Circadian pattern of short-term variability of the QT-interval in primary prevention ICD patients - EU-CERT-ICD methodological pilot study

Sprenkeler, David J.; Tuinenburg, Anton E.; Eck, Henk J. Ritsema van; Malik, Marek; Zabel, Markus; Vos, Marc A.

doi:10.1371/journal.pone.0183199

Cited by 9 publications

(5 citation statements)

References 36 publications

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“…Beat-to-beat QT interval variability (QTV) captures ventricular repolarization lability (2,7) and is a predictive of cardiovascular mortality (2,7,29). QTV shows increased diurnal variation in in the morning (14,41) and in patients with heart failure and documented ventricular tachycardias (15). Sympathetic tonus modulates ventricular repolarization in the healthy myocardium, but its effect on diseased cardiac substrate is less clear (16,27,35).…”

Section: Introductionmentioning

confidence: 99%

Nocturnal ventricular repolarization lability predicts cardiovascular mortality in the Sleep Heart Health Study

Schmidt

Baumert

Penzel

et al. 2019

American Journal of Physiology-Heart and Circulatory Physiology

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The objective of the present study was to quantify repolarization lability and its association with sex, sleep stage, and cardiovascular mortality. We analyzed polysomnographic recordings of 2,263 participants enrolled in the Sleep Heart Health Study (SHHS-2). Beat-to-beat QT interval variability (QTV) was quantified for consecutive epochs of 5 min according to the dominant sleep stage [wakefulness, nonrapid eye movement stage 2 (NREM2), nonrapid eye movement stage 3 (NREM3), and rapid eye movement (REM)]. To explore the effect of sleep stage and apnea-hypopnea index (AHI) on QT interval parameters, we used a general linear mixed model and mixed ANOVA. The Cox proportional hazards model was used for cardiovascular disease (CVD) death prediction. Sex-related differences in T wave amplitude ( P < 0.001) resulted in artificial QTV differences. Hence, we corrected QTV parameters by T wave amplitude for further analysis. Sleep stages showed a significant effect ( P < 0.001) on QTV. QTV was decreased in deep sleep compared with wakefulness, was higher in REM than in NREM, and showed a distinct relation to AHI in all sleep stages. The T wave amplitude-corrected QTV index (cQTVi) in REM sleep was predictive of CVD death (hazard ratio: 2.067, 95% confidence interval: 1.105–3.867, P < 0.05) in a proportional hazards model. We demonstrated a significant impact of sleep stages on ventricular repolarization variability. Sex differences in QTV are due to differences in T wave amplitude, which should be corrected for. Independent characteristics of QTV measures to sleep stages and AHI showed different behaviors of heart rate variability and QTV expressed as cQTVi. cQTVi during REM sleep predicts CVD death. NEW & NOTEWORTHY We demonstrate here, for the first time, a significant impact of sleep stages on ventricular repolarization variability, quantified as QT interval variability (QTV). We showed that QTV is increased in rapid eye movement sleep, reflective of high sympathetic drive, and predicts death from cardiovascular disease. Sex-related differences in QTV are shown to be owing to differences in T wave amplitude, which should be corrected for.

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Section: Introductionmentioning

confidence: 99%

Nocturnal ventricular repolarization lability predicts cardiovascular mortality in the Sleep Heart Health Study

Schmidt

Baumert

Penzel

et al. 2019

American Journal of Physiology-Heart and Circulatory Physiology

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“…In addition to the described prospective study, a retrospective registry 17 and meta-analyses in primary prophylactic ICD patients were set up 18,19 (Figure 1). Over the course of the project, several original papers [20][21][22][23][24][25][26][27] and editorials [28][29][30][31][32][33] have been published from the various work packages. At the outset of the project, its primary objectives were as follows:…”

Section: Study Objectivesmentioning

confidence: 99%

Rationale and design of the EU‐CERT‐ICD prospective study: comparative effectiveness of prophylactic ICD implantation

et al. 2018

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AimsThe clinical effectiveness of primary prevention implantable cardioverter defibrillator (ICD) therapy is under debate. The EUropean Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators (EU‐CERT‐ICD) aims to assess its current clinical value.Methods and resultsThe EU‐CERT‐ICD is a prospective investigator‐initiated non‐randomized, controlled, multicentre observational cohort study performed in 44 centres across 15 European Union countries. We will recruit 2250 patients with ischaemic or dilated cardiomyopathy and a guideline indication for primary prophylactic ICD implantation. This sample will include 1500 patients at their first ICD implantation and 750 patients who did not receive a primary prevention ICD despite having an indication for it (non‐randomized control group). The primary endpoint is all‐cause mortality; the co‐primary endpoint in ICD patients is time to first appropriate shock. Secondary endpoints include sudden cardiac death, first inappropriate shock, any ICD shock, arrhythmogenic syncope, revision procedures, quality of life, and cost‐effectiveness. At baseline (and prior to ICD implantation if applicable), all patients undergo 12‐lead electrocardiogram (ECG) and Holter ECG analysis using multiple advanced methods for risk stratification as well as detailed documentation of clinical characteristics and laboratory values. Genetic biobanking is also organized. As of August 2018, baseline data of 2265 patients are complete. All subjects will be followed for up to 4.5 years.ConclusionsThe EU‐CERT‐ICD study will provide a necessary update about clinical effectiveness of primary prophylactic ICD implantation. This study also aims for improved risk stratification and patient selection using clinical and ECG risk markers.

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“…Temporal variations in BVR have been recently described in relation to diurnal rhythms in high risk patients, and suggested as an assessment marker [10]. We have used a more clinically relevant concept of impending nsVT to demonstrate the clinical relevance of temporal BVR in improving risk stratification of IHD patients.…”

Section: Discussionmentioning

confidence: 99%

Temporal Beat-to-Beat Variability of Repolarization Changes Predict Non-Sustained Ventricular Tachycardia in Ischemic Heart Disease Patients

Moeyersons¹,

Amoni²,

Vandenberk³

et al. 2018

2018 Computing in Cardiology Conference (CinC)

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Beat-to-beat variability of repolarization (BVR) is a promising marker of increased arrhythmia risk. BVR analysis could improve non-invasive risk stratification and may be valuable in the management and prevention of ventricular tachycardia (VT). We investigated the temporal evolution in BVR before spontaneous nonsustained ventricular tachycardia (nsVT) in patients with Ischemic Heart Disease (IHD). 24h Holter recordings from 20 IHD patients were collected prior to implantable cardioverter-defibrillator (ICD) implantation. After R-peak detection, Q-wave onset and T-wave offset were determined with a semi-automated template matching technique. The QT-annotation was manually verified and adjusted if necessary. Episodes of nsVT were semi-automatically identified and BVR was assessed at time points 1, 5 and 30 minutes prior to nsVT, and at a fixed moment during sleep (03:00am). Resting BVR, measured at 03:00am, was 7.26 ± 3.88 ms and was significantly (p<0.05) higher at 5 minutes (14.40 ± 7.61 ms) and 1 minute (18.01 ± 6.48 ms), but not at 30 minutes (8.90 ± 4.93 ms) prior to nsVT. These preliminary results reinforce the value of BVR analysis in the risk stratification of IHD patients; and identify a novel prediction method of impending VT that could be used for real-time analysis and monitoring.

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Circadian pattern of short-term variability of the QT-interval in primary prevention ICD patients - EU-CERT-ICD methodological pilot study

Cited by 9 publications

References 36 publications

Nocturnal ventricular repolarization lability predicts cardiovascular mortality in the Sleep Heart Health Study

Nocturnal ventricular repolarization lability predicts cardiovascular mortality in the Sleep Heart Health Study

Rationale and design of the EU‐CERT‐ICD prospective study: comparative effectiveness of prophylactic ICD implantation

Temporal Beat-to-Beat Variability of Repolarization Changes Predict Non-Sustained Ventricular Tachycardia in Ischemic Heart Disease Patients

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