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Loen V, Smoczynska A, Aranda Hernandez A, Scheerder COS, van der Linde BHR, Beekman HDM, Cervera-Barea A, Boink GJJ, Sluijter JPG, van der Heyden MAG, Meine M, Vos MA. Automatic measurement of short-term variability of repolarization to indicate ventricular arrhythmias in a porcine model of cardiac ischaemia. Europace 2023; 25:euad341. [PMID: 37949832 PMCID: PMC10661665 DOI: 10.1093/europace/euad341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023] Open
Abstract
AIMS An automated method for determination of short-term variability (STV) of repolarization on intracardiac electrograms (STV-ARIauto) has previously been developed for arrhythmic risk monitoring by cardiac implantable devices, and has proved effective in predicting ventricular arrhythmias (VA) and guiding preventive high-rate pacing (HRP) in a canine model. Current study aimed to assess (i) STV-ARIauto in relation to VA occurrence and secondarily (ii-a) to confirm the predictive capacity of STV from the QT interval and (ii-b) explore the effect of HRP on arrhythmic outcomes in a porcine model of acute myocardial infarction (MI). METHODS AND RESULTS Myocardial infarction was induced in 15 pigs. In 7/15 pigs, STV-QT was assessed at baseline, occlusion, 1 min before VA, and just before VA. Eight of the 15 pigs were additionally monitored with an electrogram catheter in the right ventricle, underwent echocardiography at baseline and reperfusion, and were randomized to paced or control group. Paced group received atrial pacing at 20 beats per min faster than sinus rhythm 1 min after occlusion. Short-term variability increased prior to VA in both STV modalities. The percentage change in STV from baseline to successive timepoints correlated well between STV-QT and STV-ARIauto. High-rate pacing did not improve arrhythmic outcomes and was accompanied by a stronger decrease in ejection fraction. CONCLUSION STV-ARIauto values increase before VA onset, alike STV-QT in a porcine model of MI, indicating imminent arrhythmias. This highlights the potential of automatic monitoring of arrhythmic risk by cardiac devices through STV-ARIauto and subsequently initiates preventive strategies. Continuous HRP during onset of acute MI did not improve arrhythmic outcomes.
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Affiliation(s)
- Vera Loen
- Department of Medical Physiology, University Medical Center Utrecht, Yalelaan 50, 3584 CM Utrecht, The Netherlands
| | - Agnieszka Smoczynska
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Coert O S Scheerder
- CRM EMEA Medical Science, Medtronic Bakken Research Center, Maastricht, The Netherlands
| | - Britt H R van der Linde
- Department of Medical Physiology, University Medical Center Utrecht, Yalelaan 50, 3584 CM Utrecht, The Netherlands
| | - Henriëtte D M Beekman
- Department of Medical Physiology, University Medical Center Utrecht, Yalelaan 50, 3584 CM Utrecht, The Netherlands
| | - Aina Cervera-Barea
- Experimental Cardiology Laboratory, Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Gerard J J Boink
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Joost P G Sluijter
- Experimental Cardiology Laboratory, Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marcel A G van der Heyden
- Department of Medical Physiology, University Medical Center Utrecht, Yalelaan 50, 3584 CM Utrecht, The Netherlands
| | - Mathias Meine
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marc A Vos
- Department of Medical Physiology, University Medical Center Utrecht, Yalelaan 50, 3584 CM Utrecht, The Netherlands
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Smoczyńska A, Loen V, Sprenkeler DJ, Tuinenburg AE, Ritsema van Eck HJ, Malik M, Schmidt G, Meine M, Vos MA. Short-Term Variability of the QT Interval Can be Used for the Prediction of Imminent Ventricular Arrhythmias in Patients With Primary Prophylactic Implantable Cardioverter Defibrillators. J Am Heart Assoc 2020; 9:e018133. [PMID: 33215550 PMCID: PMC7763775 DOI: 10.1161/jaha.120.018133] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Short‐term variability of the QT interval (STVQT) has been proposed as a novel electrophysiological marker for the prediction of imminent ventricular arrhythmias in animal models. Our aim is to study whether STVQT can predict imminent ventricular arrhythmias in patients. Methods and Results In 2331 patients with primary prophylactic implantable cardioverter defibrillators, 24‐hour ECG Holter recordings were obtained as part of the EU‐CERT‐ICD (European Comparative Effectiveness Research to Assess the Use of Primary Prophylactic Implantable Cardioverter Defibrillators) study. ECG Holter recordings showing ventricular arrhythmias of >4 consecutive complexes were selected for the arrhythmic groups (n=170), whereas a control group was randomly selected from the remaining Holter recordings (n=37). STVQT was determined from 31 beats with fiducial segment averaging and calculated as ∑Dn+1‐Dn/30×2, where Dn represents the QT interval. STVQT was determined before the ventricular arrhythmia or 8:00 am in the control group and between 1:30 and 4:30 am as baseline. STVQT at baseline was 0.84±0.47 ms and increased to 1.18±0.74 ms (P<0.05) before the ventricular arrhythmia, whereas the STVQT in the control group remained unchanged. The arrhythmic patients were divided into three groups based on the severity of the arrhythmia: (1) nonsustained ventricular arrhythmia (n=32), (2) nonsustained ventricular tachycardia (n=134), (3) sustained ventricular tachycardia (n=4). STVQT increased before nonsustained ventricular arrhythmia, nonsustained ventricular tachycardia, and sustained ventricular tachycardia from 0.80±0.43 ms to 1.18±0.78 ms (P<0.05), from 0.90±0.49 ms to 1.14±0.70 ms (P<0.05), and from 1.05±0.22 ms to 2.33±1.25 ms (P<0.05). This rise in STVQT was significantly higher in sustained ventricular tachycardia compared with nonsustained ventricular arrhythmia (+1.28±1.05 ms versus +0.24±0.57 ms [P<0.05]) and compared with nonsustained ventricular arrhythmia (+0.34±0.87 ms [P<0.05]). Conclusions STVQT increases before imminent ventricular arrhythmias in patients, and the extent of the increase is associated with the severity of the ventricular arrhythmia.
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Affiliation(s)
- Agnieszka Smoczyńska
- Department of Medical Physiology University Medical Center Utrecht Utrecht The Netherlands
| | - Vera Loen
- Department of Medical Physiology University Medical Center Utrecht Utrecht The Netherlands
| | - David J Sprenkeler
- Department of Medical Physiology University Medical Center Utrecht Utrecht The Netherlands
| | - Anton E Tuinenburg
- Department of Cardiology University Medical Center Utrecht Utrecht The Netherlands
| | - Henk J Ritsema van Eck
- Department of Medical Informatics Erasmus University Medical Center Rotterdam The Netherlands
| | - Marek Malik
- National Heart and Lung InstituteImperial College London London United Kingdom
| | - Georg Schmidt
- Medical Klinik und Poliklinik I Technische Universität MünchenKlinikum rechts der Isar Münich Germany
| | - Mathias Meine
- Department of Cardiology University Medical Center Utrecht Utrecht The Netherlands
| | - Marc A Vos
- Department of Medical Physiology University Medical Center Utrecht Utrecht The Netherlands
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Schmidt M, Baumert M, Penzel T, Malberg H, Zaunseder S. Nocturnal ventricular repolarization lability predicts cardiovascular mortality in the Sleep Heart Health Study. Am J Physiol Heart Circ Physiol 2019; 316:H495-H505. [DOI: 10.1152/ajpheart.00649.2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The objective of the present study was to quantify repolarization lability and its association with sex, sleep stage, and cardiovascular mortality. We analyzed polysomnographic recordings of 2,263 participants enrolled in the Sleep Heart Health Study (SHHS-2). Beat-to-beat QT interval variability (QTV) was quantified for consecutive epochs of 5 min according to the dominant sleep stage [wakefulness, nonrapid eye movement stage 2 (NREM2), nonrapid eye movement stage 3 (NREM3), and rapid eye movement (REM)]. To explore the effect of sleep stage and apnea-hypopnea index (AHI) on QT interval parameters, we used a general linear mixed model and mixed ANOVA. The Cox proportional hazards model was used for cardiovascular disease (CVD) death prediction. Sex-related differences in T wave amplitude ( P < 0.001) resulted in artificial QTV differences. Hence, we corrected QTV parameters by T wave amplitude for further analysis. Sleep stages showed a significant effect ( P < 0.001) on QTV. QTV was decreased in deep sleep compared with wakefulness, was higher in REM than in NREM, and showed a distinct relation to AHI in all sleep stages. The T wave amplitude-corrected QTV index (cQTVi) in REM sleep was predictive of CVD death (hazard ratio: 2.067, 95% confidence interval: 1.105–3.867, P < 0.05) in a proportional hazards model. We demonstrated a significant impact of sleep stages on ventricular repolarization variability. Sex differences in QTV are due to differences in T wave amplitude, which should be corrected for. Independent characteristics of QTV measures to sleep stages and AHI showed different behaviors of heart rate variability and QTV expressed as cQTVi. cQTVi during REM sleep predicts CVD death. NEW & NOTEWORTHY We demonstrate here, for the first time, a significant impact of sleep stages on ventricular repolarization variability, quantified as QT interval variability (QTV). We showed that QTV is increased in rapid eye movement sleep, reflective of high sympathetic drive, and predicts death from cardiovascular disease. Sex-related differences in QTV are shown to be owing to differences in T wave amplitude, which should be corrected for.
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Affiliation(s)
- Martin Schmidt
- Institute of Biomedical Engineering, TU Dresden, Dresden, Germany
| | - Mathias Baumert
- Centre For Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Thomas Penzel
- Center for Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hagen Malberg
- Institute of Biomedical Engineering, TU Dresden, Dresden, Germany
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Zabel M, Sticherling C, Willems R, Lubinski A, Bauer A, Bergau L, Braunschweig F, Brugada J, Brusich S, Conen D, Cygankiewicz I, Flevari P, Taborsky M, Hansen J, Hasenfuß G, Hatala R, Huikuri HV, Iovev S, Kääb S, Kaliska G, Kasprzak JD, Lüthje L, Malik M, Novotny T, Pavlović N, Schmidt G, Shalganov T, Sritharan R, Schlögl S, Szavits Nossan J, Traykov V, Tuinenburg AE, Velchev V, Vos MA, Willich SN, Friede T, Svendsen JH, Merkely B. Rationale and design of the EU-CERT-ICD prospective study: comparative effectiveness of prophylactic ICD implantation. ESC Heart Fail 2018; 6:182-193. [PMID: 30299600 PMCID: PMC6351896 DOI: 10.1002/ehf2.12367] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 08/30/2018] [Indexed: 01/10/2023] Open
Abstract
Aims The clinical effectiveness of primary prevention implantable cardioverter defibrillator (ICD) therapy is under debate. The EUropean Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators (EU‐CERT‐ICD) aims to assess its current clinical value. Methods and results The EU‐CERT‐ICD is a prospective investigator‐initiated non‐randomized, controlled, multicentre observational cohort study performed in 44 centres across 15 European Union countries. We will recruit 2250 patients with ischaemic or dilated cardiomyopathy and a guideline indication for primary prophylactic ICD implantation. This sample will include 1500 patients at their first ICD implantation and 750 patients who did not receive a primary prevention ICD despite having an indication for it (non‐randomized control group). The primary endpoint is all‐cause mortality; the co‐primary endpoint in ICD patients is time to first appropriate shock. Secondary endpoints include sudden cardiac death, first inappropriate shock, any ICD shock, arrhythmogenic syncope, revision procedures, quality of life, and cost‐effectiveness. At baseline (and prior to ICD implantation if applicable), all patients undergo 12‐lead electrocardiogram (ECG) and Holter ECG analysis using multiple advanced methods for risk stratification as well as detailed documentation of clinical characteristics and laboratory values. Genetic biobanking is also organized. As of August 2018, baseline data of 2265 patients are complete. All subjects will be followed for up to 4.5 years. Conclusions The EU‐CERT‐ICD study will provide a necessary update about clinical effectiveness of primary prophylactic ICD implantation. This study also aims for improved risk stratification and patient selection using clinical and ECG risk markers.
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Affiliation(s)
- Markus Zabel
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | | | - Rik Willems
- Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Andrzej Lubinski
- Department of Cardiology, Medical University of Lodz (MUL) WAM Hospital, Lodz, Poland
| | - Axel Bauer
- Department of Cardiology, Klinikum Großhadern, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Leonard Bergau
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany
| | | | - Josep Brugada
- IDIBAPS, Department of Cardiology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Sandro Brusich
- Department of Cardiovascular Disease, KBC Rijeka, Rijeka, Croatia
| | - David Conen
- Department of Cardiology, University Hospital, Basel, Switzerland.,Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Iwona Cygankiewicz
- Department of Electrocardiology, Medical University of Lodz (MUL), Lodz, Poland
| | - Panagiota Flevari
- 2nd Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - Milos Taborsky
- Department of Cardiology, University Hospital, Olomouc, Czech Republic
| | | | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Robert Hatala
- Slovak Medical University NUSCH, Bratislava, Slovakia
| | - Heikki V Huikuri
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Svetoslav Iovev
- Department of Cardiology, St. Ekaterina University Hospital, Sofia, Bulgaria
| | - Stefan Kääb
- Department of Cardiology, Klinikum Großhadern, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | | | - Jaroslaw D Kasprzak
- Chair and Department of Cardiology, Bieganski Hospital, Medical University of Lodz (MUL), Lodz, Poland
| | - Lars Lüthje
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, London, UK
| | - Tomas Novotny
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
| | - Nikola Pavlović
- Department of Cardiology, KBC Sestre Milosrdnice, Zagreb, Croatia
| | - Georg Schmidt
- Med. Klinik und Poliklinik I, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | | | - Rajeeva Sritharan
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany
| | - Simon Schlögl
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany
| | | | - Vassil Traykov
- Department of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Anton E Tuinenburg
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vasil Velchev
- Department of Cardiology, St. Anna Hospital, Sofia, Bulgaria
| | - Marc A Vos
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefan N Willich
- Institute for Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Tim Friede
- DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.,Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Béla Merkely
- Department of Cardiology, Semmelweis University Heart Center, Budapest, Hungary
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