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Increased Monday incidence of life-threatening ventricular arrhythmias. Experience with a third-generation
R W Peters1, S McQuillan, S K Resnick
1Department of Medicine, University of Maryland School of Medicine, Baltimore, USA. Robert W Peters, MD@Baltimore. Gov
Insights
Life-threatening ventricular arrhythmias show a weekly pattern, peaking on Mondays and declining on weekends. This pattern may be influenced by beta-blockers, offering insights into sudden cardiac death prevention.
Area of Science:
- Cardiology
- Chronobiology
- Electrophysiology
Background:
- Cardiac event timing offers pathophysiological insights.
- Acute myocardial infarction commonly occurs on Mondays.
- The day-of-week pattern of sudden cardiac death and lethal arrhythmias was previously unexamined.
Purpose of the Study:
- To investigate the septadian (day of the week) pattern of life-threatening ventricular arrhythmias.
- To determine if this pattern differs from acute myocardial infarction.
- To explore potential influencing factors, including beta-blocker use.
Main Methods:
- Examined septadian distribution of ventricular arrhythmias (cycle length < 280 ms).
- Utilized data from 683 patients with implantable defibrillators (Ventak PRx).
- Analyzed patterns in relation to patient demographics and medication use.
Main Results:
- A prominent Monday peak and midweek decline in arrhythmias were observed.
- Weekend days showed a marked trough in arrhythmia occurrence.
- The pattern was consistent across various patient characteristics but absent in beta-blocker recipients.
Conclusions:
- Lethal arrhythmias exhibit a non-random daily pattern, potentially linked to the work week.
- Beta-blocker use may influence or abolish the Monday arrhythmia peak.
- Understanding this pattern may aid in preventing sudden cardiac death.
Background:
Examination of the timing of cardiac events provides important pathophysiological information. Previous studies have shown that the onset of acute myocardial infarction occurs most frequently on Monday. The septadian (day of the week) pattern of occurrence of sudden cardiac death and lethal ventricular arrhythmias has not been examined previously.
Methods And Results:
We examined the septadian distribution of life-threatening (cycle length < 280 ms) ventricular arrhythmias in 683 consecutive patients receiving a Ventak PRx, a third-generation implantable defibrillator with an event recorder. There was a prominent Monday peak, with a midweek decline and a secondary peak later in the week. A marked trough is apparent on both weekend days. The observed pattern was independent of age, sex, ejection fraction, NYHA functional class, type of heart disease, and the use of antiarrhythmic drugs but was not observed in patients receiving beta-blockers.
Conclusions:
Potentially lethal arrhythmias are not random events but occur in a daily pattern suggesting a relationship to the beginning and end of the work week. The absence of a Monday peak in patients receiving beta-blockers suggests that the pattern may be influenced by beta-blockers. This information may be useful in devising strategies to prevent sudden cardiac death.