Cycle length sequence dependent repolarization dynamics

Cardiac repolarization, particularly its heterogeneity, is known to play a significant role in arrhythmogenesis. Steepness of cardiac restitution, or the cycle length dependency of repolarization, has also been implicated as a condition that favors occurrence of reentrant arrhythmias. However, most assessments of heterogeneity and restitution are based on static observations and do not directly account for the extent or heterogeneity of dynamic changes. The uncertainty and unpredictability of arrhythmias and the difficulty of identifying patients most at risk may possibly be explained by the lack of consideration of dynamic changes of repolarization, its heterogeneity and time varying restitution. In this brief article, we show the global changes in repolarization that occur in normal canine hearts in response to programmed cycle length sequences. Specifically, we show the beat-to-beat tracking of repolarization during rapid (step) changes in cycle length as well as linear up and down (sawtooth) changes, and random cycle length sequences. The measurement and robust characterization of the dynamic repolarization response to specific cycle length sequences may offer an opportunity to characterize the substrate for arrhythmias to a greater extent than has been possible to date. Although there is no guarantee that characterization of repolarization dynamics will provide definitive means to identify patients at risk, such assessment will, at a minimum, put into perspective the role that repolarization dynamics may play in detecting states of increased arrhythmia risk. Another potential use of these techniques is in the assessment of repolarization in patients undergoing EP testing, pharmacological therapies or during other provocative testing.