Cited by 83Cardiac electrophysiology and arrhythmiasCardiac Arrhythmias and TreatmentsCardiac pacing and defibrillation studies

Detailed analysis of 24 hour ambulatory electrocardiographic recordings during ventricular fibrillation or torsade de pointes

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Lewis, Benjamin H., Antman, Elliott M., Graboys, Thomas B.·1983·Journal of the American College of Cardiology

Abstract

Although the terminal cardiac rhythm is often well documented in many cases of sudden cardiac death, the antecedent or premonitory arrhythmias are usually not retrievable. The ambulatory electrocardiographic recordings of 12 patients who sustained ventricular fibrillation or torsade de pointes while wearing a long-term electrocardiographic monitor were analyzed in detail. A printout of the entire electrocardiographic recording was made and hand counts of ventricular arrhythmias were correlated with heart rate, QTc interval, RR interval preceding ventricular fibrillation or torsade de pointes and (RR')/QT initiating ventricular fibrillation or torsade de pointes. Common ambulatory electrocardiographic features in these 12 patients experiencing ventricular fibrillation or torsade de pointes included: 1) a period of high density of increasingly frequent or complex ventricular arrhythmias, or both, preceding ventricular fibrillation or torsade de pointes (11 patients); 2) R on T beats frequently initiating ventricular fibrillation or torsade de pointes (9 patients); and 3) repolarization abnormalities present for several hours before ventricular fibrillation or torsade de pointes (7 patients). No consistent relation between the RR and RR' interval initiating ventricular fibrillation or torsade de pointes was found; no consistent alteration in heart rate occurred before ventricular fibrillation or torsade de pointes. Thus, ventricular arrhythmias leading to sudden death in an ambulatory population do not occur in isolation but are preceded by a period of increased ventricular ectopic activity. Future guidelines for assessment of antiarrhythmic drug efficacy should include an evaluation of a drug's impact not only on ectopic beat frequency but also on arrhythmia density.

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  1. [4]4. Dhurandhar RW , MacMillan RL , Brown KWG . Primary ventncular tibnllanon comphcating acute myocardial infarction. Am J Cardiol 1971;27:347-51.
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Authors
Lewis, B. H., Antman, E. M., & Graboys, T. B.
Affiliations
Brigham and Women's Hospital (US)
Corresponding author
Antman, Elliott M.
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
1983-09
Volume
2
Issue
3
Pages
426-436
ISSN
0735-1097 (ISSN-L)
OpenAlex
W2047947471
Cited by
83
References
46
Citations by year
2019: 1 · 2018: 2 · 2017: 5 · 2015: 2 · 2014: 2 · 2013: 3 · 2012: 1
FWCI
4.38
Type
journal article
Language
en
Open access
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5 -T32)
  • National Heart, Lung, and Blood Institute (HL-07049, 5-T32-HL07049)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Keywords
ventricular fibrillation, torsades de pointes, sudden cardiac death, premature ventricular contractions, repolarization abnormalities, QTc interval, antiarrhythmic efficacy
MeSH terms
Adult, Aged, Ambulatory Care, Electrocardiography, Cardiac Complexes, Premature, Female, Heart Conduction System, Heart Rate, Humans, Male, Middle Aged, Monitoring, Physiologic, Tachycardia, Time Factors, Ventricular Fibrillation

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