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Left ventricular activation-recovery interval variability predicts spontaneous ventricular tachyarrhythmia in heart failure patients

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
Pages (from-to)702-709
Issue number5
Early online date4 Dec 2018
Accepted/In press6 Nov 2018
E-pub ahead of print4 Dec 2018
Published1 May 2019


King's Authors


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.

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