Effect of short‐term fasting on electrocardiographic parameters

Abstract

IntroductionDuring early drug development trials, electrocardiograms (ECGs) in healthy volunteers who are in a fasting state are evaluated to screen for possible adverse cardiac effects. However, the effect of the duration of fasting on electrocardiographic parameters is largely unknown. We compared the effects of fasting on standard 12‐lead electrocardiographic recordings.MethodsElectrocardiograms were available for 432 healthy subjects (mean age 28.5 ± 12.5; 88.9% male) who participated in early drug development studies after 4‐ and 10‐hr fasting. All ECGs were automatically analyzed for conduction intervals and wave amplitudes with the Marquette 12SL algorithm and compared among fasting duration. Mixed model analyses were used to identify confounding variables.ResultsAfter 10 hr of fasting, compared to after 4 hr of fasting, mean P‐wave duration and amplitude were reduced by 1.95 ± 1.48 ms and 2.18 ± 2.75 μV, mean R wave and S wave amplitude were decreased by 25.83 ± 31.16 μV and 55.39 ± 78.72 μV, mean QRS duration was decreased by 1.84 ± 6.61 ms, and mean T‐wave duration and amplitude were decreased by 2.06 ± 0.72 ms and 9.36 ± 17.21 μV (lead II). The mean PR interval was prolonged by 4.26 ± 17.67 ms, the ventricular rate was reduced by 3.64 ± 8.61 min, and QTcF was reduced by 3.87 ± 14.50 ms. These observations persisted after correction for demographics, electrolytes, blood pressure, heart rate variability, and diurnal variation.ConclusionThe present analysis showed that 10‐hr fasting compared to 4‐hr fasting resulted in changes to the surface ECG, consisting of a reduced wave amplitude and duration and increased isoelectric interval duration.

Effects of Different Fasting Interventions on Cardiac Autonomic Modulation in Healthy Individuals: A Secondary Outcome Analysis of the EDIF Trial

“…Additionally, the presence of transient ER pattern, QRS shortening as well as decreased HR have been reported in subjects with food deprivation [ 32 , 33 ]. The substantial impact of fasting on ECG parameters with a certain intersubjective variability of physiological response by food intake, demonstrated in previous research [ 30 ], can be confirmed by our data on ECG parameter changes. In this context, our obtained findings in healthy subjects demonstrated the safety of various fasting interventions with no clinically relevant ECG parameter changes.…”

“…Some studies in healthy individuals demonstrated no increased cardiac risk during body mass reduction by the modified fasting intervention of moderate duration [ 28 ] and unaltered ECG following the fastening condition [ 29 ]. Contrary findings were revealed previously which analyzed the influence of brief and transient fasting on ECG parameters as well as HRV data, whereas decreased measurements for QRS duration, baseline HR and changes in QTc duration as well as HRV alterations could be revealed [ 27 , 30 , 31 ]. Additionally, the presence of transient ER pattern, QRS shortening as well as decreased HR have been reported in subjects with food deprivation [ 32 , 33 ].…”

“…Therefore, the administrated variable IF and TRF schedules in our healthy young participants seem to be safely transferable in daily routines based on our short-term follow-up assessment. Nevertheless, our observations have to be handled with care due to the following reasons: firstly, cardiac repolarization changes in general are known to be individually associated with fasting and feeding; secondly, the obtained QTc levels might be influenced by variable sympathetic activity due to circadian rhythmic; therefore, finally, the ACM might play a role in fasting-related QTc changes [ 30 , 34 ]. In order to obtain comparable and unbiased results, we scheduled the visits (mainly) in the morning hours to exclude any interferential effects of the variable sympathetic activity due to the circadian rhythm and to exclude the previously described QTc shortening after lunch and QTc lengthening after dinner [ 35 ].…”