Key result
Measuring Holter-based late potentials at the time of the worst LAS40 value significantly predicted sustained ventricular tachycardia (OR 3.75; 95% CI 1.45-9.71; p=0.006).
Why the study?
Holter-based late potentials exhibit diurnal variation, but no studies have evaluated the optimal 24-hour measurement timing for predicting lethal arrhythmia.
Does the timing of Holter-based late potential measurement affect the accuracy of predicting sustained ventricular tachycardia in post-myocardial infarction patients?
Observational (n=186)
Does the timing of Holter-based late potential measurement affect the accuracy of predicting sustained ventricular tachycardia in post-myocardial infarction patients?
Measuring Holter-based late potentials at the time of the worst LAS40 value optimizes the prediction of sustained ventricular tachycardia in post-myocardial infarction patients.
Answers are grounded in this paper and cite their sources.
Holter LP timing may refine arrhythmia risk stratification; hypothesis-generating and leaves optimal window open for prospective validation.
Background and Objectives: Holter-based late potentials (LPs) are useful for predicting lethal arrhythmias in organic cardiac diseases. Although Holter-based LPs exhibit diurnal varia-tion, 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 diurnal variability of 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 obser-vation 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 diurnal variability of 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 LP parameters in the MI-VT and control groups. In the non-VT group, LP parameters were significantly influenced by noise and parasympathetic heart rate variability parameters such as logPNN50. Conclusions: For Holter-based LP measurements, test accuracy was higher when LP was measured at the time of the highest or worst value of LAS40. Changes in autonomic nervous system activity, including heart rate and noise levels, were factors influencing diurnal variability.
No takes yet. Share an insight, caveat, or question.
Hashimoto et al. (2023) conducted an observational in Post-myocardial infarction (n=186). Holter-based late potentials measurement at the time of worst 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 worst LAS40 value significantly predicted sustained ventricular tachycardia (OR 3.75; 95% CI 1.45-9.71; p=0.006).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: