Morning Peak in Ventricular Tachyarrhythmias Detected by Time of Implantable Cardioverter/Defibrillator Therapy

Tofler, Geoffrey H.; Gebara, Otávio; Mittleman, Murray A.; Taylor, Pamela; Siegel, Wayne; Venditti, Ferdinand J.; Rasmussen, C. A.; Muller, James E.

doi:10.1161/01.cir.92.5.1203

Cited by 114 publications

(48 citation statements)

References 33 publications

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“…As we hypothesized, the endogenous circadian trough in most of the cardiovascular risk biomarkers, as well as the circadian peak in "protective" vagal markers, occurred during the biological night (≈midnight-8:00 AM; ≈300°-50°) for most variables (except for cortisol: 10:30 PM; 270°; Table 1), possibly underlying the nighttime trough in adverse cardiovascular events in epidemiological studies (3)(4)(5)(6)(7)(8)(9)(10).…”

Section: Discussionmentioning

confidence: 92%

“…cardiovascular disease C ardiovascular disease is the leading cause of mortality in both men and women in developed countries (1,2). Epidemiological studies show a clear day/night pattern in risk for myocardial infarction (3)(4)(5)(6), stroke (7), angina (5), ventricular arrhythmias (8), and sudden cardiac death (9) with primary peaks in the morning (≈6:00 AM-noon), secondary peaks in the evening (≈6:00-10:00 PM), and lowest vulnerability during the night (≈midnight-6:00 AM) (reviewed in ref. 10).…”

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confidence: 99%

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Impact of the human circadian system, exercise, and their interaction on cardiovascular function

Scheer

Evoniuk

et al. 2010

Proc. Natl. Acad. Sci. U.S.A.

269

248

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The risk of adverse cardiovascular events peaks in the morning (≈9:00 AM) with a secondary peak in the evening (≈8:00 PM) and a trough at night. This pattern is generally believed to be caused by the day/night distribution of behavioral triggers, but it is unknown whether the endogenous circadian system contributes to these daily fluctuations. Thus, we tested the hypotheses that the circadian system modulates autonomic, hemodynamic, and hemostatic risk markers at rest, and that behavioral stressors have different effects when they occur at different internal circadian phases. Twelve healthy adults were each studied in a 240-h forced desynchrony protocol in dim light while standardized rest and exercise periods were uniformly distributed across the circadian cycle. At rest, there were large circadian variations in plasma cortisol (peak-to-trough ≈85% of mean, peaking at a circadian phase corresponding to ≈9:00 AM) and in circulating catecholamines (epinephrine, ≈70%; norepinephrine, ≈35%, peaking during the biological day). At ≈8:00 PM, there was a circadian peak in blood pressure and a trough in cardiac vagal modulation. Sympathetic variables were consistently lowest and vagal markers highest during the biological night. We detected no simple circadian effect on hemostasis, although platelet aggregability had two peaks: at ≈noon and ≈11:00 PM. There was circadian modulation of the cardiovascular reactivity to exercise, with greatest vagal withdrawal at ≈9:00 AM and peaks in catecholamine reactivity at ≈9:00 AM and ≈9:00 PM. Thus, the circadian system modulates numerous cardiovascular risk markers at rest as well as their reactivity to exercise, with resultant profiles that could potentially contribute to the day/night pattern of adverse cardiovascular events.

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Section: Discussionmentioning

confidence: 92%

mentioning

confidence: 99%

Impact of the human circadian system, exercise, and their interaction on cardiovascular function

Scheer

Evoniuk

et al. 2010

Proc. Natl. Acad. Sci. U.S.A.

269

248

View full text Add to dashboard Cite

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“…Previous studies of circadian rhythm in the frequency of ventricular tachyarrhythmias have described a predominant morning peak and less pronounced afternoon peak in patients with both ischemic heart disease and dilated cardiomyopathy [3][4][5] Few studies on circadian variation of arrhythmic events are available in patients with CCM 6,7 . It could be speculated that VT and ventricular premature complexes, suspected to be harbingers of VT, might have a similar circadian pattern.…”

Section: Discussionmentioning

confidence: 99%

Padrão circadiano dos episódios de taquicardia ventricular em portadores de cardiopatia chagásica

Abello¹,

González‐Zuelgaray²,

Daglio³

et al. 2007

Arq. Bras. Cardiol.

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SummaryChronic Chagas´ cardiomyopathy (CCM) causes ventricular arrhythmias and sudden death, and constitutes the most frequent cause of death in many endemic areas 1,2 . The circadian variation in the incidence of ventricular arrhythmias and sudden death differs according to the substrate (e.g., morning and evening peaks in ischemic heart disease and non-Chagasic dilated cardiomyopathy). Third generation implantable cardioverter defibrillators (ICDs) have the ability to store the time and date of each ventricular tachycardia (VT) episode, enabling the patterns of ventricular tachyarrhythmia occurrence to be analyzed. The aim of our study was to evaluate the circadian variation of spontaneous VT in recipients of an ICD with CCM. MethodsThis was a retrospective cohort study in the whole population of patients with CCM who have undergone ICD implantation in our institution since May 1998. All patients (n=22) had 2 out of 3 specific serologic tests positive for Chagas´ disease (enzyme-linked immunosorbent assay, indirect immunofluorescence reaction and indirect hemagglutination). The presence of ischemic heart disease was ruled out by negative stress testing or coronary angiography before ICD implantation.Seven different types of ICDs were implanted in the study patients (ICD models 1746(ICD models , 1782(ICD models , 1810(ICD models , 1821(ICD models , 1831(ICD models , 1851(ICD models and 1861 Guidant Corp., St. Paul, MN, USA). A single and a dual chamber ICD were implanted in 8 and 7 patients, respectively.Spontaneous VT was defined as a sudden change in rate with stable cycle length that does not fluctuates > 10% during tachycardia. VT discrimination was based on the configuration and stability of the intracardiac ECG, the RR interval analysis, and the first post pacing interval variability. Only VT that were successfully terminated by the device were accepted. Since ventricular fibrillation and polymorphic VT may have different substrates and precipitants, these episodes were not considered for study.The distribution of VT detection time was examined and classified into four 6-hour time periods of the day. To avoid data bias in individuals with multiple therapies in a relatively short time frame, episodes within a 1-hour period were counted only once, and upper limits of the first 30 consecutive SMVT events per patient were used for this analysis. Tachyarrhythmias with an RR cycle length < 300 ms were classified as rapid tachyarrhythmia, those with an RR ≥ 300 were classified as less rapid tachycardia.Follow-up visits were scheduled for the first month following hospital discharge and then every 6 months. Clinical and ICD data were obtained by a cardiologist at each visit. All episodes were stored on floppy disks and reviewed by two independent observers. Consensus about the diagnosis of the episodes was obtained in cases of discrepancy.Continuous variables were expressed as mean ± SD or as median and interquartile range, according to the appropriate distribution type. The level of significance was set ...

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“…Overall, infarcts are approximately three fold more likely to occur during the morning than during night. Other related cardiovascular events that peak in the early or late morning hours include deadly ventricular arrhythmias (Tofler et al, 1995), defibrillation threshold (Venditti et al, 1996) atrial and ventricular refractoriness (Kong et al, 1995;Simantirakis et al, 2001), ischemic stroke (Argentine et al, 1990), rupture of aortic aneurysm or aortic dissection (Manfredini et al, 2004;Mehta et al, 2002;Sumiyoshi et al, 2002) and sudden cardiac death (Mahmoud at al., 2011;Muller et al, 1987). Some cardiovascular events, such as atrial arrhythmias (Deguchi et al, 2009;Sandberg et al, 2010) or thromboembolic stroke (Marshal, 1977) may peak at other times of day.…”

Section: Temporal Variation In the Timing Of Acute Cardiovascular Eventsmentioning

confidence: 99%

Non-Ultradian Cardiac Rhythms: Circadian Regulation of the Heart

Karaganis¹

2011

Aspects of Pacemakers - Functions and Interactions in Cardiac and Non-Cardiac Indications

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Morning Peak in Ventricular Tachyarrhythmias Detected by Time of Implantable Cardioverter/Defibrillator Therapy

Abstract: Further investigation of the late morning peak and of precipitants of ventricular tachyarrhythmias by use of data from the implantable cardioverter/defibrillator may provide insight into the pathophysiological mechanisms causing sudden cardiac death.

Cited by 114 publications

References 33 publications

Impact of the human circadian system, exercise, and their interaction on cardiovascular function

Impact of the human circadian system, exercise, and their interaction on cardiovascular function

Padrão circadiano dos episódios de taquicardia ventricular em portadores de cardiopatia chagásica

Non-Ultradian Cardiac Rhythms: Circadian Regulation of the Heart

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