Preprint Article Version 2 Preserved in Portico This version is not peer-reviewed

Diurnal Variation of and Optimal Time To Measure Holter-Based Late Potentials To Predict Lethal Arrhythmia After Myocardial In-Farction

Version 1 : Received: 6 June 2023 / Approved: 7 June 2023 / Online: 7 June 2023 (03:30:57 CEST)
Version 2 : Received: 7 June 2023 / Approved: 8 June 2023 / Online: 8 June 2023 (03:37:05 CEST)

A peer-reviewed article of this Preprint also exists.

Hashimoto, K.; Harada, N.; Kimata, M.; Kawamura, Y.; Fujita, N.; Sekizawa, A.; Ono, Y.; Obuchi, Y.; Takayama, T.; Kasamaki, Y.; Tanaka, Y. Diurnal Variation in and Optimal Time to Measure Holter-Based Late Potentials to Predict Lethal Arrhythmia after Myocardial Infarction. Medicina 2023, 59, 1460. Hashimoto, K.; Harada, N.; Kimata, M.; Kawamura, Y.; Fujita, N.; Sekizawa, A.; Ono, Y.; Obuchi, Y.; Takayama, T.; Kasamaki, Y.; Tanaka, Y. Diurnal Variation in and Optimal Time to Measure Holter-Based Late Potentials to Predict Lethal Arrhythmia after Myocardial Infarction. Medicina 2023, 59, 1460.

Abstract

Abstract: 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.

Keywords

Late potentials; signal-averaged electrocardiogrhy; heart rate variability; fatal arrhyrthmia; sudden cardiac death

Subject

Medicine and Pharmacology, Cardiac and Cardiovascular Systems

Comments (1)

Comment 1
Received: 8 June 2023
Commenter: Kenichi Hashimoto
Commenter's Conflict of Interests: Author
Comment: The co-author of last name was wrong. The we have change the last name of co-author from" Yuji Kasamaki" to "Yuji Tanaka".
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