Abnormalities in beat-to-beat dynamics of heart rate before the spontaneous onset of life-threatening ventricular tachyarrhythmias in patients with prior myocardial infarction

Heikki V. Huikuri, Tapio Seppänen, M. Juhani Koistinen, K. E Juhani Airaksinen, M. J. Ikäheimo, Agustin Castellanos, Robert J Myerburg

Research output: Contribution to journalArticle

207 Citations (Scopus)

Abstract

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 (Poincare plot). Poincare 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 abnormal plots; 9 with a complex pattern, 3 ball-shaped, and 3 torpedo-shaped. Quantitative analysis of the Poincare 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 subjects 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 episode (0.43±0.20) compared with her 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.

Original languageEnglish
Pages (from-to)1836-1844
Number of pages9
JournalCirculation
Volume93
Issue number10
StatePublished - May 15 1996

Fingerprint

Tachycardia
Heart Rate
Myocardial Infarction
Heart Diseases
Torpedo
Electric Stimulation
Healthy Volunteers
Electrocardiography
Research Design

Keywords

  • dynamics
  • heart rate
  • tachyarrhythmias

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Abnormalities in beat-to-beat dynamics of heart rate before the spontaneous onset of life-threatening ventricular tachyarrhythmias in patients with prior myocardial infarction. / Huikuri, Heikki V.; Seppänen, Tapio; Koistinen, M. Juhani; Airaksinen, K. E Juhani; Ikäheimo, M. J.; Castellanos, Agustin; Myerburg, Robert J.

In: Circulation, Vol. 93, No. 10, 15.05.1996, p. 1836-1844.

Research output: Contribution to journalArticle

Huikuri, Heikki V. ; Seppänen, Tapio ; Koistinen, M. Juhani ; Airaksinen, K. E Juhani ; Ikäheimo, M. J. ; Castellanos, Agustin ; Myerburg, Robert J. / Abnormalities in beat-to-beat dynamics of heart rate before the spontaneous onset of life-threatening ventricular tachyarrhythmias in patients with prior myocardial infarction. In: Circulation. 1996 ; Vol. 93, No. 10. pp. 1836-1844.
@article{9c8907459b1b469a8beeb68e0c8213a9,
title = "Abnormalities in beat-to-beat dynamics of heart rate before the spontaneous onset of life-threatening ventricular tachyarrhythmias in patients with prior myocardial infarction",
abstract = "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 (Poincare plot). Poincare 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 abnormal plots; 9 with a complex pattern, 3 ball-shaped, and 3 torpedo-shaped. Quantitative analysis of the Poincare 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 subjects 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 episode (0.43±0.20) compared with her 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.",
keywords = "dynamics, heart rate, tachyarrhythmias",
author = "Huikuri, {Heikki V.} and Tapio Sepp{\"a}nen and Koistinen, {M. Juhani} and Airaksinen, {K. E Juhani} and Ik{\"a}heimo, {M. J.} and Agustin Castellanos and Myerburg, {Robert J}",
year = "1996",
month = "5",
day = "15",
language = "English",
volume = "93",
pages = "1836--1844",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

TY - JOUR

T1 - Abnormalities in beat-to-beat dynamics of heart rate before the spontaneous onset of life-threatening ventricular tachyarrhythmias in patients with prior myocardial infarction

AU - Huikuri, Heikki V.

AU - Seppänen, Tapio

AU - Koistinen, M. Juhani

AU - Airaksinen, K. E Juhani

AU - Ikäheimo, M. J.

AU - Castellanos, Agustin

AU - Myerburg, Robert J

PY - 1996/5/15

Y1 - 1996/5/15

N2 - 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 (Poincare plot). Poincare 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 abnormal plots; 9 with a complex pattern, 3 ball-shaped, and 3 torpedo-shaped. Quantitative analysis of the Poincare 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 subjects 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 episode (0.43±0.20) compared with her 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.

AB - 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 (Poincare plot). Poincare 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 abnormal plots; 9 with a complex pattern, 3 ball-shaped, and 3 torpedo-shaped. Quantitative analysis of the Poincare 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 subjects 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 episode (0.43±0.20) compared with her 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.

KW - dynamics

KW - heart rate

KW - tachyarrhythmias

UR - http://www.scopus.com/inward/record.url?scp=0029885841&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029885841&partnerID=8YFLogxK

M3 - Article

C2 - 8635263

AN - SCOPUS:0029885841

VL - 93

SP - 1836

EP - 1844

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 10

ER -