| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 1996;93:1836-1844.)
© 1996 American Heart Association, Inc.
Articles |
Abnormalities in Beat-to-Beat Dynamics of Heart Rate Before the Spontaneous Onset of Life-Threatening Ventricular Tachyarrhythmias in Patients With Prior Myocardial Infarction
From the Division of Cardiology, Department of Medicine, University of Oulu (Finland) (H.V.H., T.S., M.J.K., K.E.J.A., M.J.I.), and the Division of Cardiology, Miami (Fla) University Medical Center (A.C., R.J.M.).
Correspondence to Heikki V. Huikuri, MD, Division of Cardiology, Department of Medicine, University of Oulu, Kajaanintie 50, FIN-90220 Oulu, Finland.
Background Beat-to-beat analysis of RR intervals can reveal patterns of heart-rate dynamics, which are not easily detected by summary measures of heart-rate variability. This study was designed to test the hypothesis that alterations in RR-interval dynamics occur before the spontaneous onset of ventricular tachyarrhythmias (VT).
Methods and Results Ambulatory ECG recordings from 15 patients with prior myocardial infarction (MI) who had spontaneous episodes of sustained VT during the recording and VT inducible by programmed electrical stimulation (VT group) were analyzed by plotting each RR interval of a sinus beat as a function of the previous one (Poincaré plot). Poincaré plots were also generated for 30 post-MI patients who had no history of spontaneous VT events and no inducible VT (MI control subjects) and for 30 age-matched subjects without heart disease (normal control subjects). The MI control subjects and VT group were matched with respect to age and severity of underlying heart disease. All the healthy subjects and MI control subjects showed fan-shaped Poincaré plots characterized by an increased next-interval difference for long RR intervals relative to short ones. All the VT patients had abnormal plots: 9 with a complex pattern, 3 ball-shaped, and 3 torpedo-shaped. Quantitative analysis of the Poincaré plots showed the SD of the long-term RR-interval variability (SD2) to be smaller in all VT patients (52±14 ms; range, 31 to 75 ms) than in MI control subjects (110±24 ms; range, 78 to 179 ms, P<.001) or the normal control subjects (123±38 ms, P<.001), but the SD of the instantaneous beat-to-beat variability (SD1) did not differ between the groups. The complex plots were caused by periods of alternating sinus intervals, resulting in an increased SD1/SD2 ratio in the VT group. This ratio increased during the 1-hour period preceding the onset of 27 spontaneous VT episodes (0.43±0.20) compared with the 24-hour average ratio (0.33±0.19) (P<.01).
Conclusions Reduced long-term RR-interval variability, associated with episodes of beat-to-beat sinus alternans, is a highly specific sign of a propensity for spontaneous onset of VT, suggesting that abnormal beat-to-beat heart-rate dynamics may reflect a transient electrical instability favoring the onset of VT in patients conditioned by structurally abnormal hearts.
Key Words: dynamics • heart rate • tachyarrhythmias
This article has been cited by other articles:
 |
|
 |
|
  A. Porta, K. R. Casali, A. G. Casali, T. Gnecchi-Ruscone, E. Tobaldini, N. Montano, S. Lange, D. Geue, D. Cysarz, and P. Van Leeuwen Temporal asymmetries of short-term heart period variability are linked to autonomic regulation Am J Physiol Regulatory Integrative Comp Physiol, August 1, 2008; 295(2): R550 - R557. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Zhong, K.-M. Jan, K. H. Ju, and K. H. Chon Quantifying cardiac sympathetic and parasympathetic nervous activities using principal dynamic modes analysis of heart rate variability Am J Physiol Heart Circ Physiol, September 1, 2006; 291(3): H1475 - H1483. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Guzzetti, E. Borroni, P. E. Garbelli, E. Ceriani, P. D. Bella, N. Montano, C. Cogliati, V. K. Somers, A. Mallani, and A. Porta Symbolic Dynamics of Heart Rate Variability: A Probe to Investigate Cardiac Autonomic Modulation Circulation, July 26, 2005; 112(4): 465 - 470. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Z.-K. Wu, S. Vikman, J. Laurikka, E. Pehkonen, T. Iivainen, H. V. Huikuri, and M. R. Tarkka Nonlinear heart rate variability in CABG patients and the preconditioning effect Eur. J. Cardiothorac. Surg., July 1, 2005; 28(1): 109 - 113. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M.J. Reed, C.E. Robertson, and P.S. Addison Heart rate variability measurements and the prediction of ventricular arrhythmias QJM, February 1, 2005; 98(2): 87 - 95. [Full Text] [PDF]
|
|
|
|
 |
|
 A.-M. Still, P. Raatikainen, A. Ylitalo, H. Kauma, M. Ikäheimo, Y. A. Kesäniemi, and H. V. Huikuri Prevalence, characteristics and natural course of inappropriate sinus tachycardia Europace, January 1, 2005; 7(2): 104 - 112. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C P Earnest, R Jurca, T S Church, J L Chicharro, J Hoyos, and A Lucia Relation between physical exertion and heart rate variability characteristics in professional cyclists during the Tour of Spain Br. J. Sports Med., October 1, 2004; 38(5): 568 - 575. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. K. Stein Increased randomness of heart rate could explain increased heart rate variability preceding onset of atrial fibrillation J. Am. Coll. Cardiol., August 4, 2004; 44(3): 668 - 669. [Full Text] [PDF]
|
|
|
|
 |
|
 T. T. Laitio, H. V. Huikuri, T. H. Makikallio, J. Jalonen, E. S. H. Kentala, H. Helenius, O. Pullisaar, J. Hartiala, and H. Scheinin The Breakdown of Fractal Heart Rate Dynamics Predicts Prolonged Postoperative Myocardial Ischemia Anesth. Analg., May 1, 2004; 98(5): 1239 - 1244. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Luukinen, P. Laippala, and H.V. Huikuri Depressive symptoms and the risk of sudden cardiac death among the elderly Eur. Heart J., November 2, 2003; 24(22): 2021 - 2026. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Halamek, T. Kara, P. Jurak, M. Soucek, D. P. Francis, L. C. Davies, W. K. Shen, A. J.S. Coats, M. Novak, Z. Novakova, et al. Variability of Phase Shift Between Blood Pressure and Heart Rate Fluctuations: A Marker of Short-Term Circulation Control Circulation, July 22, 2003; 108(3): 292 - 297. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H Ansakorpi, J T Korpelainen, H V Huikuri, U Tolonen, V V Myllyla, and J I T Isojarvi Heart rate dynamics in refractory and well controlled temporal lobe epilepsy J. Neurol. Neurosurg. Psychiatry, January 1, 2002; 72(1): 26 - 30. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Loimaala, H. Huikuri, P. Oja, M. Pasanen, and I. Vuori Controlled 5-mo aerobic training improves heart rate but not heart rate variability or baroreflex sensitivity J Appl Physiol, November 1, 2000; 89(5): 1825 - 1829. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Pruvot, G. Thonet, J.-M. Vesin, G. van-Melle, K. Seidl, H. Schmidinger, J. Brachmann, W. Jung, E. Hoffmann, R. Tavernier, et al. Heart Rate Dynamics at the Onset of Ventricular Tachyarrhythmias as Retrieved From Implantable Cardioverter-Defibrillators in Patients With Coronary Artery Disease Circulation, May 23, 2000; 101(20): 2398 - 2404. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. V. Huikuri, T. H. Makikallio, C.-K. Peng, A. L. Goldberger, U. Hintze, and M. Moller Fractal Correlation Properties of R-R Interval Dynamics and Mortality in Patients With Depressed Left Ventricular Function After an Acute Myocardial Infarction Circulation, January 4, 2000; 101(1): 47 - 53. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. V. Huikuri, T. Makikallio, K. E. J. Airaksinen, R. Mitrani, A. Castellanos, and R. J. Myerburg Measurement of heart rate variability: a clinical tool or a research toy? J. Am. Coll. Cardiol., December 1, 1999; 34(7): 1878 - 1883. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Vikman, T. H. Makikallio, S. Yli-Mayry, S. Pikkujamsa, A.-M. Koivisto, P. Reinikainen, K. E. J. Airaksinen, and H. V. Huikuri Altered Complexity and Correlation Properties of R-R Interval Dynamics Before the Spontaneous Onset of Paroxysmal Atrial Fibrillation Circulation, November 16, 1999; 100(20): 2079 - 2084. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. V. Huikuri, A.-M. Poutiainen, T. H. Makikallio, M. J. Koistinen, K. E. J. Airaksinen, R. D. Mitrani, R. J. Myerburg, and A. Castellanos Dynamic Behavior and Autonomic Regulation of Ectopic Atrial Pacemakers Circulation, September 28, 1999; 100(13): 1416 - 1422. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. T. Korpelainen, K. A. Sotaniemi, A. Makikallio, H. V. Huikuri, and V. V. Myllyla Dynamic Behavior of Heart Rate in Ischemic Stroke Stroke, May 1, 1999; 30(5): 1008 - 1013. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Shusterman, B. Aysin, V. Gottipaty, R. Weiss, S. Brode, D. Schwartzman, K. P. Anderson, and for the ESVEM Investigators Autonomic nervous system activity and the spontaneous initiation of ventricular tachycardia J. Am. Coll. Cardiol., December 1, 1998; 32(7): 1891 - 1899. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. D Wagner and P. B Persson Chaos in the cardiovascular system: an update Cardiovasc Res, November 1, 1998; 40(2): 257 - 264. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. W. Hogue Jr, P. P. Domitrovich, P. K. Stein, G. D. Despotis, L. Re, R. B. Schuessler, R. E. Kleiger, and J. N. Rottman RR Interval Dynamics Before Atrial Fibrillation in Patients After Coronary Artery Bypass Graft Surgery Circulation, August 4, 1998; 98(5): 429 - 434. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. V. Huikuri, T. H. Makikallio, K. E. J. Airaksinen, T. Seppanen, P. Puukka, I. J. Raiha, and L. B. Sourander Power-Law Relationship of Heart Rate Variability as a Predictor of Mortality in the Elderly Circulation, May 26, 1998; 97(20): 2031 - 2036. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. P. Tulppo, T. H. Makikallio, T. Seppanen, R. T. Laukkanen, and H. V. Huikuri Vagal modulation of heart rate during exercise: effects of age and physical fitness Am J Physiol Heart Circ Physiol, February 1, 1998; 274(2): H424 - H429. [Abstract] [Full Text] [PDF]
|
|