Premium
Circadian periodicity affects the type of ventricular arrhythmias and efficacy of implantable defibrillator therapies
Author(s) -
Vergara Pasquale,
Pignalberi Carlo,
Pisanò Ennio C.,
Maglia Giampiero,
Della Bella Paolo,
Zanotto Gabriele,
Iacopino Saverio,
Solimene Francesco,
Calvi Valeria,
Marini Massimiliano,
Giammaria Massimo,
Biffi Mauro,
Rovaris Giovanni,
Caravati Fabrizio,
Quartieri Fabio,
Curnis Antonio,
Rapacciuolo Antonio,
Senatore Gaetano,
Pedretti Stefano,
Saporito Davide,
Dello Russo Antonio,
Santobuono Vincenzo E.,
Pepi Patrizia,
Duca Antonio,
Baroni Matteo,
Falasconi Giulio,
Giacopelli Daniele,
Gargaro Alessio,
D'Onofrio Antonio
Publication year - 2021
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.15154
Subject(s) - medicine , implantable cardioverter defibrillator , cardiology , confidence interval , odds ratio , circadian rhythm , shock (circulatory) , ventricular tachycardia , logistic regression , cardiac resynchronization therapy , tachycardia , heart failure , ejection fraction
Factors influencing malignant arrhythmia onset are not fully understood. We explored the circadian periodicity of ventricular arrhythmias (VAs) in patients with implantable cardioverter and cardiac resynchronization defibrillators (ICD/CRT‐D). Methods Time, morphology (monomorphic/polymorphic), and mode of termination (anti‐tachycardia pacing [ATP] or shock) of VAs stored in a database of remote monitoring data were adjudicated. Episodes were grouped in six 4‐h timeslots from 00:00 to 24:00. Circadian distributions and adjusted marginal odds ratios (ORs), with 95% confidence interval (CI), were analyzed using mixed‐effect models and logit generalized estimating equations, respectively, to account for within‐subject correlation of multiple episodes. Results Among 1303 VA episodes from 446 patients (63% ICD and 37% CRT‐D), 120 (9%) self‐extinguished, and 842 (65%) were terminated by ATP, 343 (26%) by shock. VAs clustered from 08:00 to 16:00 with 44% of episodes, as compared with 22% from 00:00 to 08:00 ( p < .001) and 34% from 16:00 to 24:00 ( p = .005). Episodes were more likely to be polymorphic at night with an adjusted marginal OR of 1.66 (CI, 1.15–2.40; p = .007) at 00:00–04:00 versus other timeslots. Episodes were less likely to be terminated by ATP in the 00:00–04:00 (success‐to‐failure ratio, 0.67; CI, 0.46–0.98; p = .039) and 08:00–12:00 (0.70; CI, 0.51–0.96; p = .02) timeslots, and most likely to be terminated by ATP between 12:00 and 16:00 (success‐to‐failure ratio 1.42; CI, 1.06–1.91; p = .02). Conclusion VAs did not distribute uniformly over the 24 h, with a majority of episodes occurring from 08:00 to 16:00. Nocturnal episodes were more likely to be polymorphic. The efficacy of ATP depended on the time of delivery.