duration

Autonomic Modulation in Patients with Heart Failure Increases Beat-to-Beat Variability of Ventricular Action Potential Duration

Longitudinal changes in intracardiac repolarization lability in patients with implantable cardioverter-defibrillator

Evaluation of Toxicity for Heart Failure Therapeutics

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