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Ventricular arrhythmias and changes in heart rate preceding ventricular tachycardia in patients with an implantable cardioverter defibrillator

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Abstract

The objective was to determine the characteristics of heart rate variability and ventricular arrhythmias prior to the onset of ventricular tachycardia (VT) in patients with an implantable cardioverter defibrillator (ICD). Sixty-eight beat-to-beat time series from 13 patients with an ICD were analyzed to quantify heart rate variability and ventricular arrhythmias. The episodes of VT were classified in one of two groups depending on whether the sinus rate in the 1 min preceding the VT was greater or less than 90 beats per minute. In a subset of patients, increased heart rate and reduced heart rate variability was often observed up to 20 min prior to the VT. There was a non-significant trend to higher incidence of premature ventricular complexes (PVCs) before VT compared to control recordings. The patterns of the ventricular arrhythmias were highly heterogeneous among different patients and even within the same patient. Analysis of the changes of heart rate and heart rate variability may have predictive value about the onset of VT in selected patients. The patterns of ventricular arrhythmia could not be used to predict onset of VT in this group of patients.

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Abbreviations

ACE :

Angiotensin converting enzyme inhibitor

ARB:

Angiotensin II receptor blocker

CI :

Coupling interval

FFT :

Fast Fourier transform

FWShannon :

Shannon entropy of the symbolic word distribution

HF :

Mean power at the high frequency band (from 0.15 to 0.4 Hz)

HRV :

Heart rate variability

ICD :

Implantable cardioverter defibrillator

LF :

Mean power at the low frequency band (from 0.04 to 0.15 Hz)

N :

Normal heart beat

NIB :

Number of intervening sinus beats (N) between two consecutive V beats

NN :

RR intervals from normal heartbeats

nu :

Normalized units

NYHA :

New York Heart Association

pNN50 :

Percentage of beat-to-beat differences greater than 50 ms

Polvar10 :

Incidence of beats segments during which the beat-to-beat differences of RR intervals is less than 10 ms

PVCs :

Premature ventricular complexes

RMSsd :

Root mean square of successive beat-to-beat differences

sdNN :

Standard deviation of NN

TOCSY :

Toolbox for Complex Systems

V :

Premature ventricular complex

VF :

Ventricular fibrillation

VT:

Ventricular tachycardia

VTCI :

Ventricular tachycardia coupling interval

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Acknowledgments

The authors thank the CIHR and MITACS for financial support. J. K. and N. W. acknowledge financial support by the EU Network of Excellence, Grant No. NoE 005137 BioSim, as well as by the Deutsche Forschungsgemeinschaft Grants Nos. KU 837/23-1 and KU 837/20-2.

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Authors and Affiliations

  1. Departamento de Instrumentación Electromecánica, Instituto Nacional de Cardiología “Ignacio Chávez”, Mexico, D.F, Mexico

    Claudia Lerma

  2. Institut für Physik, AG NLD, Kardiovaskuläre Physik, Universität Potsdam, Postfach 601553, 14415, Potsdam, Germany

    Niels Wessel & Jürgen Kurths

  3. Department of Cardiology and Pneumology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany

    Niels Wessel & Alexander Schirdewan

  4. Centre for Nonlinear Dynamics, Department of Physiology, McGill University, Montreal, QC, Canada

    Leon Glass

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  1. Claudia Lerma
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  2. Niels Wessel
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Correspondence to Niels Wessel.

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Lerma, C., Wessel, N., Schirdewan, A. et al. Ventricular arrhythmias and changes in heart rate preceding ventricular tachycardia in patients with an implantable cardioverter defibrillator. Med Biol Eng Comput 46, 715–727 (2008). https://doi.org/10.1007/s11517-008-0326-y

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