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Circadian variation in ventricular electrical instability associated with coronary artery disease
J McClelland1, B Halperin, J Cutler
1Department of Medicine, Oregon Health Sciences University, Portland 97201.
Insights
This study found no evidence of daily (circadian) variations in ventricular electrical instability. Therefore, the timing of electrophysiologic testing does not impact results for patients with coronary artery disease.
Area of Science:
- Cardiology
- Electrophysiology
- Circadian Biology
Background:
- Sudden cardiac death and ischemic cardiac events exhibit circadian patterns.
- Primary arrhythmic events are implicated in sudden cardiac death but their circadian pattern is unknown.
Purpose of the Study:
- To investigate circadian variation in ventricular electrical instability.
- To determine if the timing of electrophysiologic testing affects results.
Main Methods:
- Analysis of 2 drug-free ventricular stimulation studies in 162 patients with coronary artery disease.
- Evaluation of induced arrhythmia rate, duration, and stimuli required, comparing tests performed 4-28 hours apart.
- Temporal analysis by half-day, hour, and continuous methods.
Main Results:
- No significant circadian variation was detected in any electrophysiologic measure of ventricular electrical instability.
- Statistical power was adequate to detect variations if they existed.
Conclusions:
- The time of day for ventricular stimulation testing does not influence results.
- Circadian changes in ventricular electrical instability may not be a major factor in the daily pattern of sudden cardiac death.
Abstract:
Although sudden cardiac deaths and ischemic cardiac events clearly occur in a circadian pattern, such a pattern has not been shown for primary arrhythmic events. Because primary arrhythmic events are thought to play an important role in sudden cardiac death, a large series of ventricular stimulation studies was analyzed to determine whether circadian variation in ventricular electrical instability exists. If such a circadian variation could be shown, it could have implications for the conduct and interpretation of electrophysiologic testing and the etiology of circadian variation in sudden cardiac death. Results of 2 drug-free ventricular stimulation studies performed 4 to 28 hours apart in each of 162 patients with coronary artery disease were analyzed. Rate and duration of induced arrhythmia, number of extrastimuli required to induce arrhythmia and changes in these factors between the 2 tests in each patient were analyzed. Comparisons were made by half-day, by hour and in a temporally continuous manner to eliminate errors associated with any single method. No significant circadian variation was found in any electrophysiologic measure of ventricular electrical instability despite adequate statistical power. These findings show that the time of day during which ventricular stimulation tests are performed does not affect test results, and therefore does not need to be controlled during electrophysiologic studies. If these findings are parallel to those in ambulatory patients with coronary artery disease, then circadian changes in ventricular electrical instability may not play as important a role in the circadian pattern of sudden cardiac death as had been previously thought.