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[Study of lethal arrhythmias using Holter ECG monitoring]
1Department of Bioclimatology and Medicine, Kyushu University, Beppu.
Insights
Sudden cardiac death (SD) risk factors include coronary artery disease, ventricular tachycardia, and reduced night-time heart rate variability. Male sex and paroxysmal atrial fibrillation also increase risk.
Area of Science:
- Cardiology
- Electrophysiology
- Public Health
Context:
- Long-term Holter monitoring data from 2733 patients (1973-1986) were analyzed.
- Patients were categorized into sudden cardiac death (SD), cardiac failure (CF), and survival groups.
- The study investigated precipitating factors for SD by comparing clinical characteristics and underlying conditions.
Purpose:
- To identify key risk factors and clinical characteristics associated with sudden cardiac death.
- To compare patients experiencing SD with those who died of cardiac failure or survived.
- To evaluate the role of coronary artery disease, arrhythmias, and heart rate variability in SD.
Summary:
- Coronary artery disease (CAD) incidence did not significantly differ between groups.
- Ventricular tachycardia (VT) and paroxysmal atrial fibrillation (PAf) were more frequent in the SD group.
- Reduced night-time heart rate variability (RR50) and male sex were identified as significant risk factors for SD.
Impact:
- Findings highlight specific electrophysiological and clinical markers predictive of sudden cardiac death.
- This research can inform risk stratification and preventative strategies for patients at risk of SD.
- Understanding these factors may lead to improved patient outcomes and reduced cardiac mortality.
Abstract:
Holter monitorings were performed on 2733 cases (male 1547, female 1186; age 16-92 yrs.) from 1973 to 1986 in our hospital. Among these cases, 18 patients (0.66%) died suddenly (group A), 47 patients (1.72%) died of cardiac failure (group B) and 142 patients (5.27%) survived irrespective of the presence of advanced arrhythmias (group C). To evaluate the precipitating factors for sudden cardiac death (SD), underlying diseases, electrical instability and clinical characteristics were compared between each group. 1. The incidence of coronary artery disease (CAD) was 6 cases (33.3%) in group A, 13 cases (27.8%) in group B and 70 cases (49.3%) in group C. There were no significant differences in the incidence of CAD between each group. 2. The incidence of ventricular tachycardia (VT) was 5 cases (27.8%) in group A, 13 cases (27.7%) in group B and 33 cases (23.2%) in group C. Paroxysmal atrial fibrillation (PAf) also showed the higher incidence in group A. 3. The subjects older than 60 years old were 4 cases (22.2%) in group A, 30 cases (63.8%) in group B and 60 cases (42.2%) in group C. The sex ratios were higher in male (over 60%) in 3 groups than in female. 4. In patients with CAD, VT showed higher incidence in SD (3/6 cases (50.0%)), cardiac death (CD) (6/13 cases (46.2%)) and those who survived with myocardial infarction (11/30 cases (36.7%)). 5. In patients with CAD, the reproducibility of advanced arrhythmias was found in 1/3 cases (33.3%) for SD and in 6/9 cases (66.7%) for CD. 6. Heart rate variability evaluated by RR50 (total number of changes in successive RR intervals greater than absolute value of 50 msec.) showed smaller value in the night (3:00 a.m.) than in the daytime (3:00 p.m.) in the patients with SD and CD. The night value of RR50 was significantly lower in patients with SD than in patients with CAD (p less than 0.05). The above results suggest that the presence of coronary artery disease, VT, PAf, decrease in RR50 at night and sex (male) will be precipitating factors for sudden cardiac death.