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Use of a novel transfer function to reduce repolarization interval hysteresis

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Cardiac repolarization is assessed by the QT interval on the surface electrocardiogram and varies with the heart rate. Standard QT corrections (QTc) do not account for the lag in QT change following a change in heart rate (QT hysteresis). Our group has developed and tested a transfer function (TRF) model to assess the effectiveness of a dynamic model of QT/RR coupling in eliminating hysteresis.

Methods

We studied three groups: group I, healthy volunteers (n = 23, 41 ± 17 years); group II, hypertensive patients (n = 25, 45 ± 11 years); and group III, patients in a predominately paced rhythm (n = 5, 75 ± 6 years). To vary the heart rate, either exercise bicycling in the supine position (groups I and II) or manipulation of the pacemaker parameters (group III) was done. We then compared a dynamic TRF model with a model based on weighted averages of previous RR intervals. Two parameters were tested: root mean square (RMS) of the error signal between measured and computed QT and the elimination of hysteretic loops.

Results

TRF-based measurements eliminated hysteresis in 22/23 (95%) group I patients, 21/25 (84%) group II patients, and 4/5 (80%) group III patients. When hysteresis elimination was not complete, the QT drift that followed RR intervals was different before and after bicycling (100 ms). In these patients, the corresponding QT interval did not significantly change during this period. The TRF model was found superior to the other tested models with respect to both analyzed parameters (RMS and hysteresis elimination).

Conclusion

The TRF model limited QT hysteresis in healthy, hypertensive, and pacemaker-dependent patients. In addition, an important finding of QT drift in patients with hypertension was identified. With further study in these and other diseased states, the TRF model may improve our ability to measure accurately cardiac repolarization and to determine arrhythmia risk.

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Abbreviations

TRF:

Transfer function

ECG:

Electrocardiogram

RMS:

Root mean square

Ms:

Milliseconds

RR:

Heart interval

QTc:

QT corrected

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Acknowledgments

The work was supported by Grant No. 102/08/1129 of the Grant Agency of the Czech Republic.

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Authors and Affiliations

  1. Institute of Scientific Instruments, Brno, Czech

    Josef Halámek, Pavel Jurák, Vlastimil Vondra & Pavel Leinveber

  2. Intermountain Medical Center, Murray, UT, USA

    T. Jared Bunch

  3. St Anne’s University Hospital, Brno, Czech

    Jolana Lipoldová, Miroslav Novák, Pavel Leinveber, Martin Plachy, Tomas Kara, Petr Fráňa & Miroslav Souček

  4. Università di Bergamo, Dalmine, Italy

    Marco Villa

  5. Mayo Clinic, Rochester, MN, USA

    Virend K. Somers & Samuel J. Asirvatham

  6. Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic Rochester, 200 1st St. SW, Rochester, MN, 55905, USA

    Samuel J. Asirvatham

  7. Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic Rochester, 200 1st St. SW, Rochester, MN, 55905, USA

    Samuel J. Asirvatham

Authors
  1. Josef Halámek
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  2. Pavel Jurák
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  3. T. Jared Bunch
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  4. Jolana Lipoldová
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  5. Miroslav Novák
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  6. Vlastimil Vondra
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  7. Pavel Leinveber
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  8. Martin Plachy
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  9. Tomas Kara
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  10. Marco Villa
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  11. Petr Fráňa
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  12. Miroslav Souček
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  13. Virend K. Somers
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  14. Samuel J. Asirvatham
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Corresponding author

Correspondence to Samuel J. Asirvatham.

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Halámek, J., Jurák, P., Bunch, T.J. et al. Use of a novel transfer function to reduce repolarization interval hysteresis. J Interv Card Electrophysiol 29, 23–32 (2010). https://doi.org/10.1007/s10840-010-9500-x

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  • DOI: https://doi.org/10.1007/s10840-010-9500-x

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