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Diurnal Variation in and Optimal Time to Measure Holter-Based Late Potentials to Predict Lethal Arrhythmia after
Kenichi Hashimoto1, Naomi Harada1, Motohiro Kimata1
1Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
Insights
Optimal timing for Holter-based late potential (LP) testing is crucial for predicting lethal arrhythmias. Measuring LPs when the low-amplitude signals (LAS40) are worst, typically at night, improves accuracy for identifying patients at risk of sudden cardiac death.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Diagnostics
Background:
- Holter-based late potentials (LPs) are established predictors of lethal arrhythmias in organic cardiac diseases.
- Diurnal variation in LPs is recognized, but optimal measurement timing for predicting sudden cardiac death remains uninvestigated.
Purpose of the Study:
- To validate the most effective timing for Holter-based LP testing.
- To explore factors influencing diurnal variability in LP parameters for improved arrhythmia prediction.
Main Methods:
- Retrospective analysis of 126 post-myocardial infarction (MI) patients and 60 controls undergoing high-resolution Holter ECG.
- LP parameters, including LAS40, were measured at 6 intervals over 24 hours.
- Heart rate variability analysis was performed to identify influencing factors.
Main Results:
- LP parameters exhibited diurnal variation, worsening at night and improving during the day.
- Measuring LAS40 at its longest duration of low-amplitude signals (< 40 μV) yielded the highest accuracy (AUC 0.659) for VT prediction.
- Heart rate and noise significantly affected LP parameters; parasympathetic activity influenced LPs in the non-VT group.
Conclusions:
- Holter-based LP test accuracy is maximized when measured during periods of worst LAS40 values, often at night.
- Autonomic nervous system activity, particularly heart rate and parasympathetic tone, influences LP diurnal variability.
- Increased parasympathetic activity or bradycardia may exacerbate Holter-based LP parameters, impacting arrhythmia risk assessment.
Abstract:
Background and Objectives: Holter-based late potentials (LPs) are useful for predicting lethal arrhythmias in organic cardiac diseases. Although Holter-based LPs exhibit diurnal variation, no studies have evaluated the optimal timing of LP measurement over 24 h for predicting lethal arrhythmia that leads to sudden cardiac death. Thus, this study aimed to validate the most effective timing for Holter-based LP testing and to explore factors influencing the diurnal variability in LP parameters. Materials and Methods: We retrospectively analyzed 126 patients with post-myocardial infarction (MI) status and 60 control participants who underwent high-resolution Holter electrocardiography. Among the 126 post-MI patients, 23 developed sustained ventricular tachycardia (VT) (the MI-VT group), while 103 did not (the MI-non-VT group) during the observation period. Holter-based LPs were measured at 0:00, 4:00, 8:00, 12:00, 16:00, and 20:00, and heart rate variability analysis was simultaneously performed to investigate factors influencing the diurnal variability in LP parameters. Results: Holter-based LP parameters showed diurnal variation with significant deterioration at night and improvement during the day. Assessment at the time with the longest duration of low-amplitude signals < 40 μV in the filtered QRS complex terminus (LAS40) gave the highest receiver operating characteristics curve (area under the curve, 0.659) and the highest odds ratio (3.75; 95% confidence interval, 1.45-9.71; p = 0.006) for predicting VT. In the multiple regression analysis, heart rate and noise were significant factors affecting the LP parameters in the MI-VT and control groups. In the non-VT group, the LP parameters were significantly influenced by noise and parasympathetic heart rate variability parameters, such as logpNN50. Conclusions: For Holter-based LP measurements, the test accuracy was higher when the LP was measured at the time of the highest or worst value of LAS40. Changes in autonomic nervous system activity, including heart rate, were factors influencing diurnal variability. Increased parasympathetic activity or bradycardia may exacerbate Holter-based LP parameters.
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