Beat-to-beat variations in activation-recovery interval derived from the right ventricular electrogram can monitor arrhythmic risk under anesthetic and awake conditions in the canine chronic atrioventricular block model

Wijers, Sofieke C.; Sprenkeler, David J.; Bossu, Alexandre; Dunnink, Albert; Beekman, Jet D.M.; Varkevisser, Rosanne; Hernández, Alfonso Aranda; Meine, Mathias; Vos, Marc A.

doi:10.1016/j.hrthm.2017.11.011

Cited by 13 publications

(20 citation statements)

References 21 publications

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“…Wijers et al 16 Whilst strategies to analyze fractionated electrograms have been proposed, 33 a clear consensus in their interpretation does not exist. In the context of the assessment of BVR this could prove a challenge.…”

Section: Clinical Implications and Future Workmentioning

confidence: 99%

“…Recent animal studies have demonstrated significant increases in the BBV of ARI prior to the onset of Torsades de pointes and have highlighted its potential for integration into implantable cardiac devices to monitor arrhythmia risk. 16 In the present study, we have recorded left ventricular (LV) unipolar electrograms (UEGs), while pacing from the right ventricular (RV) lead to maintain a constant cycle length in patients with heart failure. From these electrograms we have calculated ARI variability (ARIV).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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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).

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Section: Clinical Implications and Future Workmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…Despite the methodological differences, a similar correlation between STV ARI and STV MAPD was found with an r 2 of 0.71. Recently, Wijers et al (2018) observed a positive correlation between STV MAPD and STV ARI from the RV EGM. Yet, the correlation was less strong (r 2 = 0.41), possibly due to differences in sampling frequency between the MAP and EGM recording (1,000 Hz for the MAP and 250 Hz, resampled to 400 Hz, for the EGM).…”

Section: Different Methods Of Stv Ari Compared To Stv Mapdmentioning

confidence: 95%

“…Therefore, STV dynamics could provide important information about impending arrhythmic events. Since MAP-catheters are rarely used outside the experimental laboratory, recent interest shifted toward measurement of STV on the EGM of chronically implanted ICD-leads (Oosterhoff et al, 2010(Oosterhoff et al, , 2011Wijers et al, 2018). These leads have the advantage of recording EGMs 24/7 from a fixed position on the myocardium.…”

Section: Stv As a Marker Of Arrhythmic Riskmentioning

confidence: 99%

“…While STV seems a promising parameter in predicting upcoming arrhythmic events, the use of monophasic action potential (MAP) catheters is not feasible for 24/7 monitoring in a clinical setting. Recently, it has been shown that STV of the activation recovery interval (STV ARI ) of the electrogram (EGM) derived from the right ventricular ICD lead can be used as surrogate for the MAPD and accurately reflects arrhythmic risk in the CAVB dog under both anesthetized and awake conditions (Wijers et al, 2018). This would imply that the EGMs stored on the device could be used in the prediction of upcoming arrhythmic events.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a Fully Automatic Measurement of Short-Term Variability of Repolarization on Intracardiac Electrograms in the Chronic Atrioventricular Block Dog

et al. 2020

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Background: Short-term variability (STV) of repolarization of the monophasic action potential duration (MAPD) or activation recovery interval (ARI) on the intracardiac electrogram (EGM) increases abruptly prior to the occurrence of ventricular arrhythmias in the chronic AV-block (CAVB) dog model. Therefore, this parameter might be suitable for continuous monitoring of imminent arrhythmias using the EGM stored on an implanted device. However, 24/7 monitoring would require automatic STV ARI measurement by the device. Objective: To evaluate a newly developed automatic measurement of STV ARI for prediction of dofetilide-induced torsade de pointes (TdP) arrhythmias in the CAVB-dog. Methods: Two retrospective analyses were done on data from recently performed dog experiments. (1) In seven anesthetized CAVB-dogs, the new automatic STV ARI method was compared with the gold standard STV MAPD at baseline and after dofetilide administration (0.025 mg/kg in 5 min). (2) The predictive value of the automatic method was compared to currently used STV ARI methods, i.e., slope method and fiducial segment averaging (FSA) method, in 11 inducible (≥3 TdP arrhythmias) and 10 non-inducible CAVB-dogs. Results: (1) The automatic measurement of STV ARI had good correlation with STV MAPD (r 2 = 0.89; p < 0.001). Bland-Altman analysis showed a small bias of 0.06 ms with limits of agreement between −0.63 and 0.76 ms. (2) STV ARI of all three methods was significantly different between inducible and non-inducible dogs after dofetilide. The automatic method showed the highest predictive performance with an area under the ROC-curve of 0.93, compared to 0.85 and 0.87 of the slope and FSA methods, respectively. With a threshold of STV set at 1.69 ms, STV ARI measured with the automatic method had a sensitivity of 0.91 and specificity of 0.90 in differentiating inducible from non-inducible subjects. Smoczyńska et al.

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Repolarization tremors: Do they predict arrhythmic earthquakes?

Patil

Berger

2018

Heart Rhythm

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Beat-to-beat variations in activation-recovery interval derived from the right ventricular electrogram can monitor arrhythmic risk under anesthetic and awake conditions in the canine chronic atrioventricular block model

Cited by 13 publications

References 21 publications

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

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

Evaluation of a Fully Automatic Measurement of Short-Term Variability of Repolarization on Intracardiac Electrograms in the Chronic Atrioventricular Block Dog

Repolarization tremors: Do they predict arrhythmic earthquakes?

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