TY - JOUR
T1 - Left ventricular activation-recovery interval variability predicts spontaneous ventricular tachyarrhythmia in heart failure patients
AU - Porter, Bradley
AU - Bishop, Martin J.
AU - Claridge, Simon
AU - Child, Nicholas
AU - Van Duijvenboden, Stefan
AU - Bostock, Julian
AU - Sieniewicz, Benjamin J.
AU - Gould, Justin
AU - Sidhu, Baldeep
AU - Hanson, Ben
AU - Chen, Zhong
AU - Rinaldi, Christopher A.
AU - Taggart, Peter
AU - Gill, Jaswinder S.
PY - 2019/5/1
Y1 - 2019/5/1
N2 - Background Enhanced beat-to-beat variability of repolarization (BVR) is strongly linked to arrhythmogenesis and is largely due to variation in ventricular action potential duration (APD). Previous studies in humans have relied on QT interval measurements; however, a direct relationship between beat-to-beat variability of APD and arrhythmogenesis in humans has yet to be demonstrated. Objectives This study aimed to explore the beat-to-beat repolarization dynamics within a heart failure population at the level of ventricular APD. Methods 43 patients with heart failure and implanted cardiac resynchronization therapy defibrillator devices were studied. Activation-recovery intervals (ARI) as a surrogate for APD were recorded from the left ventricular epicardial lead while pacing from the right ventricular lead to maintain constant cycle length. Results During mean follow-up of 23.6±13.6 months, 11 patients sustained VT/VF and received appropriate implantable cardioverter-defibrillator therapies (Anti-Tachycardia Pacing or shock therapy). ARI variability (ARIV) was significantly greater in patients with subsequent VT/VF vs. those without VT/VF (3.55±1.3 ms vs. 2.77±1.09 ms, p=0.047). Receiver operating characteristic curve analysis (AUC 0.71, p=0.046) suggested high and low risk ARIV groups for VT/VF. The Kaplan–Meier survival analysis demonstrated that the time until first appropriate therapy for VT/VF was significantly shorter in the high-risk ARIV group (p=0.028). ARIV was a predictor for VT/VF in the multivariate Cox model (HR, 1.623; 95% CI, 1.1 to 2.393; p=0.015). Conclusions Increased left ventricular ARIV is associated with an increased risk of VT/VF in patients with heart failure.
AB - Background Enhanced beat-to-beat variability of repolarization (BVR) is strongly linked to arrhythmogenesis and is largely due to variation in ventricular action potential duration (APD). Previous studies in humans have relied on QT interval measurements; however, a direct relationship between beat-to-beat variability of APD and arrhythmogenesis in humans has yet to be demonstrated. Objectives This study aimed to explore the beat-to-beat repolarization dynamics within a heart failure population at the level of ventricular APD. Methods 43 patients with heart failure and implanted cardiac resynchronization therapy defibrillator devices were studied. Activation-recovery intervals (ARI) as a surrogate for APD were recorded from the left ventricular epicardial lead while pacing from the right ventricular lead to maintain constant cycle length. Results During mean follow-up of 23.6±13.6 months, 11 patients sustained VT/VF and received appropriate implantable cardioverter-defibrillator therapies (Anti-Tachycardia Pacing or shock therapy). ARI variability (ARIV) was significantly greater in patients with subsequent VT/VF vs. those without VT/VF (3.55±1.3 ms vs. 2.77±1.09 ms, p=0.047). Receiver operating characteristic curve analysis (AUC 0.71, p=0.046) suggested high and low risk ARIV groups for VT/VF. The Kaplan–Meier survival analysis demonstrated that the time until first appropriate therapy for VT/VF was significantly shorter in the high-risk ARIV group (p=0.028). ARIV was a predictor for VT/VF in the multivariate Cox model (HR, 1.623; 95% CI, 1.1 to 2.393; p=0.015). Conclusions Increased left ventricular ARIV is associated with an increased risk of VT/VF in patients with heart failure.
KW - ventricular arrhythmia
KW - activation-recovery interval
KW - beat-to-beat variability
KW - intracardiac electrogram
KW - cardiac resynchronization therapy defibrillator
U2 - 10.1016/j.hrthm.2018.11.013
DO - 10.1016/j.hrthm.2018.11.013
M3 - Article
SN - 1547-5271
VL - 16
SP - 702
EP - 709
JO - HEART RHYTHM
JF - HEART RHYTHM
IS - 5
ER -