Key result
Measuring Holter-based late potentials at the time of the longest duration of low-amplitude signals <40 μV (LAS40) predicted ventricular tachycardia (OR 3.75; 95% CI 1.45-9.71; p=0.006).
Why the study?
Although Holter-based late potentials exhibit diurnal variation, no studies have evaluated the optimal timing of measurement over 24 hours to predict lethal arrhythmia leading to sudden cardiac death.
Does the timing of Holter-based late potential measurement affect its accuracy in predicting sustained ventricular tachycardia in post-myocardial infarction patients?
Observational (n=186)
Does the timing of Holter-based late potential measurement affect its accuracy in predicting sustained ventricular tachycardia in post-myocardial infarction patients?
Answers are grounded in this paper and cite their sources.
Measuring Holter-based late potentials at the time of the worst LAS40 value improves the prediction of sustained ventricular tachycardia in post-myocardial infarction patients.
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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Hashimoto et al. (2023) conducted an observational in Post-myocardial infarction (n=186). Holter-based late potentials (LPs) measurement at highest LAS40 was evaluated on sustained ventricular tachycardia (VT) (OR 3.75, 95% CI 1.45-9.71, p=0.006). Measuring Holter-based late potentials at the time of the longest duration of low-amplitude signals <40 μV (LAS40) predicted ventricular tachycardia (OR 3.75; 95% CI 1.45-9.71; p=0.006).
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