Key result
Increased repolarization variability is linked to ~5% higher risk of appropriate ICD therapy.
Why the study?
Increased beat-to-beat variability of repolarization predicts arrhythmia onset in experimental models, but its clinical translation was not well established.
Does beat-to-beat variability of repolarization predict imminent nonsustained ventricular tachycardia and future appropriate ICD therapy in patients with ischemic and nonischemic dilated cardiomyopathy?
Observational (n=185)
No
Does beat-to-beat variability of repolarization predict imminent nonsustained ventricular tachycardia and future appropriate ICD therapy in patients with ischemic and nonischemic dilated cardiomyopathy?
Beat-to-beat variability of repolarization increases in the minute preceding nonsustained ventricular tachycardia and independently predicts future appropriate ICD therapy in patients with cardiomyopathy.
May support short-term arrhythmia prediction in cardiomyopathy; hypothesis-generating pending prospective validation.
Background An increase in beat‐to‐beat variability of repolarization (BVR) predicts arrhythmia onset in experimental models, but its clinical translation is not well established. We investigated the temporal changes in BVR before nonsustained ventricular tachycardia (nsVT) in patients with implantable cardioverter defibrillator (ICD). Methods and Results Patients with nsVT on 24‐hour Holter before ICD implantation for ischemic cardiomyopathy (ischemic cardiomyopathy+nsVT, n=43) or dilated cardiomyopathy (dilated cardiomyopathy+nsVT, n=37), matched ICD candidates without nsVT (ischemic cardiomyopathy‐nsVT, n=29 and dilated cardiomyopathy‐nsVT, n=26), and patients without ICD without structural heart disease (n=50) were studied. Digital Holter recordings from these patients were analyzed using a modified fiducial segment averaging technique to detect the QT interval. The nsVT episodes were semi‐automatically identified and QT‐BVR was assessed 1‐, 5‐, and 30‐minutes before nsVT, and at rest (at 3:00 am ). Resting BVR was higher in ICD patients compared with controls without structural heart disease. In ICD patients with nsVT, BVR increased significantly 1‐minute pre‐nsVT in ischemic cardiomyopathy (2.21±0.59 ms, versus 5 minutes pre‐nsVT: 1.78±0.50 ms, P <0.001) and dilated cardiomyopathy (2.09±0.57 ms, versus 5‐minutes pre‐nsVT: 1.58±0.51 ms, P <0.001), but not in patients without nsVT. In multivariable Cox regression analysis, pre‐nsVT BVR was a significant predictor for appropriate therapy during follow‐up. Conclusions Baseline BVR is elevated and temporal changes in BVR predict imminent nsVT events in patients with ICD independent of underlying cause. Real‐time BVR monitoring could be used to predict impending ventricular arrhythmia and allow preventive therapy to be incorporated into ICDs.
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Amoni et al. (2022) conducted an observational in Ischemic and nonischemic dilated cardiomyopathy (n=185). Beat-to-beat variability of repolarization (BVR) vs. Lower BVR or absence of nsVT was evaluated on First appropriate ICD therapy (APT) (HR 1.05, 95% CI 1.01-1.09, p=0.012). Beat-to-beat variability of repolarization significantly increased in the minute preceding nonsustained ventricular tachycardia and independently predicted appropriate ICD therapy during follow-up (HR 1.05).
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