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ECG Recordings (ecg + recording)

Distribution by Scientific Domains
Medical Sciences97%

Kinds of ECG Recordings

  • ambulatory ecg recording
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    Selected Abstracts

    Value of Different Follow-Up Strategies to Assess the Efficacy of Circumferential Pulmonary Vein Ablation for the Curative Treatment of Atrial Fibrillation

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2005
    CHRISTOPHER PIORKOWSKI M.D.
    Background: The objective of this study was to compare transtelephonic ECG every 2 days and serial 7-day Holter as two methods of follow-up after atrial fibrillation (AF) catheter ablation for the judgment of ablation success. Patients with highly symptomatic AF are increasingly treated with catheter ablation. Several methods of follow-up have been described, and judgment on ablation success often relies on patients' symptoms. However, the optimal follow-up strategy objectively detecting most of the AF recurrences is yet unclear. Methods: Thirty patients with highly symptomatic AF were selected for circumferential pulmonary vein ablation. During follow-up, a transtelephonic ECG was transmitted once every 2 days for half a year. Additionally, a 7-day Holter was recorded preablation, after ablation, after 3 and 6 months, respectively. With both, procedures symptoms and actual rhythm were correlated thoroughly. Results: A total of 2,600 transtelephonic ECGs were collected with 216 of them showing AF. 25% of those episodes were asymptomatic. On a Kaplan-Meier analysis 45% of the patients with paroxysmal AF were still in continuous SR after 6 months. Simulating a follow-up based on symptomatic recurrences only, that number would have increased to 70%. Using serial 7-day ECG, 113 Holter with over 18,900 hours of ECG recording were acquired. After 6 months the percentage of patients classified as free from AF was 50%. Of the patients with recurrences, 30,40% were completely asymptomatic. The percentage of asymptomatic AF episodes stepwise increased from 11% prior ablation to 53% 6 months after. Conclusions: The success rate in terms of freedom from AF was 70% on a symptom-only-based follow-up; using serial 7-day Holter it decreased to 50% and on transtelephonic monitoring to 45%, respectively. Transtelephonic ECG and serial 7-day Holter were equally effective to objectively determine long-term success and to detect asymptomatic patients. [source]

    Validation of 2 Techniques for Electrocardiographic Recording in Dogs and Cats

    JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 4 2006
    Luca Ferasin
    Background: Standard electrocardiographic (ECG) recording in the dog and cat is commonly performed in right lateral recumbency, by connecting the ECG leads to the skin of the patient via metallic alligator clips. The jaws of the alligator clips are usually filed or flattened to reduce their uncomfortable pressure on the patient's skin. However, filed and flattened alligator clips can occasionally lose their grip to the skin, causing lead detachment during standard ECG recording. Hypothesis: The aim of the study was to validate two novel ECG recording techniques ("gel" and "pads"). Animals: Six-lead standard ECG recording was obtained from 42 dogs and 40 cats using the standard technique, as well as the two novel methods. Methods: Measurements were taken of the amplitude and duration of P waves and QRS complexes, duration of PQ and QT intervals, and mean electrical axis (MEA). In each recording, five representative complexes were measured, and the results were averaged for each parameter. Results: A good quality ECG recording was obtained with all the three different techniques, although a degree of wandering trace was observed in one third of cats with the "pads" technique. Bland-Altman analysis showed good agreement between the ECG values recorded with the two novel techniques and those recorded with the standard traditional technique. Furthermore, the observed differences were not clinically relevant, except for the R wave amplitude recorded with the "pads" method in cats (-0.35 to 0.37 mV). Conclusions and Clinical Importance: In conclusion, this study supports the reliability and clinical validity of the "gel" and "pads" techniques for ECG recording both in the dog and the cat, with some limitations for the "pads" technique in cats. [source]

    Evaluating Patients with Acute Ischemic Stroke with Special Reference to Newly Developed Atrial Fibrillation in Cerebral Embolism

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 9 2007
    MINORU TAGAWA M.D.
    Background:Cardioembolic strokes are extensive and have a poor prognosis. To identify the cardiovascular risk factors of cardioembolic stroke, we evaluated the cardiovascular status with special reference to persistent atrial fibrillation (AF) and paroxysmal atrial fibrillation (PAF) combined with the type of acute ischemic stroke. Methods:We divided 315 consecutive patients admitted to our Department of Neurosurgery with an acute ischemic stroke into four types of brain infarction using clinical history, onset pattern of stroke, and brain imaging: cardioembolic (group E, n = 105), lacunar (group L, n = 92), atherothrombotic (group T, n = 111), and unclassified (n = 7). All patients underwent standard electrocardiography (ECG), a 24-hour ECG recording (Holter ECG) and transthoracic echocardiography (UCG). Results:Persistent AF or PAF was detected in 97 patients (31.5%) using Holter ECG: more frequently in group E (67.6%) than in groups L (15.2%) or T (9.2%). Persistent AF or PAF was first diagnosed on admission using a standard ECG in 16 patients (5.2%) with no previous history and 14 of these patients belonged to group E (13.3%). PAF was newly detected on Holter ECG in another 26 patients (8.4%) and 13 of these patients (12.4%) belonged to group E. Concerning UCG, left atrial enlargement and mitral regurgitation were more frequent in group E than in group L or T. Conclusion:Holter ECG in addition to ECG on admission is important for detecting persistent AF or PAF in patients with ischemic stroke, especially with cardioembolism as diagnosed by neuroimaging. [source]

    Cardiac Arrhythmias Triggered by Sudden and Dynamic Efforts

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2010
    Emanuel C. Furtado M.D.
    Background: Some arrhythmias are triggered only during exercise. The aim of this study is to describe the frequency and type of arrhythmia induced by a standardized protocol of sudden and dynamic exercise, which tends to reflect routine situations of efforts (e.g., climbing stairs), and compare with those found on maximal cardiopulmonary exercise test (CPET). Methods: A total of 2329 subjects (1594 men) aged 9,91 years (mean 52 years, SD ± 16) were submitted to a standardized protocol of sudden and dynamic exercise (4-second exercise test [4sET]) prior to a CPET. A continuous digital electrocardiogram (ECG) was recorded during 4sET and CPET, and later reviewed and interpreted by the same physician (who supervised all the procedures). Results: A total of 1125 subjects (43%) had cardiac arrhythmias during one or both procedures. About 57% of the arrhythmias were supraventricular, but 47 subjects (2% of all subjects) presented more complex arrhythmias including 43 cases of nonsustained supraventricular tachycardia and four nonsustained ventricular tachycardia. While arrhythmias were more often exposed by the CPET (P < 0.01), in 221 cases (10% of the total sample) of arrhythmias they were only induced by 4sET; these included four cases of nonsustained supraventricular tachycardia. Conclusion: 4sET-induced arrhythmias tend to be simple and were always short-lasting. In some cases, ECG recording during 4sET showed arrhythmias that would not be induced by a progressive maximal exercise test. Different situations of exercise, sudden and short versus maximal and progressive, tend to generate different arrhythmic responses and possibly complementary clinical implications. Ann Noninvasive Electrocardiol 2010;15(2):151,156 [source]

    Altered Interatrial Conduction Detected in MADIT II Patients Bound to Develop Atrial Fibrillation

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 3 2009
    Fredrik Holmqvist M.D., Ph.D.
    Background: Changes in P-wave morphology have recently been shown to be associated with interatrial conduction route used, without noticeable changes of P-wave duration. This study aimed at exploring the association between P-wave morphology and future atrial fibrillation (AF) development in the Multicenter Automatic Defibrillator Trial II (MADIT II) population. Methods: Patients included in MADIT-II without a history of AF with sinus rhythm at baseline who developed AF during the study ("Pre-AF") were compared to matched controls without AF development ("No-AF"). Patients were followed for a mean of 20 months. A 10-minute high-resolution bipolar ECG recording was obtained at baseline. Signal-averaged P waves were analyzed to determine orthogonal P-wave morphology, P-wave duration, and RMS20. The P-wave morphology was subsequently classified into one of three predefined types using an automated algorithm. Results: Thirty patients (age 68 ± 7 years) who developed AF during MADIT-II were compared with 60 patients (age 68 ± 8 years) who did not. P-wave duration and RMS20 in the Pre-AF group was not significantly different from the No-AF group (143 ± 21 vs 139 ± 30 ms, P = 0.26, and 2.0 ± 1.3 vs 2.1 ± 1.0 ,V, P = 0.90). The distribution of P-wave morphologies was shifted away from Type 1 in the Pre-AF group when compared to the No-AF group (Type 1/2/3/atypical; 25/60/0/15% vs 10/63/10/17%, P = 0.04). Conclusions: This study is the first to describe changes in P-wave morphology in patients prior to AF development. The results indicate that abnormal interatrial conduction may play a role in AF development in patients with prior myocardial infarction and congestive heart failure. [source]

    Detailed ECG Analysis of Atrial Repolarization in Humans

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 1 2009
    Fredrik Holmqvist M.D., Ph.D.
    Introduction: Data on human atrial repolarization are scarce since the QRS complex normally obscures its ECG trace. In the present study, consecutive patients with third-degree AV block were studied to better describe the human Ta wave. Methods and Results: Forty patients (mean age 75 years, 17 men) were included. All anti-arrhythmic drugs were discontinued before ECG recording. Standard 12-lead ECGs were recorded, transformed to orthogonal leads and studied using signal-averaged P wave analysis. The average P wave duration was 124 ± 16 ms. The PTa duration was 449 ± 55 ms (corrected PTa 512 ± 60 ms) and the Ta duration (P wave end to Ta wave end) was 323 ± 56 ms. The polarity of the Ta wave was opposite to that of the P wave in all leads. The Ta peaks were located at 196 ± 55 ms in Lead Y, 216 ± 50 ms in Lead X, and 335 ± 92 in Lead Z. No correlation was found between P wave duration and Ta duration, or between Ta peak amplitude and Ta duration. The morphology of the Ta wave was similar regardless of the interatrial conduction. Conclusions: The Ta wave has the opposite polarity, and the duration is generally two to three times that, of the P wave. Although the Ta peak may occasionally be located in the PQ interval during normal AV conduction, it is unlikely that enough information can be obtained from analysis of this segment to differentiate normal from abnormal atrial repolarization. Hence, an algorithm for QRST cancellation during sinus rhythm is needed to further improve analysis. [source]

    Adenosine-Induced Ventricular Arrhythmias in Patients with Supraventricular Tachycardias

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 4 2008
    Cagatay Ertan M.D.
    Background: Adenosine is widely used for the diagnosis and the termination of supraventricular arrhythmias. There are many case reports and few series about the proarrhythmic potential of adenosine. We sought to evaluate the proarrhythmic potential of adenosine used to terminate the supraventricular arrhythmias. Methods: The records of all patients that received adenosine for the termination of supraventricular tachycardia were reviewed retrospectively and those with a continuous electrocardiographic (ECG) recording during adenosine administration were included to the study. Results: Our search identified 52 supraventricular episodes of 46 patients with a continuous ECG recording during adenosine administration. Following adenosine administration, premature ventricular contraction (PVC) or ventricular tachycardia (VT) developed in 22 (47.8%) patients and in 26 (50%) tachycardia episodes. No patient had a sustained VT. Nonsustained VT developed in eight (17.4%) patients. All VT episodes were polymorphic, short, and self-terminating. When the basal and demographic properties of patients with PVC or VT and those without PVT or VT were compared, there was no significant difference. Conclusions: Adenosine is a quite safe and effective drug for the termination of narrow QRS complex tachycardia but it often induces nonsustained VT or PVC that are clinically insignificant in the absence of other accompanying heart disease. [source]

    Heart Rate Variability Fraction,A New Reportable Measure of 24-Hour R-R Interval Variation

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 1 2005
    Maciej Sosnowski M.D.
    Background: The scatterplot of R-R intervals has several unique features. Its numerical evaluation may produce a new useful index of global heart rate variability (HRV) from Holter recordings. Methods: Two-hundred and ten middle-aged healthy subjects were enrolled in this study. The study was repeated the next day in 165 subjects. Each subject had a 24-hour ECG recording taken. Preprocessed data were transferred into a personal computer and the standard HRV time-domain indices: standard deviation of total normal R-R intervals (SDNN), standard deviation of averaged means of normal R-R intervals over 5-minute periods (SDANN), triangular index (TI), and pNN50 were determined. The scatterplot area (0.2,1.8 second) was divided into 256 boxes, each of 0.1-second interval, and the number of paired R-R intervals was counted. The heart rate variability fraction (HRVF) was calculated as the two highest counts divided by the number of total beats differing from the consecutive beat by <50 ms. The HRVF was obtained by subtracting this fraction from 1, and converting the result to a percentage. Results: The normal value of the HRVF was 52.7 ± 8.6%. The 2,98% range calculated from the normal probability plot was 35.1,70.3%. The HRVF varied significantly with gender (female 48.7 ± 8.4% vs male 53.6 ± 8.6%, P = 0.002). The HRVF correlated with RRI (r = 0.525) and showed a similar or better relationship with SDNN (0.851), SDANN (0.653), and TI (0.845) than did the standard HRV measures with each other. Bland-Altman plot showed a good day-by-day reproducibility of the HRVF, with the intraclass correlation coefficient of 0.839 and a low relative standard error difference (1.8%). Conclusion: We introduced a new index of HRV, which is easy for computation, robust, reproducible, easy to understand, and may overcome the limitations that belong to the standard HRV measures. This index, named HRV fraction, by combining magnitude, distribution, and heart-rate influences, might become a clinically useful index of global HRV. [source]

    Evaluation of Patients with Palpitations: Cardiac Event Recorder Versus 48-hour Holter Monitoring

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 4 2000
    Ewa Makowska M.D.
    Objectives: (1) To compare a diagnostic yield of cardiac event recorders with that of 48-hour Holler monitoring, (2) to determine the etiologies of palpitations, and (3) to assess an optimal duration of using an event recorder by a patient. Background: Palpitation is a common symptom which accounts for 16% of total complaints reported by patients in general medical settings. An ambulatory Holter ECG monitoring or an event recorder can be used to establish the cause of palpitations. Methods: (1)The study group consisted of 33 consecutive patients (24 females, 9 males, mean age 50 ± 32 years) with undiagnosed attacks of palpitations, occurring at least once per month. Each patient was randomly allocated to use either an event monitor or 48-hour Holler monitoring. The patient kept the event monitor for 4 weeks. After the first monitor was returned, the patient was given the other device. Results: Holter monitoring determined the etiology of palpitations in 11 (33%) patients, and the event recorder in 21 (64%) patients (P = 0.0138). In the whole study group, the etiology of palpitations was disclosed in 23 (70%) patients. The diagnosis was possible using Holler ECG monitoring in only 2 (9%) patients, whereas the event recorder revealed the underlying mechanism of palpitations in 12 (52%) patients (P = 0.0007). In nine (39%) patients both methods were able to disclose the eliology of palpitations. The findings of 117 recordings obtained using an event recorder during palpitations were atrial fibrillation in 10 (9%), narrow QRS tachycardia in 4 (3%), frequent supraventricular eclopy in 17 (15%), frequent ventricular eclopy in 6 (5%), and episodes of palpitations sinus rhythm were recorded in the remaining 80 (68%). Of patients who experienced episodes of palpitations while using an event recorder, the earliest recording was obtained on the first day of the study, and the latest on the 18 day of using the event recorder. Conclusions: (1) The cardiac event recorders yield more diagnoses than 48-hour Holter monitoring in patients with palpitations occurring at least once per month, (2) in this group of patients the event recorder provided a diagnostic ECG recording during the first 18 days of using the device, and (3) in the majority (57%) of patients a normal sinus rhythm was recorded during episodes of palpitations. A.N.E. 2000;5(4):315,321 [source]

    Cardiac function and antiepileptic drug treatment in the elderly: A comparison between lamotrigine and sustained-release carbamazepine

    EPILEPSIA, Issue 8 2009
    Erik Saetre
    Summary Purpose:, To investigate the comparative effects of carbamazepine (CBZ) and lamotrigine (LTG) on electrocardiography (ECG) parameters in elderly patients with newly diagnosed epilepsy. Methods:,, The study was conducted in the Norwegian subcohort (n = 108) of an international randomized double-blind 40-week trial, which compared the efficacy and tolerability of LTG and sustained-release CBZ in patients aged 65 and older with newly diagnosed epilepsy. Target maintenance doses were 400 mg/day for CBZ and 100 mg/day for LTG, with adjustments based on clinical response. Patients with significant unpaced atrioventricular (AV) conduction defect were excluded. Resting 12-lead ECG recordings were made under standardized conditions at pretreatment (baseline) and at the 40-week study visit (treatment visit). Changes in QRS interval (primary endpoint), heart rate (HR), PQ, and QTc (HR-corrected QT) intervals were assessed and compared between groups. Results:, Of the 108 patients randomized, 33 discontinued prematurely because of adverse events (n = 24, none of which was cardiac) or other reasons (n = 9), and 15 were nonevaluable due to incomplete ECG data. None of the assessed ECG parameters differed significantly between groups at baseline. No significant ECG changes were recorded between baseline and treatment visit for QRS duration and QTc intervals, whereas HR fell and PQ intervals increased slightly on both treatments. However, there were no differences between groups in changes from baseline to treatment visit. There were no significant relationships between individual ECG changes and serum drug concentrations, except for QTc intervals, which decreased slightly with increasing CBZ concentrations. The proportion of patients with ECG parameters outside the normal range at treatment visit was similar to that recorded at baseline. Discussion:, Clinically significant ECG changes are not common during treatment with CBZ or LTG in elderly patients with no preexisting significant AV conduction defects. [source]

    Cardiac Autonomic Control in Patients with Refractory Epilepsy before and during Vagus Nerve Stimulation Treatment: A One-Year Follow-up Study

    EPILEPSIA, Issue 3 2006
    Eija Ronkainen
    Summary:,Purpose: To elucidate possible effect of vagus nerve stimulation (VNS) therapy on interictal heart rate (HR) variability in patients with refractory epilepsy before and after 1-year VNS treatment. Methods: A 24-hour electrocardiogram (ECG) was recorded at the baseline and after 12 months of VNS treatment in 14 patients with refractory epilepsy, and once in 28 healthy age- and sex-matched control subjects. Time and frequency domain measures, along with fractal and complexity measures of HR variability, were analyzed from the ECG recordings. Results: The mean value of the RR interval (p = 0.008), standard deviation of N-N intervals (SDNN) (p < 0.001), very-low frequency (VLF) (p < 0.001), low-frequency (LF) (p = 0.001), and high-frequency (HF) (p = 0.002) spectral components of HR variability, and the Poincaré components SD1 (p = 0.005) and SD2 (p < 0.001) of the patients with refractory epilepsy were significantly lower than those of the control subjects before VNS implantation. The nocturnal increase in HR variability usually seen in the normal population was absent in patients with refractory epilepsy. VNS had no significant effects on any of the HR-variability indexes despite a significant reduction in the frequency of seizures. Conclusions: HR variability was reduced, and the nocturnal increase in HR variability was not present in patients with refractory epilepsy. One-year treatment with VNS did not have a marked effect on HR variability, suggesting that impaired cardiovascular autonomic regulation is associated with the epileptic process itself rather than with recurrent seizures. [source]

    Endurance exercise is associated with increased plasma cardiac troponin I in horses

    EQUINE VETERINARY JOURNAL, Issue S36 2006
    T. C. HOLBROOK
    Summary Reason for performing study: Information is lacking regarding the influence of long distance exercise on the systemic concentration of cardiac troponin I (cTnl) in horses. Objectives: To determine if the concentration of cTnl in horses competing in 80 and 160 km endurance races increases with exercise duration and if cTnl concentrations can be correlated with performance data. Methods: Blood samples for the measurement of cTnl and 3 min electrocardiogram recordings were obtained from horses prior to, during and after completion of 80 and 160 km endurance races at 3 ride sites during the 2004 and 2005 American Endurance Ride Conference competition seasons. Results: Full data sets were obtained from 100 of the 118 horses. Endurance exercise was associated with a significant increase in cTnl over baseline in both distance groups. Failure to finish competition (poor performance) was also associated with an increased cTnl concentration over baseline at the time of elimination when data from both distances were combined. Other than one horse that developed paroxysmal atrial fibrillation, no arrhythmias were noted on the 3 minute ECG recordings that were obtained after endurance exercise in either distance group. Conclusions: Systemic concentrations of cTnl increase in endurance horses competing in both 80 and 160 km distances. Although final cTnl concentrations were significantly increased over their baseline values in horses that failed to finish competition, the degree of increase was not greater than the increase over baseline seen in the horses that successfully completed competition. The clinical significance of increased cTnl in exercising horses could not be ascertained from the results of this study. Potential relevance: These data indicate that cardiac stress may occur in horses associated with endurance exercise. Future studies utilising echocardiograpy to assess cardiac function in horses with increased cTnl are warranted. [source]

    Detection and delineation of P and T waves in 12-lead electrocardiograms

    EXPERT SYSTEMS, Issue 1 2009
    Sarabjeet Mehta
    Abstract: This paper presents an efficient method for the detection and delineation of P and T waves in 12-lead electrocardiograms (ECGs) using a support vector machine (SVM). Digital filtering techniques are used to remove power line interference and baseline wander. An SVM is used as a classifier for the detection and delineation of P and T waves. The performance of the algorithm is validated using original simultaneously recorded 12-lead ECG recordings from the standard CSE (Common Standards for Quantitative Electrocardiography) ECG multi-lead measurement library. A significant detection rate of 95.43% is achieved for P wave detection and 96.89% for T wave detection. Delineation performance of the algorithm is validated by calculating the mean and standard deviation of the differences between automatic and manual annotations by the referee cardiologists. The proposed method not only detects all kinds of morphologies of QRS complexes, P and T waves but also delineates them accurately. The onsets and offsets of the detected P and T waves are found to be within the tolerance limits given in the CSE library. [source]

    Ranolazine Exerts Potent Effects on Atrial Electrical Properties and Abbreviates Atrial Fibrillation Duration in the Intact Porcine Heart

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 7 2009
    KAPIL KUMAR M.D.
    Introduction: In vitro studies and ambulatory ECG recordings from the MERLIN TIMI-36 clinical trial suggest that the novel antianginal agent ranolazine may have the potential to suppress atrial arrhythmias. However, there are no reports of effects of ranolazine on atrial electrophysiologic properties in large intact animals. Methods and Results: In 12 closed-chest anesthetized pigs, effects of intravenous ranolazine (,9 ,M plasma concentration) on multisite atrial effective refractory period (ERP), conduction time (CT), and duration and inducibility of atrial fibrillation (AF) initiated by intrapericardial acetylcholine were investigated. Ranolazine increased ERP by a median of 45 ms (interquartile range 29,50 ms; P < 0.05, n = 6) in right and left atria compared to control at pacing cycle length (PCL) of 400 ms. However, ERP increased by only 28 (24,34) ms in right ventricle (P < 0.01, n = 6). Ranolazine increased atrial CT from 89 (71,109) ms to 98 (86,121) ms (P = 0.04, n = 6) at PCL of 400 ms. Ranolazine decreased AF duration from 894 (811,1220) seconds to 621 (549,761) seconds (P = 0.03, n = 6). AF was reinducible in 1 of 6 animals after termination with ranolazine compared with all 6 animals during control period (P = 0.07). Dominant frequency (DF) of AF was reduced by ranolazine in left atrium from 11.7 (10.7,20.5) Hz to 7.6 (2.9,8.8) Hz (P = 0.02, n = 6). Conclusions: Ranolazine, at therapeutic doses, increased atrial ERP to greater extent than ventricular ERP and prolonged atrial CT in a frequency-dependent manner in the porcine heart. AF duration and DF were also reduced by ranolazine. Potential role of ranolazine in AF management merits further investigation. [source]

    The Morphology Changes in Limb Leads after Ablation of Verapamil-Sensitive Idiopathic Left Ventricular Tachycardia and Their Correlation with Recurrence

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2008
    SHU-YUAN YAO Ph.D
    Objectives: This study was designed to explore the morphology changes in limb leads of ECGs after successful ablation of verapamil sensitive idiopathic left ventricular tachycardia (ILVT) and their correlation with tachycardia recurrence. Methods: Between January 2001 and December 2006, 116 patients who underwent successful ablation of ILVT were included in the study. Twelve-lead surface ECG recordings during sinus rhythm were obtained in all patients before and after ablation to compare morphology changes in limb leads. Results: The ECG morphology changes after ablation were divided into two categories: one with new or deepening Q wave in inferior leads and/or disappearance of Q wave in leads I and aVL, and the other without change. The changes in any Lead II, III, or aVF after ablation occurred significantly more in patients without recurrence of ventricular tachycardia (VT) (P < 0.0001, 0.002, and 0.0001, respectively). The patients with recurrence of VT tended to have no ECG changes, compared with those without recurrence of VT (P = 0.009). The sensitivity of leads II, III, and aVF changes in predicting nonrecurrence VT were 66.7%, 78.7%, and 79.6%, specificity were 100%, 75%, and 87.5%, and nonrecurrence predictive value of 100%, 97.7%, and 98.9%, respectively. When inferior leads changes were combined, they could predict all nonrecurrence patients with 100% specificity. Conclusions: Successful radiofrequency ablation of ILVT could result in morphology changes in limb leads of ECG, especially in inferior leads. The combined changes in inferior leads can be used as an effective endpoint in ablation of this ILVT. [source]

    Autonomic dysfunction in unselected and untreated primary open angle glaucoma patients: a pilot study

    OPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 4 2007
    Doina Gherghel
    Abstract Purpose:, To investigate the presence of silent cardiac ischaemic episodes and the status of autonomic function in consecutive, newly diagnosed and untreated primary open-angle glaucoma patients. Methods:, Twenty-four consecutively diagnosed glaucoma patients and 22 age-matched controls were subjected to ambulatory 24-h blood pressure (BP) and electrocardiogram (ECG) monitoring by using Cardiotens-01 (Meditech Ltd). Based on the ECG recordings, heart rate variability (HRV) frequency domain parameters [low-frequency (LF), high-frequency (HF) and LF/HF ratio] were calculated and analysed in the two study groups. Results:, Glaucoma patients demonstrated higher LF and LF/HF values than normal subjects for both the active period (p = 0.020 and 0.029) and the passive period (p = 0.044 and 0.049 respectively). HRV parameters were similar in patients and controls suffering from silent cardiac ischaemia (p > 0.05); however, glaucoma patients with normal ECG demonstrated higher LF and LF/HF values during the active period of the 24-h measurement period than control subjects characterized by the same cardiac activity (p = 0.010 and 0.021 respectively). Conclusion:, Independent of a history and/or clinical signs of cardiovascular disease, glaucoma patients exhibit abnormal autonomic function. [source]

    Effect of Noise on T-Wave Alternans Measurement in Ambulatory ECGs Using Modified Moving Average versus Spectral Method

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 5 2009
    RAJA J. SELVARAJ M.D.
    Background: The modified moving average (MMA) and spectral method (SM) are commonly used to measure T-wave alternans (TWA), but their accuracy has not been compared in ambulatory electrocardiograms (ECGs) where TWA signal-to-noise ratio is low. Our objective was to compare the effect of noise and signal nonstationarity on the accuracy of TWA measurement using MMA versus SM when applied to synthetic and ambulatory ECGs. Methods: Periodic and nonperiodic noise were added to noiseless synthetic ECGs. Simulated TWA (0,20 ,V) was added to synthetic ECGs and ambulatory ECG recordings. TWA was measured using SM and MMA, and the measurement error relative to added TWA was compared. An MMA ratio was used to discriminate TWA signal from noise. Signal nonstationarity was simulated by changing heart rate, TWA magnitude, and TWA phase. Results: With no added TWA, MMA falsely measured TWA in synthetic and ambulatory ECGs, while false measurement was not seen with SM. An MMA ratio > 1.2 eliminated false TWA detection. In the presence of low TWA magnitude (<10 ,V), TWA was overestimated by MMA and underestimated by SM in proportion to the noise level. In synthetic ECGs with periodic noise and 10-,V added TWA, MMA was less accurate than SM. The effects of simulated signal nonstationarity on the TWA magnitude measured with MMA versus SM were similar using a 64-beat analysis window. Conclusions: In the presence of noise, MMA falsely detects or overestimates simulated TWA in ambulatory ECG recordings. In this setting, the proposed MMA ratio improves the specificity of MMA. [source]

    Effect of Right Ventricular Apex Pacing on the Tei Index and Brain Natriuretic Peptide in Patients with a Dual-Chamber Pacemaker

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 9 2006
    HITOSHI ICHIKI
    Background: Asynchronous electrical activation induced by right ventricular apex (RVA) pacing can cause various abnormalities in left ventricular (LV) function, particularly in the context of severe LV dysfunction or structural heart disease. However, the effect of RVA pacing in patients with normal LV and right ventricular (RV) function has not been fully elucidated. The aim of this study was to characterize the effects of RVA pacing on LV and RV function by assessing isovolumic contraction time and isovolumic relaxation time divided by ejection time (Tei index) and by assessing changes in plasma brain natriuretic peptide (BNP). Methods: Doppler echocardiographic study and BNP measurements were performed at follow-up (mean intervals from pacemaker implantation, 44 ± 75 months) in 76 patients with dual chamber pacemakers (sick sinus syndrome, n = 30; atrioventricular block, n = 46) without structural heart disease. Patients were classified based on frequency of RVA pacing, as determined by 24-hour ambulatory electrocardiogram (ECG) that was recorded just before echocardiographic study: pacing group, n = 46 patients with RVA pacing ,50% of the time, percentage of ventricular paced 100 ± 2%; sensing group, n = 30, patients with RVA pacing <50% of the time, percentage of ventricular paced 3 ± 6%. Results: There was no significant difference in mean heart rate derived from 24-hour ambulatory ECG recordings when comparing the two groups (66 ± 11 bpm vs 69 ± 8 bpm). LV Tei index was significantly higher in pacing group than in sensing group (0.67 ± 0.17 vs 0.45 ± 0.09, P < 0.0001), and the RV Tei index was significantly higher in pacing group than in sensing group (0.34 ± 0.19 vs 0.25 ± 0.09, P = 0.011). Furthermore, BNP levels were significantly higher in pacing group than in sensing group (40 ± 47 pg/mL vs 18 ± 11 pg/mL, P = 0.017). With the exception of LV diastolic dimension (49 ± 5 mm vs 45 ± 5 mm, P = 0.012), there were no significant differences in other echocardiographic parameters, including left atrium (LA) diameter (35 ± 8 mm vs 34 ±5 mm), LA volume (51 ± 27 cm3 vs 40 ± 21 cm3), LV systolic dimension (30 ± 6 mm vs 29 ± 7 mm), or ejection fraction (66 ± 9% vs 63 ± 11%), when comparing the two groups. Conclusions: These findings suggest that the increase of LV and RV Tei index, LVDd, and BNP are highly correlated with the frequency of the RVA pacing in patients with dual chamber pacemakers. [source]

    An Approach to Measure Atrial and Ventricular Heart Rate Variability Using Pacemaker-Mediated Intracardiac Electrograms

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 12 2003
    ANDREAS SCHUCHERT
    Heart rate variability (HRV) measurements are usually performed from ventricular beat-to-beat intervals because of the difficulty to precisely locate the P wave fiducial point in surface ECG recordings. The aim of the study was to describe an approach to determine the atrial and ventricular HRV using pacemaker-mediated intracardiac electrograms. Twelve patients with the dual chamber pacemaker Logos were included. The atrial and ventricular intracardiac electrograms were transmitted with the high resolution telemetry channel of the pacemaker to an external recorder for 20 minutes while the patients were supine. During the measurements the patients were in sinus rhythm with intrinsic AV conduction. After computer assisted triggering of the atrial and ventricular events, the resultant intervals were used to calculate the standard deviation of all NN intervals (SDNN), the square root of the mean squared differences of successive NN intervals (RMSSD), and the percentage of successive interval differences >50 ms (pNN50). The differences between atrial and ventricular HRV-Indexes were assessed for each patient with a cut-off point of 1%. Differences >1% were analyzed in detail. A total of 15,504 heart cycles were analyzed. A manual correction due to false or not triggered atrial or ventricular events was necessary in 0.9%. The overall difference between atrial and ventricular pNN50 was ,0.5%±2.1%and differences >1% were observed in 4 patients. The NN50 events occurred in the atrial as well as in the related ventricular interval in 84%. NN50 events occurred only in the atrium in 6% and only in the ventricle in 10%. The mean differences between atrial and ventricular SDNN and RMSSD were0.4±2.1ms and ,0.1±3.5 mswith intra-individual differences <1%. The present study described a new method and demonstrated its feasibility to determine atrial as well as ventricular HRV from pacemakermediated intracardiac electrograms. The differences for pNN50 indicate that ventricular HRV did not reflect the changes of sinus node activity in all patients. (PACE 2003; 26:2272,2274) [source]

    Steady-State versus Non-Steady-State QT-RR Relationships in 24-hour Holter Recordings

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2000
    GILLES LANDE
    The aim of the present study was to investigate the QT-RR interval relationship in ambulatory ECG recordings with special emphasis on the physiological circumstances under which the QT-RR intervals follow a linear relation. Continuous ECG recordings make it possible to automatically measure QT duration in individual subjects under various physiological circumstances. However, identification of QT prolongation in Holter recordings is hampered by the rate dependence of QT duration. Comparison of QT duration and QT interval rate dependence between different individuals implies that the nature of the QT-RR relationship is defined in ambulatory ECG. Holter recordings were performed in healthy volunteers at baseline and after administration of dofetilide, a Class III antiarrhythmic drug. After dofetilide, beat-to-beat automated QT measurements on Holter tapes were compared with manually measured QT intervals on standard ECGs matched by time. The QT-RR relationship was analyzed at baseline in individual and group data during three different periods: 24-hour, daytime, and nighttime. Data were collected under steady-state or non-steady-state conditions of cycle length and fitted with various correction formulae. Our study demonstrated an excellent agreement between manually and automated measurements. The classic Bazett correction formula did not fit the QT-RR data points in individual or group data. When heart beats were selected for a steady rhythm during the preceding minute, QT-RR intervals fit a linear relationship during the day and night periods, but not during the 24-hour period in both individual and group data. In contrast, in the absence of beat selection, data fit a more complex curvilinear relationship irrespective of the period. Our study provides the basis for comparison of QT interval durations and QT-RR relationships between individuals and between groups of subjects. [source]

    Electrocardiographic Indices of Left Ventricular Hypertrophy and Repolarization Phase Share the Same Genetic Influences: A Twin Study

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 4 2009
    Sara Mutikainen M.Sc.
    Background: Both left ventricular hypertrophy (LVH) and repolarization phase (RP) are known to be attributable to genetic influences, but less is known whether they share same genetic influences. The aim of this study was to investigate to what extent individual differences in electrocardiographic (ECG) LVH and RP are explained by genetic and environmental influences and whether these influences are shared between these two traits. Methods: Resting ECG recordings were obtained from 186 monozygotic and 203 dizygotic female twin individuals, aged 63 to 76 years. Latent factors, called LVH and RP, were formed to condense the information obtained from LVH indices (Cornell voltage and Cornell product) and T-wave amplitudes (leads V5 and II), respectively. Multivariate quantitative genetic modeling was used both to decompose the phenotypic variances into additive genetic, common environmental, and unique environmental influences, and for the calculation of genetic and environmental correlations between LVH and RP. Results: Additive genetic influences explained 16% of individual differences in LVH and 74% in RP. The remaining individual differences were explained by both common and unique environmental influences. The genetic correlation and unique environmental correlation between LVH and RP were ,0.93 and ,0.05, respectively. Conclusions: In older women without overt cardiac diseases, RP is under stronger genetic control than LVH. The majority of genetic influences are shared between LVH and RP whereas environmental influences are mainly specific to each. [source]

    Assessment of Physiological Amplitude, Duration, and Magnitude of ECG T-Wave Alternans

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 4 2009
    Laura Burattini Ph.D.
    Background: An association between T-wave alternans (TWA) and malignant ventricular arrhythmias is generally recognized. Because relatively low levels of TWA have also been observed in healthy (H) subjects, the question arises as to whether these are ascribable to noise and artifacts, or can be given the relevance of a physiological phenomenon characterizing a preclinical condition. Methods: To answer this question, in the present study 20-minute not noisy, sinus ECG recordings, from 138 H-subjects and 148 coronary artery diseased (CAD) patients, were submitted to our adaptive match filter (AMF) procedure to identify and parameterize TWA in terms of duration (TWAD), amplitude (TWAA), and magnitude (TWAM, defined as the product of TWAD times TWAA). The 99.5th percentiles of mean values of TWAA, TWAD, and TWAM over 20-minute ECGs were used to define three threshold levels (THRD, THRA, and THRM), which allow discrimination of abnormal TWA levels. Results: Nonstationary TWA was found in all our H-subjects and CAD-patients. TWAD, TWAA, and TWAM levels were classified as being physiological in 99% of H-subjects and 87% of CAD-patients. A linear correlation (r =,0.52, P < 0.001) was found between TWAA and RR interval in the H-population. Conclusions: Our results support the hypothesis of the existence of physiological TWA levels, which are to be considered in the effort to improve reliability of nonphysiological TWA levels discrimination. [source]

    Technical Mistakes during the Acquisition of the Electrocardiogram

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 4 2009
    Javier García-Niebla R.N.
    In addition to knowledge of normal and pathological patterns, the correct interpretation of electrocardiographic (ECG) recordings requires the use of acquisition procedures according to approved standards. Most manuals on standard electrocardiography devote little attention to inadequate ECG recordings. In this article, we present the most frequent ECG patterns resulting from errors in limb and precordial lead placement, artifacts in 12-lead ECG as well as inadequate filter application; we also review alternative systems to the standard ECG, which may help minimize errors. [source]

    Nondipolar Content of T Wave Derived from a Myocardial Source Simulation with Increased Repolarization Inhomogeneity

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2009
    Milos Kesek M.D., Ph.D.
    Background: Several conditions with repolarization disturbances are associated with increased level of nondipolar components of the T wave. The nondipolar content has been proposed as a measure of repolarization inhomogeneity. This computer simulation study examines the link between increased nondipolar components and increased repolarization inhomogeneity in an established model. Methods: The simulation was performed with Ecgsim software that uses the equivalent double-layer source model. In the model, the shape of transmembrane potential is derived from biological recordings. Increased repolarization inhomogeneity was simulated globally by increasing the variance in action potential duration and locally by introducing changes mimicking acute myocardial infarction. We synthesized surface ECG recordings with 12, 18, and 300 leads. The T-wave residue was calculated by singular value decomposition. The study examined the effects of the number of ECG leads, changes in definition of end of T wave and random noise added to the signal. Results: Normal myocardial source gave a low level of nondipolar content. Increased nondipolar content was observed in the two types of increased repolarization inhomogeneity. Noise gave a large increase in the nondipolar content. The sensitivity of the result to noise increased when a higher number of principal components were used in the computation. Conclusions: The nondipolar content of the T wave was associated with repolarization inhomogeneity in the computer model. The measure was very sensitive to noise, especially when principal components of high order were included in the computations. Increased number of ECG leads resulted in an increased signal-to-noise ratio. [source]

    Genetic Influences on Resting Electrocardiographic Variables in Older Women: A Twin Study

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 1 2009
    Sara Mutikainen M.Sc.
    Background: Previous studies in young and middle-aged men and women have shown that resting electrocardiographic (ECG) variables are influenced by genetic factors. However, the extent to which resting ECG variables are influenced by genetic factors in older women is unknown. Thus, the aim of this study was to estimate the relative contribution of genetic and environmental influences to individual differences in resting ECG variables among older female twins without overt cardiac diseases. Methods: Resting ECG recordings were obtained from 186 monozygotic and 203 dizygotic twin individuals, aged 63,76 years. Quantitative genetic modeling was used to decompose the phenotypic variance in each resting ECG variable into additive genetic, dominance genetic, shared environmental, and unique environmental influences. Results: The results showed that individual differences in the majority of the resting ECG variables were moderately to highly explained by additive genetic influences, ranging from 32% for T axis to 72% for TV5. The results also suggested dominance genetic influences on QRS duration, TV1, and Sokolow,Lyon voltage (36%, 53%, and 57%, respectively). Unique environmental influences were important for each resting ECG variable, whereas shared environmental influences were detected only for QT interval and QTc. Conclusion: In older women without overt cardiac diseases, genetic influences explain a moderate to high proportion of individual differences in the majority of the resting ECG variables. Genetic influences are especially strong for T-wave amplitudes, left ventricular mass, and hypertrophy indices, whereas other variables, including heart rate, intervals, and axes, are more affected by environmental influences. [source]

    Electrocardiographic Transmural Dispersion of Repolarization in Patients with Inherited Short QT Syndrome

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 3 2008
    Olli Anttonen M.D.
    Background: Short QT syndrome (SQTS) carries an increased risk for sudden cardiac death. However, only a short QT interval does not express the risk of ventricular arrhythmias. Thus, additional evaluation of the repolarization abnormality in SQTS patients is essential. In experimental models of SQTS, increased transmural dispersion of repolarization (TDR) and its electrocardiographic counterpart T-wave peak to T-wave end interval (TPE) appeared critical for induction of polymorphic ventricular tachycardia (PMVT). In a clinical study with acquired long QT syndrome patients, TPE/QT ratio > 0.28 indicated arrhythmia risk. We hypothesized that the TPE/QT ratio would be greater in SQTS patients than in control subjects. Methods and Results: We compared the behavior of the electrocardiographic TDR in three seriously symptomatic SQTS patients of unknown genotype presenting baseline QTc values <320 ms and in nine healthy age-matched control subjects. We determined QT and TPE intervals as well as TPE/QT ratio from 24-hour ECG recordings using a computer-assisted program. Diurnal average of TPE/QT ratio was 0.28 ± 0.03 in SQTS patients and 0.21 ± 0.02 in control subjects (P = 0.01). SQTS patients had also lesser capacity to change TPE intervals from steady-state conditions to abrupt maximal values than control subjects. Conclusion: SQTS patients have increased and autonomically uncontrolled electrocardiographic TDR. According to experimental SQTS models, the present results may in part explain increased vulnerability of SQTS patients to ventricular arrhythmias. [source]

    Electrocardiographic Alterations during Hyperinsulinemic Hypoglycemia in Healthy Subjects

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2008
    Tomi Laitinen M.D.
    Background: We evaluated the arrhythmogenic potential of hypoglycemia by studying electrocardiographic (ECG) changes in response to hyperinsulinemic hypoglycemia and associated sympathoadrenal counterregulatory responses in healthy subjects. Methods: The study population consisted of 18 subjects, aged 30,40 years. Five-minute ECG recordings and blood samplings were performed at baseline and during the euglycemic and hypoglycemic hyperinsulinemic clamp studies. PR, QT, and QTc intervals of electrocardiogram and ECG morphology were assessed from signal-averaged ECG. Results: Although cardiac beat interval remained unchanged, PR interval decreased (P < 0.01) and QTc interval (P < 0.001) increased in response to hyperinsulinemic hypoglycemia. Concomitant morphological alterations consisted of slight increases in R-wave amplitude and area (P < 0.01 for both), significant decreases in T-wave amplitude and area (P < 0.001 for both), and moderate ST depression (P < 0.001). Counterregulatory norepinephrine response correlated with amplification of the R wave (r =,0.620, P < 0.05) and epinephrine response correlated with flattening of the T wave (r =,0.508, P < 0.05). Conclusions: Hyperinsulinemic hypoglycemia with consequent sympathetic humoral activation is associated with several ECG alterations in atrioventricular conduction, ventricular depolarization, and ventricular repolarization. Such alterations in cardiac electrical function may be of importance in provoking severe arrhythmias and "dead-in-bed" syndrome in diabetic patients with unrecognized hypoglycemic episodes. [source]

    Clinical Implications of QRS Duration and QT Peak Prolongation in Patients with Suspected Coronary Disease Referred for Elective Cardiac Catheterization

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2008
    M. Nadeem Attar M.D., M.R.C.P.
    Background: The electrocardiogram (ECG) remains a simple, universally available, and prognostically powerful investigation in heart failure, and acute coronary syndromes. We sought to assess the prognostic utility of clinical, angiographic, and simple ECG parameters in a large cohort of patients undergoing elective cardiac catheterization (CC) for known or suspected coronary artery disease. Methods: Consecutive consenting patients undergoing CC for coronary disease were enrolled at a single tertiary center. Patient data, drug therapy, catheter reports, and ECG recordings were prospectively recorded in a validated electronic archive. The primary outcome measure was death or nonfatal myocardial infarction (MI) over 1 year or until percutaneous or cardiac surgical intervention. Independent prognostic markers were identified using the Cox proportional hazard model. Results: A total of 682 individuals were recruited of whom 17(2.5%) died or suffered a nonfatal MI in 1 year. In multivariate analysis QRS duration (ms) (HR 1.03 95% CI 1.01,1.05, P = 0.003), extent of coronary disease (HR 2.01 95% CI 1.24,3.58, P = 0.006), and prolonged corrected QT peak interval in lead I (HR 1.02 95% CI 1.00,1.03, P = 0.044) were independently associated with death or nonfatal MI. Receiver-operator characteristic (ROC) analysis for the multivariate model against the primary end point yielded an area under the curve of 0.759 (95% CI 0.660,0.858), P < 0.001. Conclusions: QRS duration and QT peak are independently associated with increased risk of death or nonfatal MI in stable patients attending for coronary angiography. [source]

    Sodium Channel Blockers Enhance the Temporal QT Interval Variability in the Right Precordial Leads in Brugada Syndrome

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 1 2008
    Tetsuzou Kanemori M.D.
    Background: Temporal QT interval variability is associated with sudden cardiac death. The purpose of this study was to evaluate temporal QT interval variability in Brugada syndrome (BS). Methods: We measured QT and RR intervals in precordial leads (V1,V6) based on 12-beat resting ECG recordings from 16 BS patients (B group) with spontaneous ST elevation in right precordial leads (V1,V2) and from 10 patients with normal hearts (C group). We measured the response in B group before and after administration of pilsicainide (1 mg/kg). The standard deviation (QT-SD, RR-SD) of the time domain and total frequency power (QT-TP, RR-TP) were calculated for all precordial leads, and the latter was to analyze the frequency domain. Results: The right precordial leads in BS exhibited an additional and prominent ST elevation (coved-type) after pilsicainide administration. Both QT-SD and QT-TP values were significantly more increased in B, than in C (5.1 ± 1.2 vs 3.6 ± 0.2 and 23.4 ± 2.9 vs 12.3 ± 1.7 msec2, P < 0.01, respectively) and after pilsicainide administration in B. (5.1 ± 0.4 vs 3.9 ± 0.3, 25.8 ± 3.4 vs 16.3 ± 2.6 msec2, P < 0.01, respectively) However, QT-SD and QT-TP did not significantly change in any of other leads (V3,V6) and RR-SD and RR-TP were similar for both groups, as well as after intravenous pilsicainide administration in B. Conclusions: The temporal QT interval variability was identified in BS. Moreover, sodium channel blocker induced temporal fluctuation in QT interval and it may possibly provide a substrate for ventricular arrhythmia in BS patients. [source]

    Dynamics of Ventricular Repolarization in Patients with Dilated Cardiomyopathy Versus Healthy Subjects

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2005
    Jose Luis Alonso M.D.
    Background: Patients with impaired left ventricular function have a high risk of developing ventricular arrhythmias and sudden death. Among different markers of risk, the prolongation and regional heterogeneity of repolarization are of increasing interest. However, there are limited data regarding feasibility of analyzing repolarization parameters and their dynamics in 24-hour Holter ECG recordings. Methods: Dynamic behavior of repolarization parameters was studied with a new automatic algorithm in digital 24-hour Holter recordings of 60 healthy subjects and 55 patients with idiopathic dilated cardiomyopathy (IDC). Repolarization parameters included the mean value of QT and QTc durations, QT dispersion, and peaks of QT duration and QT dispersion above prespecified thresholds. Results: In comparison to healthy subjects, patients with IDC had lower heart rate variability, longer mean QT and QTc durations, higher content of QTc peaks >500 ms, longer QT dispersion and its standard deviation, and a higher content of peaks >100 ms of QT dispersion (P < 0.01 for all comparisons). These repolarization parameters were significantly higher in IDC patients after adjustment for age, sex, and heart rate variability. The parameters of repolarization dynamics correlated with SDNN in healthy subjects but not in dilated cardiomyopathy patients. Conclusions: The automatic assessment of repolarization parameters in 24-hour digital ECG recordings is feasible and differentiates dilated cardiomyopathy patients from healthy subjects. Patients with dilated cardiomyopathy have increased QT duration, QT dispersion, and increased variability of QT dispersion reflecting variations in T-wave morphology, the factors which might predispose them to the development of arrhythmic events. [source]