Fine-scale spatial and temporal variation in temperature and arrhythmia episodes in the VA Normative Aging Study

Abstract

Many studies have demonstrated that cold and hot temperatures are associated with increased deaths and hospitalization rates; new findings indicate also an association with more specific cardiac risk factors. Most of these existing studies have relied on few weather stations to characterize exposures; few have used residence-specific estimates of temperature, or examined the exposure-response function. We investigated the association of arrhythmia episodes with spatial and temporal variation in temperature. We also evaluated the association between monitored ambient temperature (central) and the same outcome. This longitudinal analysis included 701 older men participating in the VA Normative Aging Study. Arrhythmia episodes were measured as ventricular ectopy (VE) (bigeminy, trigemini or couplets episodes) by 4min electrocardiogram (ECG) monitoring in repeated visits during 2000–2010. The outcome was defined as having or not VE episodes during a study visit. We applied a mixed effect logistic regression model with a random intercept for subject, controlling for seasonality, weekday, medication use, smoking, diabetes status, body mass index and age. We also examined effect modification by personal characteristics, confounding by air pollution, and the exposure-response function. For 1° C increase in the same day residence-specific temperature, the odds of having VE episodes was 1.10 (95%CI: 1.04–1.17). The odds associated with 1° C increase in central temperature was 1.05 (95%CI: 1.02–1.09). The exposure-response function was non-linear for averages of temperature, presenting a J-shaped pattern, suggesting greater risk at lower and higher temperatures. Increased warm temperature and decreased cold temperature may increase the risk of ventricular arrhythmias.

Metabolomic signatures of the long-term exposure to air pollution and temperature

“…For example, there is clearly increased mortality in Boston at 25 °C compared to the minimum mortality temperature [ 24 ]. Furthermore, similar associations of non-extreme temperature exposure with other adverse health outcomes other than mortality were reported [ 25 ]. Hence it is critical to identify mechanisms by which temperature may have these effects.…”

Arrhythmic Risk in Elderly Patients Candidates to Transcatheter Aortic Valve Replacement: Predictive Role of Repolarization Temporal Dispersion

“…Another, possibly clinical relevant, finding of the present study was that a simple non-invasive short period myocardial repolarization index, such as the QTe sd obtained at rest, seems to be able to identify those patients with the highest probability to increase ventricular arrhythmias (PVC or complex ventricular arrhythmias) during the MMSE administration. Thus, albeit highly speculative, the QTe sd obtained at rest could be potentially useful in disclosing a general arrhythmias propensity and, accordingly, an increased risk of sudden cardiac death in elderly patients with AS candidate to a TAVR procedure (Massing et al, 2006; Cheriyath et al, 2011; Ataklte et al, 2013; Agarwal et al, 2015; Zanobetti et al, 2017). This clinical feature could frustrate the TAVR’s outcomes and, accordingly, should be worthy to be weighted during the screening procedures.…”

“…During the rhythm analysis, a quantitative evaluation of PVC has been made by dividing the number of PVC every 3 min of each single examined recording thus disclosing the patients with the increase of PVC per minutes during the MENTAL STRESS session. If during the MENTAL STRESS session only, patients showed bigeminy, trigeminy, couplets episodes, R on T phenomenon, sustained or non-sustained ventricular tachycardia, we considered this fact as an increase of arrhythmias (Zanobetti et al, 2017). Secondly, we identified the PVC and sPVC on the traces and we eliminated manually their QRS-T data and also the corresponding following beat (Figure 1), as recommended in previous consensus guidance (Baumert et al, 2016).…”

“…Then, we grouped patients in two categories according to the presence or the absence of complex ventricular arrhythmias recorded during the MENTAL STRESS session. The criteria to include a patient in the complex ventricular arrhythmia group were the following rhythm disturbs during the MENTAL STRESS session: bigeminy, trigeminy or couplet episodes, R on T phenomenon, sustained or non-sustained ventricular tachycardia (Zanobetti et al, 2017). Thereafter we also grouped the patients in two other categories according the presence or the absence of an increase PVC per minute during the MENTAL STRESS session.…”

“…Particularly, we analyzed the short period RR- and QT-interval variables (Baumert et al, 2016) at rest, during controlled breathing and during mild mental stress, the latter being represented by a mini-mental state evaluation (MMSE). Thereafter we evaluated a possible MMSE-induced increase in premature ventricular contraction (PVC) or complex ventricular arrhythmias (bigeminy, trigeminy, couplets episodes, R on T phenomena, sustained or non-sustained ventricular tachycardia) (Zanobetti et al, 2017). Eventually, we sought to assess a possible relationship between the abovementioned ECG derived markers obtained during rest and the arrhythmic risk in terms of complex ventricular arrhythmias increase during MMSE.…”