Heart rate variability and dispersion of QT interval in patients with vulnerability to ventricular tachycardia and ventricular fibrillation after previous myocardial infarction

Juha S. Perkiömäki, Heikki V. Huikuri, Juhani M. Koistinen, Timo Mäkikallio, Agustin Castellanos, Robert J. Myerburg

Research output: Contribution to journalArticle

86 Scopus citations

Abstract

Objectives. This study was designed to compare QT dispersion measured from the standard 12-lead electrocardiogram and 24-h heart rate variability in patients with vulnerability to either ventricular tachycardia fibrillation after a previous myocardial infarction. Background. Increased QT interval dispersion and reduced heart rate variability have been shown to be associated with vulnerability to ventricular tachyarrythmias, but the data have mainly been pooled from patients with presentation of stable ventricular tachycardia and ventricular fibrillation. Methods. QT dispersion and time and two-dimensional vector analysis of heart rate variability were studied in 30 survivors of ventricular fibrillation with a myocardial infarction and with inducible unstable ventricular tachyarrythmia by programed electrical stimulation and in 30 postinfarction patients with clinical and inducible stable monomorphic sustained ventricular tachycardia. Both of these patient groups were matched, with respect to age, gender and left ventricular ejection fraction, with an equal number of postinfarction control patients without a history of arrythmic events or inducible ventricular tachyarrythmia-free survival during a follow-up period of 2 years. Forty- five age-matched healthy subjects served as normal control subjects. Results. Standard deviation of all sinus intervals and long-term continuous RR interval variability analyzed from Poincare plots were reduced in patients with vulnerability to ventricular fibrillation (p < 0.001 for both), but not in patients with ventricular tachycardia (p = NS for both), compared with postinfarction control subjects. Corrected QT (QTc) dispersion was significantly broader both in patients with ventricular fibrillation (p < 0.001) and in those with ventricular tachycardia (p < 0.05) than in matched postinfarction control subjects. Heart rate variability performed better than QTc dispersion in predicting vulnerability to ventricular fibrillation. Conclusion. Increased QT dispersion is associated with vulnerability to both ventricular tachycardia and ventricular fibrillation. Low heart rate variability is specifically related to susceptibility to ventricular fibrillation but not to stable monomorphic ventricular tachycardia, suggesting that the autonomic nervous system modifies the presentation of life-threatening ventricular arrhythmias.

Original languageEnglish (US)
Pages (from-to)1331-1338
Number of pages8
JournalJournal of the American College of Cardiology
Volume30
Issue number5
DOIs
StatePublished - Nov 1 1997

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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