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Gender differences in stability of the instantaneous patterns of body surface potentials during ventricular repolarisation

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Abstract

Women have a higher risk of developing torsade de pointes under QT-prolonging conditions. The electrophysiological differences between the sexes that could account for this are largely unknown. The objective of the work was to evaluate gender differences in repolarisation potentials using a method that is independent of the specific electrical properties of the thorax. 1410 normal recordings from the Glasgow 12-lead ECG database and 52 normal ECG maps obtained separately in Milan were analysed. The average difference between 1 and the correlation coefficient of the instantaneous pattern at the peak of T with that at every other instant is called the early repolarisation deviation index (ERDI) for J-T peak and the late repolarisation deviation index (LRDI) for T peak-T end. In standard ECG recordings, the ERDI was 0.42±0.22 in females compared with 0.19±0.16 in males (p<10−6). The LRDI was higher in males under the age of 50. In body surface maps, the ERDI was 0.32±0.21 in females against 0.16±0.17 in males (p<0.01), and the LRDI was non-significantly higher in males. The pattern of instantaneous body surface potentials showed gender differences during repolarisation with a method that is independent of the electrical properties of the thorax.

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References

  • Abildskov, J. A., Burgess, M. J., Lux, R. L., Wyatt, R., andVincent, M. (1976): ‘The expression of normal ventricular repolarization in the body surface distribution of T potentials’,Circulation,54, pp. 901–906

    Google Scholar 

  • Antzelevitch, C., Shimizu, W., andYan, G.-X. (1999): ‘The M cell: Its contribution to the ECG and to normal and abnormal electrical function of the heart’,J. Cardiovasc. Electrophysiol.,10, pp. 1124–1152

    Google Scholar 

  • Barnard, A., Duck, I. M., andLynn, M. S. (1967): ‘The application of electromagnetic theory in electrocardiology. I Derivation of the integral equations’,Biophys. J.,7, pp. 443–462

    Google Scholar 

  • Bazzett, H. (1920): ‘An analysis of the time-relations of electrocardiograms’,Heart,7, pp. 353–370

    Google Scholar 

  • Bidoggia, H., Maciel, J. P., Capalozza, N., Mosca, S., Blaksley, E. J., Valverde, E., Bertran, G., Arini, P., Biagetti, M. O., andQuinteiro, R. A. (2000): ‘Sex-dependent electrocardiographic pattern of cardiac repolarization’,Am. Heart. J.,140, pp. 430–436

    Google Scholar 

  • Corlan, A. D., andDe Ambroggi, L. (2000): ‘New quantitative methods of ventricular repolrization analysis in patients with left ventricular hypertrophy’,Ital. Heart. J.,1, pp. 542–548

    Google Scholar 

  • Corlan, A. D., Corlan, R., andDe Ambroggi, L. (2002): ‘Variability of simulated ECG autocorrelation maps with electrode placement’,Int. J. Bioelectromagn.,4, pp. 347–348

    Google Scholar 

  • De Ambroggi, L., Aime, E., Ceriotti, C., Rovida, M., andNegroni, S. (1997): ‘Mapping of ventricular repolarization potentials in patients with arrhythmogenic right ventricular dysplasia: principal component analysis of the ST-T waves’,Circulation,96, pp. 4314–4318

    Google Scholar 

  • Franz, M. R., Bargheer, K., Rafflenbeul, W., Haverich, A., andLichtlen, P. R. (1987): ‘Monophasic action potential mapping in human subjects with normal electrocardiograms: direct evidence for the genesis of the T wave’,Circulation,75, pp. 379–386

    Google Scholar 

  • Gambill, C. L., Wilkins, M. L. andHaisty, W. K. (1995): ‘T wave amplitudes in normal population’,J. ELectrocardiol.,29, pp. 191–197

    Google Scholar 

  • Green L. S., Lux, R. L., Haws, C. W., Williams, R. R., Hunt, S. C., andBurgess, M. J. (1985): ‘Effects of age, sex, and body habitus on QRS and ST-T potential maps of 1100 normal subjects’,Circulation,71, pp. 244–253

    Google Scholar 

  • Gulrajani, R., Roberge, F. A., andMailloux, G. E. (1989): ‘The forward problem of electrocardiography’, in ‘Comprehensive electrocardiology. Theory and practice in health and disease’ (Pergamon Press, Oxford, 1989), p. 202

    Google Scholar 

  • Hirano, Y., Moscucci, A., andJanuary, C. T. (1977): ‘Direct measurement of L-type Ca++ window current in heart cells’,Circ. Res.,70, pp. 445–455

    Google Scholar 

  • Hoekema, R., Uijen, G. J., Stilli, D., andvan Oosterom, A. (1998): ‘Lead system transformation of body surface map data’,J. Electrocardiol.,31, pp. 71–82

    Article  Google Scholar 

  • Hoekema, R., Uijen, G. J. H., van Erning, L., andvan Oosterom, A. (1999): ‘Interindividual variability of multilead electrocardiographic recordings. Influence of heart position’,J. Electrocardiol.,32–2, pp. 137–148

    Google Scholar 

  • Kaas, R. S., andTsien, R. W. (1975): ‘Multiple effects of calcium antagonists on plateau currents in, cardiac Purkinje fibers’,J. Gen. Physiol.,66, pp. 169–192

    Google Scholar 

  • Kawasaki, R., Machado, C., Reinoehl, J., Fromm, B., Baga, J. J., Steinman, R. T., andLehmann, M. H. (1995): ‘Increased propensity of women to develop torsade de pointes during complete heart block’,J. Cardiovasc. Electrophysiol.,6, pp. 1032–1038

    Google Scholar 

  • Lehmann, M. H., Hardy, S., Archibald, D., Quart, B., andMacNeil, D. (1996): ‘Sex difference in risk of torsade de pointes with d,l-sotalol’Circulation,94, pp. 2535–2541

    Google Scholar 

  • Lehmann, M. H., andYang, H. (2001): ‘Sexual dimorphism in the electrocardiographic dynamics of human ventricular repolarization: characterization in true domain’,Circulation,104, pp. 32–88

    Google Scholar 

  • Lepeschkin, E., andSurawicz, B. (1953): ‘The duration of the Q-U interval and its components in electrocardiograms of normal persons’,Am. Heart. J.,46, pp. 1–12

    Article  Google Scholar 

  • Macfarlane, P. W., andLawrie, T. D. V. (Eds) (1989): ‘Normal limits’ inMacfarlane, P. W., andLawrie, T. D. V. (Eds): ‘Comprehensive electrocardiology theory and practice in health and disease’ (Pergamon Press, Oxford, 1989), pp. 1442–1525

    Google Scholar 

  • Macfarlane, P. W., McLaughlin, S. C., Devine, B., andYang, T. F. (1994): ‘Effects of age, sex, and race on ECG interval measurement’,J. Electrocardiol.,27, pp. 14–19

    Article  Google Scholar 

  • Macfarlane, P. W., McLaughlin, S. C., andRodger, C. J. (1998): ‘Influence of lead selection and population on automated measurement of QT dispersion’,Circulation,98, pp. 2160–2167

    Google Scholar 

  • Makkar, R. R., Fromm, B. S., Steinman, R. T., Meissner, M. D., andLehmann, M. H. (1993): ‘Female gender as a risk factor for torsades de pointes associated with cardiovascular drugs’,JAMA,270, pp. 2590–2597

    Article  Google Scholar 

  • Merri, M., Benhorin, J., Alberti, M., Locati, E., andMoss, A. J. (1998): ‘Electrocardiographic quantitation of ventricular repolarization’,Circulation,80, pp. 1301–1308

    Google Scholar 

  • Osaka, T., Kodama, I., Tsuboi, N., Toyama, J., andYamada K. (1987): ‘Effects of activation sequence and anisotropic cellular geometry on the repolarization phase of action potential of dog ventricular muscles’,Circulation,76, pp. 226–236

    Google Scholar 

  • Pham, T. V., Robinson, R. B., Danilo, P., andRosen, M. R. (2002): ‘Effects of gonadal steroids on gender-related differences in transmural dispersion of L-type calcium current’,Cardiovasc. Res.,53, pp. 752–762

    Google Scholar 

  • Pham, T. V., andRosen, M. R. (2002): ‘Sex, hormones and repolarization’,Cardiovasc. Res.,53, pp. 740–751

    Google Scholar 

  • Reinoehl, J., Frankovich, D., Machado, C., Kawasaki, R., Baga, J. J., Pires, L. A., Steinman, R. T., Fromm B. S., andLehmann, M. H. (1996): ‘Probucol-associated tachyarrhythmic events and QT prolongation: importance of gener’,Am. Heart J.,131, pp. 1184–1191

    Google Scholar 

  • Sicouri, S., andAntzelevitch, C. (1993): ‘Drug-induced after depolarizations and triggered activity occur in discrete subpopulation of ventricular muscle cells (M cells) in the canine heart: quinidine and digitalis’,J. Cardiovasc. Electrophysiol.,4, pp. 48–58

    Google Scholar 

  • Spach, M. S., andBarr, R. C. (1975): ‘Ventricular intramural and epicardial potential distributions during ventricular activation and repolarization in the intact dog’,Circ. Res.,37, pp. 243–257

    Google Scholar 

  • Surawicz, B. (2001): ‘Puzzling gender repolarization gap’,J. Cardiovasc. Electrophysiol.,12, pp. 613–615

    Google Scholar 

  • Taccardi, B. (1966): ‘Body surface distribution of equipotential lines during atrial depolarization and ventricular repolarization’,Circ. Res.,19, pp. 865–878

    Google Scholar 

  • van Dam, R. Th., andDurrer, D. (1961): ‘Experimental study on the intramural distribution of excitability cycle and on the form of the epicardial T wave of the dog heart in situ’,Am. Heart J.,61, pp. 537–542

    Google Scholar 

  • van Oosterom, A., Hoekema, R., andUijen, G. J. H. (2000): ‘Geometrical factors affecting the interindividual variability of the ECG and VCG’,J. Electrocardiol.,33, pp. 219–227

    Google Scholar 

  • Watts, M. P., andShoat, D. B. (1987): ‘Trends in electrocardiographic design’,J. IERE,57, pp. 140–150

    Google Scholar 

  • Yan, G. X., andAntzelevitch, C. (1998): ‘Cellular basis for the normal T wave and the electrocardiographic manifestations of the long-QT syndrome’,Circulation,98, pp. 1928–1936

    Google Scholar 

  • Yang, H., Elko, P., Fromm, B., Baga, J. J., Pires, L. A., Schuger, C. D., Steinman, R. T., andLehmann, M. H. (1994): ‘Maximal ascending and descending slopes of the T wave in men and women’,J. Electrocardiol.,30, pp. 267–276

    Google Scholar 

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Authors and Affiliations

  1. Cardiology Department, University Hospital of Bucharest, Academy of Medical Sciences, Romania

    A. D. Corlan

  2. Division of Cardiovascular & Medical Sciences, Section of Cardiology, University of Glasgow, Scotland, UK

    P. W. Macfarlane

  3. Cardiology department, Istituto Policlinico San Donato, University of Milan, Italy

    L. De Ambroggi

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  1. A. D. Corlan
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  2. P. W. Macfarlane
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  3. L. De Ambroggi
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Correspondence to P. W. Macfarlane.

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Corlan, A.D., Macfarlane, P.W. & De Ambroggi, L. Gender differences in stability of the instantaneous patterns of body surface potentials during ventricular repolarisation. Med. Biol. Eng. Comput. 41, 536–542 (2003). https://doi.org/10.1007/BF02345315

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  • DOI: https://doi.org/10.1007/BF02345315

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