Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 18 de 18
Filter
1.
J Cardiol ; 75(2): 155-163, 2020 02.
Article in English | MEDLINE | ID: mdl-31474497

ABSTRACT

BACKGROUND: Recent guidelines have stated that left ventricular ejection fraction (LVEF) is the gold standard marker for identifying patients at risk for cardiac mortality. However, little information is present regarding electrocardiographic (ECG) markers. This study aimed to assess ECG markers for predicting mortality or serious arrhythmia in patients with structural heart disease (SHD). METHODS: In total, 1829 patients were enrolled into the Japanese Multicenter Observational Prospective Study (JANIES study). In this study, we analyzed data of 719 patients (569 men, age 64 ± 13 years) with SHD including mainly ischemic heart disease (65.8%). As ECG markers based on 24-hour Holter recordings, nonsustained ventricular tachycardia (NSVT), ventricular late potentials, and heart rate turbulence (HRT) were assessed. The primary endpoint was all-cause mortality, and the secondary endpoint was fatal arrhythmic events. RESULTS: During a mean follow-up of 21 ± 11 months, all-cause mortality was eventually observed in 39 patients (5.4%). Among those patients, 32 patients (82%) suffered from cardiac causes such as heart failure and arrhythmia. Multivariate Cox regression analysis showed that after adjustment for age and LVEF, documented NSVT [hazard ratio = 2.46, 95% confidence interval (CI): 1.16-5.18, p = 0.02] and abnormal HRT (hazard ratio = 2.40, 95% CI: 1.16-4.93, p = 0.02) were significantly associated with the primary endpoint. These two ECG markers also had significant predictive values with the secondary endpoint. The combined assessment of two ECG markers improved predictive accuracy. CONCLUSION: This study demonstrated that combined assessment of documented NSVT and abnormal HRT based on 24-hour Holter ECG recordings are recommended for predicting future serious events in this population.


Subject(s)
Heart Diseases/mortality , Heart Diseases/physiopathology , Aged , Electrocardiography, Ambulatory , Female , Heart Rate , Heart Ventricles/physiopathology , Humans , Male , Middle Aged , Prospective Studies , Risk Assessment , Ventricular Function, Left
3.
Circ J ; 77(2): 432-8, 2013.
Article in English | MEDLINE | ID: mdl-23059771

ABSTRACT

BACKGROUND: T-wave alternans based on the modified moving average method (MMA-TWA) and heart rate turbulence (HRT) have been introduced as predictors for cardiac mortality. In this study, we simultaneously recorded MMA-TWA and HRT in patients after myocardial infarction (MI) and designed a prospective observational study. METHODS AND RESULTS: We prospectively enrolled 313 consecutive post-MI patients (age 70 ± 12 years, 232 men). The MMA-TWA and HRT were simultaneously measured using algorithms based on 24-h Holter ECG monitoring during daily activity. MMA-TWA was determined positive when the maximal voltage was >64 µV, and HRT was determined positive when both turbulence onset and turbulence slope were abnormal. The endpoint was defined as overall cardiac mortality and fatal arrhythmic events. MMA-TWA was positive in 14 patients (4.4%) and HRT was positive in 61 patients (19.5%). During follow-up of 1,190 ± 441 days, 28 patients (9%) reached the endpoint, including 12 patients with fatal arrhythmic events. Both MMA-TWA and HRT were significant predictors for the endpoint. On multivariate analysis, HRT had the most significant value, with a hazard ratio (HR) of 5.7 (P=0.0008). When focused on fatal arrhythmic events including sudden cardiac death, MMA-TWA had the most significant value (HR 5.8, P=0.0072). CONCLUSIONS: The present study revealed that both MMA-TWA and HRT were significant predictors. MMA-TWA is more associated with arrhythmic events than cardiac mortality in post-MI patients.


Subject(s)
Death, Sudden, Cardiac/epidemiology , Electrocardiography, Ambulatory , Heart Rate/physiology , Myocardial Infarction/mortality , Myocardial Infarction/physiopathology , Aged , Aged, 80 and over , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/mortality , Arrhythmias, Cardiac/physiopathology , Comorbidity , Female , Follow-Up Studies , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Myocardial Infarction/diagnosis , Predictive Value of Tests , Prognosis , Proportional Hazards Models , Prospective Studies , Risk Factors
5.
Ann Noninvasive Electrocardiol ; 17(3): 260-7, 2012 Jul.
Article in English | MEDLINE | ID: mdl-22816545

ABSTRACT

BACKGROUND: Previous studies have described the clinical usefulness of the presence of nonsustained ventricular tachycardia (NSVT) and defined heart rate turbulence (HRT) in stratifying patients at risk. We prospectively assessed whether HRT can facilitate the predictive accuracy of NSVT for identifying patients at risk for serious arrhythmic events in patients with left ventricular (LV) dysfunction. METHODS: We enrolled 299 consecutive patients with LV dysfunction (ejection fraction ≤ 40%) including ischemic (n = 184) and nonischemic causes (n = 115). The presence of NSVT was assessed on Holter electrocardiograms (ECGs). HRT was simultaneously measured from Holter ECGs, assessing two parameters: turbulence onset (TO) and turbulence slope (TS). HRT was considered positive when both TO and TS were abnormal. The end point was defined as of sudden cardiac death (SCD) and sustained ventricular tachyarrhythmias (VTs). RESULTS: NSVT was documented in 93 patients (32.7%). For HRT assessment, 17 patients (5.6%) were not utilized. Of 282 patients, 68 (24.1%) were HRT positive. During follow-up of 960 ± 444 days, 14 patients (5.0%) reached the end point. NSVT, HRT, and diabetes were significantly associated with the end point. On multivariate analysis, NSVT had the strongest value for the end point, with an HR of 4.4 (95%CI, 1.4-14.3; P = 0.0138). When NSVT combined with HRT, the predictive accuracy is more increased, with an HR of 8.2 (95%CI, 2.9-23.3; P < 0.0001). The predictive values of the combination were higher than single use of NSVT or HRT. CONCLUSIONS: HRT can facilitate the predictive accuracy of NSVT for identifying patients at risk for serious arrhythmic events in patients with LV dysfunction.


Subject(s)
Arrhythmias, Cardiac/diagnosis , Electrocardiography, Ambulatory , Tachycardia, Ventricular/diagnosis , Ventricular Dysfunction, Left/complications , Aged , Aged, 80 and over , Analysis of Variance , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/mortality , Cohort Studies , Confidence Intervals , Death, Sudden, Cardiac , Female , Heart Rate/physiology , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Predictive Value of Tests , Prognosis , Proportional Hazards Models , Prospective Studies , Risk Assessment , Survival Analysis , Tachycardia, Ventricular/etiology , Tachycardia, Ventricular/mortality , Time Factors , Ventricular Dysfunction, Left/diagnosis
6.
Int Heart J ; 53(2): 113-6, 2012.
Article in English | MEDLINE | ID: mdl-22688315

ABSTRACT

Pacing from the right ventricular (RV) apex is associated with adverse effects such as heart failure and atrial fibrillation. We attempted pacing from the RV mid-septum, which is theoretically a more physiological pacing site. A total of 172 consecutive patients with indications for permanent pacemaker implantation were studied. A screw-in lead and a curved stylet were used for lead positioning on the RV mid-septum. Pacemaker indices were evaluated at implantation and one year later. As an electrocardiographic parameter, QRS duration was measured in lead II. These data were compared to those of 66 patients subjected to conventional RV apical pacing. Lead placement was successful in all patients of RV mid-septal pacing. There were no technical problems during or after the procedure. The cumulative percentage of ventricular pacing at one year postimplantation was 85 ± 24 % in the SSP group. Sensing, pacing threshold, and lead impedance in the SSP group remained clinically stable over one year. When these measurements were compared between the SSP and AP groups, the pacing threshold and the lead impedance at one year postimplantation in the SSP group were higher (P < 0.05) and lower (P < 0.01), respectively, than those of the AP group. The mean QRS duration was markedly shorter (123 ± 16 versus 150 ± 18 msec, P < 0.0001). Selective site pacing from the RV mid-septum is feasible and results in less conduction delay compared to conventional RV apical pacing, and its procedure seems to be more physiological in permanent pacemaker implantation.


Subject(s)
Atrioventricular Block/therapy , Cardiac Pacing, Artificial/methods , Pacemaker, Artificial , Sick Sinus Syndrome/therapy , Aged , Aged, 80 and over , Cardiac Pacing, Artificial/adverse effects , Electrocardiography , Female , Follow-Up Studies , Heart Ventricles , Humans , Male , Treatment Outcome , Ventricular Septum
7.
Heart Rhythm ; 9(7): 1033-7, 2012 Jul.
Article in English | MEDLINE | ID: mdl-22342862

ABSTRACT

BACKGROUND: It has been reported that intracardiac electrogram T-wave alternans (IE-TWA) is greater prior to spontaneous ventricular tachyarrhythmia (VTA) than for baseline recordings. OBJECTIVE: To investigate IE-TWA just prior to VTA episodes and at baseline and compare these with microvolt TWA (M-TWA) measured during exercise. METHODS: We analyzed right ventricular ring-can electrogram recordings just prior to VTA episodes and compared T-wave pattern and degree of variation to baseline recordings from 3 patients (2 with idiopathic ventricular fibrillation and 1 with hypertrophic cardiomyopathy) who were enrolled in the Japan Intracardiac Electrogram TWA Study of ICD Recipients. In a stable state, we measured the M-TWA of the surface electrocardiogram during treadmill exercise in these 3 patients. RESULTS: We found 3 patterns of IE-TWA among these 3 patients with implantable cardioverter-defibrillator immediately prior to spontaneous VTAs. Case 1 had AB pattern of IE-TWA, case 2 ABC pattern, and case 3 nonspecific pattern but great T-wave amplitude variations. These IE-TWA amplitudes and the distribution of T-amplitude difference were greater than at baseline. Case 1 had a positive outcome in regard to the M-TWA determination, whereas cases 2 and 3 did not. CONCLUSIONS: We indicate different patterns of IE-TWA prior to spontaneous VTAs. The phenomena of IE-TWA correspond to outcomes of M-TWA measured during exercise in the surface electrocardiogram.


Subject(s)
Defibrillators, Implantable , Electrocardiography , Heart Conduction System/physiopathology , Tachycardia/physiopathology , Aged , Electrophysiologic Techniques, Cardiac , Female , Heart Rate/physiology , Humans , Male , Middle Aged
8.
J Cardiovasc Electrophysiol ; 22(10): 1135-40, 2011 Oct.
Article in English | MEDLINE | ID: mdl-21539643

ABSTRACT

BACKGROUND: Previous studies have described the clinical utility of heart rate turbulence (HRT) as an autonomic predictor in risk-stratifying patients after myocardial infarction (MI). Some reports showed that diabetes mellitus (DM) affects the prognostic value of autonomic markers. We assessed the utility of HRT as a risk marker in post-MI patients with DM and without DM. METHODS: We prospectively enrolled 231 consecutive DM patients and 300 non-DM patients after acute MI. HRT was measured using an algorithm based on 24-hour Holter electrocardiograms (ECGs), assessing 2 parameters: turbulence onset (TO) and turbulence slope (TS). HRT was considered positive when both TO ≥0% and TS ≤2.5 ms/R-R interval were met. The endpoint was defined as cardiac mortality. RESULTS: Of patients with DM, 9 patients (4%) were not utilized for HRT assessment because of frequent ventricular contractions or presence of atrial fibrillation. Forty-two of 222 patients (19%) were HRT positive. During follow-up of 876 ± 424 days, 26 patients (22%) reached the endpoint. Several factors including left ventricular ejection fraction (LVEF), renal dysfunction, documentation of nonsustained ventricular tachycardia (VT), and a HRT-positive outcome had significant association with the endpoint. Multivariate analysis determined that renal dysfunction and a positive HRT outcome had significant value with a hazard ratio (HR) of 4.7 (95%CI, 1.9-11.5; P = 0.0008) and 3.5 (95%CI, 1.4-8.8; P = 0.007), respectively. In non-DM patients, only a positive HRT outcome had significant value. CONCLUSIONS: This study reveals that HRT detected by 24-hour Holter ECG can predict cardiac mortality in post-MI patients whether DM is present or not.


Subject(s)
Diabetes Complications/diagnosis , Diabetes Complications/mortality , Electrocardiography, Ambulatory , Heart Rate , Myocardial Infarction/diagnosis , Myocardial Infarction/mortality , Aged , Aged, 80 and over , Algorithms , Chi-Square Distribution , Diabetes Complications/physiopathology , Female , Humans , Japan , Kaplan-Meier Estimate , Male , Middle Aged , Myocardial Infarction/physiopathology , Predictive Value of Tests , Prognosis , Proportional Hazards Models , Prospective Studies , Risk Assessment , Risk Factors , Signal Processing, Computer-Assisted , Time Factors
9.
Circ J ; 74(9): 1880-7, 2010 Sep.
Article in English | MEDLINE | ID: mdl-20625216

ABSTRACT

BACKGROUND: It has been reported that cardiovascular events occur more frequently in the morning than in the evening. The purpose of the present study was to assess the characteristics of out-of-hospital cardiac arrests due to cardiac cause in a 24-h period in Japanese patients. METHODS AND RESULTS: Of 2,199 consecutive patients with cardiopulmonary resuscitation outside hospital, 1,293 cardiogenic patients were enrolled. The incidence of cardiac arrests was assessed as hourly data (ie, circadian variation), and investigated for differences in age, gender, and the location at onset. Cardiac arrests had an apparent circadian rhythm that was characterized by 2 long zeniths in the morning and evening. The peak was at 17:00-18:00 hours. Younger patients had more cardiac arrests in the morning than in the evening. In contrast, older patients had more events in the evening than in the morning. The circadian rhythm did not differ in gender. Regarding location, the patient's residence was the most common place for cardiac arrest. In the residence, the bathroom was associated with the evening zenith of circadian variation. CONCLUSIONS: Out-of-hospital cardiac arrests due to cardiac cause in Japanese patients have an apparent circadian variation with 2 long zeniths, with an evening predominance in older patients. Aging affects the evening zenith, in that elderly patients > or =80 years old have a zenith associated with bath time in the evening.


Subject(s)
Circadian Rhythm , Out-of-Hospital Cardiac Arrest/epidemiology , Age Factors , Aged , Aged, 80 and over , Asian People , Cardiopulmonary Resuscitation , Female , Humans , Incidence , Male , Out-of-Hospital Cardiac Arrest/etiology , Sex Factors
10.
Heart Rhythm ; 7(5): 675-82, 2010 May.
Article in English | MEDLINE | ID: mdl-20189495

ABSTRACT

BACKGROUND: The presence of J waves on ECGs is related to idiopathic ventricular fibrillation (VF). OBJECTIVE: The purpose of this study was to investigate the pathophysiology of J waves by assessing risk markers that reflect electrophysiologic abnormalities. METHODS: The study enrolled 22 idiopathic VF patients (17 men and 5 women; mean age 36 +/- 13 years). Patients were divided into two groups according to the presence or absence of J waves. The following risk stratifiers were assessed: late potentials (LPs; depolarization abnormality marker) for 24 hours using a newly developed signal-averaging system, and T-wave alternans and QT dispersion (repolarization abnormality markers). Frequency-domain heart rate variability (HRV), which reflects autonomic modulation, also was assessed. The results were compared to those of 30 control subjects with J waves and 30 with no J wave, matched for age and gender to the idiopathic VF patients. RESULTS: J waves were present in 7 (32%) idiopathic VF patients. The incidence of LP in the idiopathic VF J-wave group was higher than in the idiopathic VF non-J-wave group (86% vs 27%, P = .02). In contrast, repolarization abnormality markers did not differ between the two groups. In the idiopathic VF J-wave group, dynamic changes in LP parameters (fQRS, RMS(40), LAS(40)) were observed and were pronounced at nighttime; this was not the case in the idiopathic VF non-J-wave group and the control J-wave group. High-frequency components (vagal tone index) on frequency-domain HRV analysis were associated with J waves in idiopathic VF patients (P < .05). CONCLUSION: Idiopathic VF patients with J waves had a high incidence of LP showing circadian variation with night ascendancy. J waves may be more closely associated with depolarization abnormality and autonomic modulation than with repolarization abnormality.


Subject(s)
Action Potentials , Circadian Rhythm , Heart Rate , Ventricular Fibrillation/pathology , Adult , Autonomic Nervous System , Biomarkers , Body Surface Potential Mapping , Case-Control Studies , Electrocardiography, Ambulatory , Female , Heart Conduction System , Heart Ventricles/innervation , Heart Ventricles/pathology , Humans , Incidence , Japan/epidemiology , Male , Middle Aged , Predictive Value of Tests , Risk Assessment , Risk Factors , Signal Processing, Computer-Assisted , Time Factors , Ventricular Fibrillation/epidemiology , Ventricular Fibrillation/etiology
11.
Circ J ; 74(5): 856-63, 2010 May.
Article in English | MEDLINE | ID: mdl-20339194

ABSTRACT

BACKGROUND: Occasionally it is difficult to inhibit electrical storm (ES) with standard pharmacological treatment. In the present study the effect of landiolol, an ultra-short-acting beta(1)-selective blocker, on ES refractory to class III antiarrhythmic drugs was evaluated. METHODS AND RESULTS: The study group comprised 42 consecutive patients who developed ES for which intravenous class III antiarrhythmic drugs, such as amiodarone and nifekalant, were ineffective. Landiolol was administered intravenously with an initial dose of 2.5 microg x kg(-1) x min(-1), which was doubled if it was ineffective, up to a maximum dose of 80 microg x kg(-1) x min(-1). Landiolol inhibited ES in 33 patients (79%) at a mean dose of 7.5+/-12.2 microg x kg(-1) x min(-1). All patients in whom landiolol was ineffective died of arrhythmia. Of the 33 patients in whom landiolol was effective, 25 survived and were discharged (60% of all patients). Landiolol significantly decreased heart rate (P<0.0001), but did not affect blood pressure. Landiolol was not discontinued for adverse effects in any of the responders. Age, APACHE II score, and pH of arterial blood gas differed significantly between the responders and nonresponders. CONCLUSIONS: Landiolol is useful as a life-saving drug for class III antiarrhythmic drug-resistant ES. The main mechanism of ES refractory to class III antiarrhythmic drugs could be abnormal automaticity but not reentry.


Subject(s)
Adrenergic beta-Antagonists/pharmacology , Heart Rate/drug effects , Morpholines/pharmacology , Tachycardia, Ventricular/diet therapy , Tachycardia, Ventricular/physiopathology , Urea/analogs & derivatives , Aged , Aged, 80 and over , Anti-Arrhythmia Agents/adverse effects , Anti-Arrhythmia Agents/pharmacology , Drug Resistance/drug effects , Female , Humans , Male , Middle Aged , Urea/pharmacology
12.
Circ J ; 73(11): 2021-8, 2009 Nov.
Article in English | MEDLINE | ID: mdl-19724153

ABSTRACT

BACKGROUND: Intravenous amiodarone (AMD) has been used for the treatment of ventricular tachycardia/fibrillation (VT/VF) in emergency care medicine. However, AMD acts slowly and is occasionally accompanied by hypotension and bradycardia. The antiarrhythmic effect of intravenous nifekalant (NIF) was assessed in patients with VT/VF complicating acute coronary syndrome (ACS) according to our study protocol. METHODS AND RESULTS: Among a series of 1,143 ACS patients, 41 patients who suffered sustained VT/VF were enrolled; 19 failed to respond to a preceding lidocaine (LID) injection. NIF was given first as an intravenous bolus injection (0.2 mg/kg) and then as a continuous intravenous infusion at a relatively low dose level (0.2 mg x kg(-1) x h(-1)). Sustained VT/VF was successfully inhibited by NIF in 34 patients (83%). In subgroup analysis, NIF achieved VT/VF inhibition in 79% of patients who received preceding LID and in 86% of patients who received direct NIF. There were no significant changes in systolic blood pressure or heart rate following NIF therapy. A corrected QT interval was significantly prolonged (P<0.01), whereas torsade de pointes developed in only 1 patient (2%). CONCLUSIONS: An intravenous bolus injection and subsequent continuous infusion of NIF at a relatively low dosage were effective in treating severe ventricular tachyarrhythmias complicating ACS, reducing the potential risk of proarrhythmia.


Subject(s)
Acute Coronary Syndrome/complications , Acute Coronary Syndrome/drug therapy , Anti-Arrhythmia Agents/administration & dosage , Pyrimidinones/administration & dosage , Tachycardia, Ventricular/drug therapy , Tachycardia, Ventricular/etiology , Ventricular Fibrillation/drug therapy , Ventricular Fibrillation/etiology , Acute Coronary Syndrome/physiopathology , Aged , Amiodarone/administration & dosage , Anti-Arrhythmia Agents/adverse effects , Blood Pressure/drug effects , Electrocardiography/drug effects , Emergency Medical Services , Female , Heart Rate/drug effects , Humans , Infusions, Intravenous , Injections, Intravenous , Lidocaine/administration & dosage , Male , Middle Aged , Pyrimidinones/adverse effects , Tachycardia, Ventricular/physiopathology , Torsades de Pointes/chemically induced , Ventricular Fibrillation/physiopathology
13.
J Cardiol ; 54(1): 86-92, 2009 Aug.
Article in English | MEDLINE | ID: mdl-19632526

ABSTRACT

BACKGROUND: Cibenzoline (CBZ), a class I antiarrhythmic drug, has been widely used to maintain sinus rhythm in patients with paroxysmal atrial fibrillation (P-AF). This agent has an anticholinergic action and will become the drug of first choice for vagally mediated P-AF. We assessed its efficacy quantitatively by analyzing the frequency-domain heart rate variability (FD-HRV) of the Holter electrocardiogram (ECG) in patients with vagal P-AF. METHODS: We enrolled 65 consecutive patients with vagal P-AF, but 31 patients were excluded because of the occurrence of significant arrhythmias during the 24-h Holter recordings. Accordingly, CBZ was administered to the remaining 34 patients. After administration, a Holter ECG recording was made again. High frequency (HF) components, i.e., vagal tone index, on the FD-HRV analysis from 00:00 h to 06:00 h were used for assessment. In 14 patients, the treatment was changed to disopyramide (DSP) and the same analyses were performed. RESULTS: In two patients, the FD-HRV analysis was not utilized after administration. Finally, 32 patients were available for evaluation. CBZ was considered effective for vagal P-AF in 24 patients (75%). After administration, the HF component levels decreased (1589+/-795 ms(2) vs. 850+/-524 ms(2), p<0.0001). Comparison of the pre-administration HF component levels between the CBZ-responsive group and the CBZ-non-responsive group showed higher levels in the CBZ-responsive group (1766+/-758 ms(2) vs. 1058+/-690 ms(2), p=0.026). Although no significant difference in the reduction of the HF component levels was found between CBZ and DSP, DSP had anticholinergic side effects in two patients (14%). CONCLUSIONS: In vagal P-AF patients, larger HF components on the FD-HRV analysis could be a hallmark of the antiarrhythmic action of CBZ. The reduction in the HF component levels after drug administration is useful for a quantitative assessment of anticholinergic action.


Subject(s)
Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/drug therapy , Electrocardiography, Ambulatory , Imidazoles/therapeutic use , Cholinergic Antagonists/therapeutic use , Disopyramide/therapeutic use , Female , Heart Rate , Humans , Male , Middle Aged , Treatment Outcome
14.
Heart Rhythm ; 6(3): 332-7, 2009 Mar.
Article in English | MEDLINE | ID: mdl-19251207

ABSTRACT

BACKGROUND: Time-domain T-wave alternans (TWA) is useful for identifying patients at risk for serious events after myocardial infarction. OBJECTIVE: The purpose of this study was to prospectively evaluate the utility of time-domain TWA measured from Holter ECGs in predicting cardiac mortality in patients with left ventricular (LV) dysfunction. METHODS: Two hundred ninety-five consecutive patients with LV dysfunction were enrolled in the study. Patients were divided into two groups: the ischemic group (n = 195) and the nonischemic group (n = 100). Time-domain TWA was assessed using the modified moving average method from routine 24-hour Holter ECGs recorded during daily activity. The maximal time-domain TWA voltage at heart rate or=65 microV. The primary end-point was defined as cardiac mortality. RESULTS: Mean maximal time-domain TWA voltage was 54 +/- 16 microV. During follow-up of 390 +/- 212 days, 27 patients (17 in the ischemic group and 10 in the nonischemic group) died of cardiac causes. Fifty-three patients (18%) were time-domain TWA positive and 242 (82%) were time-domain TWA negative. Univariate Cox proportional hazards analyses revealed that older age, New York Heart Association functional class III or IV, diabetes, renal dysfunction, nonsustained ventricular tachycardia, and time-domain TWA were associated with cardiac mortality. In multivariate analysis, time-domain TWA had the most significant value (hazard ratio = 17.1, P <.0001). This index also was significant in both subgroups (ischemic group: hazard ratio = 19.0, P <.0001; nonischemic group: hazard ratio = 12.3, P = .002). CONCLUSION: Time-domain TWA measured from 24-hour Holter ECGs predicts cardiac mortality in patients with ischemic and nonischemic LV dysfunction.


Subject(s)
Electrocardiography, Ambulatory , Heart Diseases/mortality , Ventricular Dysfunction, Left/physiopathology , Aged , Disease-Free Survival , Female , Humans , Male , Middle Aged , Signal Processing, Computer-Assisted , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/mortality
15.
J Cardiovasc Electrophysiol ; 20(7): 788-95, 2009 Jul.
Article in English | MEDLINE | ID: mdl-19298569

ABSTRACT

BACKGROUND: Few studies have described the clinical usefulness of heart rate turbulence (HRT), an autonomic predictor of mortality, in stratifying patients with dilated cardiomyopathy (DCM) at risk of cardiac mortality and arrhythmic events. We prospectively assessed the utility of HRT for risk stratification in patients with ischemic or nonischemic DCM. METHODS: We enrolled 375 consecutive patients with DCM including ischemic (n = 241) and nonischemic causes (n = 134). HRT was measured using an algorithm based on routine 24-hour Holter electrocardiograms, assessing 2 parameters: turbulence onset (TO) and turbulence slope (TS). HRT was considered positive when both TO was > or = 0% and TS was < or = 2.5 ms/R-R interval. The primary endpoint was defined as cardiac mortality and the secondary endpoint as occurrence of hemodynamically stable sustained ventricular tachyarrhythmias. RESULTS: Of patients enrolled, 83 patients (22.1%) were not utilized for HRT assessment because there were too few ventricular premature beats, or for other reasons. Eighty-one of 292 patients (27.7%) were HRT-positive. During follow-up of 445 +/- 216 days, 30 patients (10.3%) reached the primary endpoint and 17 patients, the secondary endpoint. The hazard ratio (HR) of patients with an HRT-positive outcome was 6.4 (95%CI, 3.0-14.1; P < 0.0001) for the primary endpoint and 5.1 (95%CI, 2.8-9.3; P < 0.0001) for combined endpoints. On subanalysis, HRT positivity was significantly associated in both the ischemic and nonischemic DCM patients with both the primary endpoint (HR = 4.9, P = 0.0006 and HR = 12.3, P = 0.002, respectively) and with combined endpoints. CONCLUSIONS: HRT is a powerful risk stratification marker for cardiac mortality and arrhythmic events in patients with DCM whether ischemia is present or not.


Subject(s)
Cardiomyopathy, Dilated/mortality , Cardiomyopathy, Dilated/physiopathology , Electrocardiography, Ambulatory , Heart Rate , Tachycardia, Ventricular/etiology , Tachycardia, Ventricular/mortality , Aged , Aged, 80 and over , Cardiomyopathy, Dilated/complications , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Predictive Value of Tests , Proportional Hazards Models , Prospective Studies , Risk Assessment , Risk Factors , Tachycardia, Ventricular/physiopathology , Time Factors
16.
Int Heart J ; 49(3): 281-93, 2008 May.
Article in English | MEDLINE | ID: mdl-18612186

ABSTRACT

In the treatment of arrhythmia, beta-blockers are mainly used to regulate the heart rate. However, beta-blockers are also known as drugs with an antiarrhythmic effect due to the suppression of sympathetic activity. We evaluated the antiarrhythmic effects of a highly selective beta(1)-blocker, bisoprolol, in patients with diurnal paroxysmal atrial fibrillation (P-AF). A total of 136 patients with symptomatic diurnal P-AF were enrolled. Patients were divided into a diurnal-specific P-AF group and a diurnal & nocturnal P-AF group, as well as into a bisoprolol single use group and a combined use group with an antiarrhythmic drug. The effects of bisoprolol were evaluated in 3 categories: subjective symptom improvement, quality of life (QOL) improvement, and elimination of P-AF episode in Holter electrocardiograms (ECGs). For patients with effective treatment, a long-term effect up to 24 months was evaluated. Five patients (3.7%) discontinued bisoprolol due to side effects. Following administration of bisoprolol, 109 patients (80%) experienced subjective symptom improvement, 103 patients (76%) experienced QOL improvement, and elimination of P-AF episodes in ECGs was observed in 84 patients (62%). The elimination rate of P-AF episodes in ECGs was higher in the diurnal P-AF group than in the diurnal & nocturnal P-AF group (P=0.042). There was no significant difference between the bisoprolol single use group and the combined use group. A long-term suppressive effect by bisoprolol was observed in 70 of 83 patients (84%). The results demonstrate that bisoprolol has an antiarrhythmic effect against sympathetic diurnal P-AF, improving subjective symptoms and QOL and eliminating P-AF episodes in ECGs.


Subject(s)
Adrenergic beta-Antagonists/administration & dosage , Anti-Arrhythmia Agents/administration & dosage , Atrial Fibrillation/drug therapy , Bisoprolol/administration & dosage , Receptors, Adrenergic, beta-1/drug effects , Aged , Atrial Fibrillation/diagnosis , Circadian Rhythm , Electrocardiography, Ambulatory , Female , Humans , Male , Middle Aged , Quality of Life , Treatment Outcome
17.
Circ J ; 71 Suppl A: A106-14, 2007.
Article in English | MEDLINE | ID: mdl-17587733

ABSTRACT

Sudden cardiac death (SCD) is a leading cause of mortality in industrialized countries, and ventricular fibrillation and sustained ventricular tachycardia are the major causes of SCD. Although there are now effective devices and medications that can prevent such serious arrhythmias, it is crucial to have methods of identifying patients at risk. Numerous studies suggest that most patients dying of SCD have coronary artery disease or cardiomyopathy. Functional or electrophysiological measurements are effective in risk stratification. Left ventricular ejection fraction measured by echocardiography or cardiac imaging techniques is the gold standard to detect high-risk patients. Electrophysiological studies have also been used for risk stratification. Noninvasive techniques and measurements, such as T-wave alternans, signal-averaged electrocardiography, nonsustained ventricular tachycardia, heart rate variability, and heart rate turbulence, have been proposed as useful tools in identifying patients at risk for SCD. This article reviews the epidemiology, mechanisms, substrates, and current status of risk stratification of SCD.


Subject(s)
Death, Sudden, Cardiac/etiology , Heart Diseases/complications , Death, Sudden, Cardiac/epidemiology , Death, Sudden, Cardiac/prevention & control , Evidence-Based Medicine , Heart Diseases/diagnosis , Heart Diseases/epidemiology , Heart Diseases/therapy , Humans , Practice Guidelines as Topic , Predictive Value of Tests , Risk Assessment , Risk Factors
18.
J Cardiovasc Electrophysiol ; 17(6): 602-7, 2006 Jun.
Article in English | MEDLINE | ID: mdl-16836706

ABSTRACT

INTRODUCTION: Autonomic modulation, particularly high vagal tone, plays an important role in the occurrence of ventricular tachyarrhythmias in the Brugada syndrome. Food intake modulates vagal activity. We assessed the usefulness of a novel diagnostic technique, the "full stomach test," for identifying a high-risk group in patients with a Brugada-type electrocardiogram (ECG). METHODS AND RESULTS: In 35 patients with a Brugada-type ECG, we assessed 12-lead ECGs before and after a large meal, a pilsicainide pharmacological test, spontaneous ST-segment change, late potentials by signal-averaged ECG, microvolt T-wave alternans, and four other ECG parameters. These patients were divided into two groups (i.e., high-risk group [n = 17] and indeterminate risk group [n = 18]). The full stomach test was defined as positive when augmentation of characteristic ECG abnormalities was observed after meals. Thirteen patients had a prior history of life-threatening events such as aborted sudden death and syncope, with a total of 30 episodes. These episodes had a circadian pattern, at night and after meals. The full stomach test was positive in 17 of the study patients (49%). A positive test outcome was characterized by a higher incidence of a history of life-threatening events than a negative test outcome (P = 0.015, odds ratio = 7.1). In comparison between the two groups, the incidence (82%) of positive outcomes in the high-risk group was significantly higher than that (17%) in the indeterminate risk group (P = 0.0002). CONCLUSIONS: Characteristic ECG changes diagnostic of Brugada syndrome are augmented by a large meal. These data are associated with a history of life-threatening events in Brugada syndrome.


Subject(s)
Brugada Syndrome/diagnosis , Electrophysiologic Techniques, Cardiac , Postprandial Period , Adult , Brugada Syndrome/complications , Brugada Syndrome/physiopathology , Circadian Rhythm , Electrocardiography , Female , Heart/innervation , Humans , Lidocaine/analogs & derivatives , Male , Middle Aged , Predictive Value of Tests , Sodium Channel Blockers , Stomach/innervation , Syncope/diagnosis , Syncope/etiology , Syncope/physiopathology , Vagus Nerve/physiology , Ventricular Fibrillation/diagnosis , Ventricular Fibrillation/etiology , Ventricular Fibrillation/physiopathology
SELECTION OF CITATIONS
SEARCH DETAIL
...