Respective role of sympathetic tone and of cardiac pauses in the genesis of 62 cases of ventricular fibrillation recorded during Holter monitoring

Abstract

Sixty-two Holter recordings of sudden death due to ventricular fibrillation (VF) were analysed by full disclosure and computerized processing. Thirteen sudden deaths were due to torsades de pointes in noncoronary subjects (11/13), related to quinidine-like drugs and/or hypokalaemia: they were always initiated by a long RR cycle due to a post-extrasystolic pause, and announced by a progressive decrease of mean heart rate (from 77.5 +/- 2.5 to 60.6 +/- 2.7 beats min-1, P less than 0.001), in the three preceding hours. The other cases occurred in coronary patients (45/49), with acceleration of ventricular tachycardia (VT), monomorphic in 24 cases, polymorphic in 13, the ventricular rate increasing from 220.6 +/- 55 to 241.5 +/- 69 beats min-1, rather than with primary VF (12 cases). A cardiac pause (RR cycle exceeding 125% of the mean five preceding cycles) was present in 22/49 cases immediately before the onset of VT/VF. The coupling interval of the extrasystole initiating VT/VF was shorter than the shortest value encountered before: 377.6 +/- 94.5 ms vs 421.4 +/- 92.3. The prematurity index (coupling interval/preceding RR cycle ratio) was lower in primary VF than in VT leading to VF. In the last hour preceding VF, ST changes were unusual (five cases), whereas heart rate increased from 82.8 +/- 20 to 92.0 +/- 26.7 beats min-1, (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Mapping and Ablation of Idiopathic Ventricular Fibrillation

“…In patients with structural heart disease or Brugada syndrome, 2 studies showed that spontaneous initiation of VF was preceded in 67% of episodes by isolated premature beats that were identical to the triggering beat. 34,35 Decreasing the incidence of VF with localized ablation may reduce defibrillation requirement and replacement and improve the patient's quality of life.…”

Nutrition in Chronocardiology: We are Indebted Professor Franz Halberg

“…A few studies [60,61] observed that there were three major time periods when a cardiac arrest was most likely to occur-an early peak in the morning around 1100 hours, a late peak in the evening around 2200 hours, and, for those whose arrest was from a cardiac disease, a third time period-around 1600 hours-also seemed to be critical. In Seattle [62] and Berlin [63], the most important times for a cardiac arrest seemed to be around 1000 and 1800 hours. Ventricular fibrillation was most frequent around 2000 hours in the series by Peckova et al [60,64], while Arntz and associates found that ventricular fibrillation occurred most often around 1000 hours, with the exception of ventricular fibrillation, the circadian variation of the arrest rhythm in both cardiac and non-cardiac groups appeared to be identical.…”

Long-Term Recording of Cardiac Arrhythmias With an Implantable Cardiac Monitor in Patients With Reduced Ejection Fraction After Acute Myocardial Infarction

“…10,11 Outside the acute phase of the AMI, documentation comes from 24-to 48-hour Holter recordings obtained at randomly selected intervals, [12][13][14] leaving large gaps in the temporal knowledge of arrhythmia incidence in these patients. Prospective studies using long-term ECG monitoring in consecutive patients surviving AMI have not been performed.…”