Abstract
During the past decade there has been a great increase in the use of prolonged ambulatory ECG monitoring for the determination of antiarrhythmic drug efficacy and for the prediction of prognosis in patients with ischemic heart disease. As with any diagnostic procedure, reproducibility of the test in the same patient is highly desirable. There is now ample evidence that considerable variation of ventricular arrhythmias may occur from minute-to-minute and day-to-day. The lack of complete reproducibility of ambulatory monitoring is in large part due to the inherent biological variability which chronic ventricular arrhythmias manifest. Therefore refinement of the technology to give more accurate tape analysis cannot be expected to improve the reproducibility of this test. The lack of reproducibility of ambulatory monitoring limits the usefulness of this test. However, by understanding the limitations of a test one can interpret the results properly and avoid overinterpretation. In this chapter we shall examine the phenomenon of spontaneous variability of ventricular arrhythmias and assess the impact this has on the use of ambulatory monitoring to assess drug efficacy and to predict prognosis. We shall also take a brief look at some factors which may cause this variability.
Keywords
- Ventricular Tachycardia
- Ventricular Arrhythmia
- Mitral Valve Prolapse
- Ambulatory Monitoring
- Ventricular Premature Beat
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References
Myburgh DP, and Van Gelder AL. 1974. The nature of ventricular ectopie beats in chronic ischemic heart disease. South African Medical Journal 48: 1067–1071.
Winkle RA. 1978. Antiarrhythmic drug effect mimicked by spontaneous variability of ventricular ectopy. Circulation 57: 1116–1121.
Kennedy HL, Chandra U, Sayther KL and Caralis DG. 1978. Effectiveness of increasing hours of continuous ambulatory electrocardiography in detecting maximal ventricular ectopy. The American Journal of Cardiology 42: 925–930.
Winkle RA, Gradman AH, Fitzgerald JW and Bell PA. 1978. Antiarrhythmic drug efficacy assessed from ventricular arrhythmia reduction in ambulatory electrocardiogram and treadmill test: Comparison of propranolol, procainamide and guinidine. The American Journal of Cardiology 42: 473–480.
Pratt CM, Fong A, DeMaria AN, Amsterdam EA and Mason DT. 1979. Recent advances in the understanding of ambulatory electrocardiography. Clinical Cardiology 2: 56–61.
Morganroth J, Michelson EL, Horowitz LN, Josephson ME, Pearlman AS and Dunkman WB. 1978. Limitations of routine long-term electrocardiographic monitoring to assess ventricular ectopie beats. Circulation 58: 408–414.
Engler R, Ryan W, LeWinter M, Bluestein H and Karliner JS. 1979. Assessment of longterm antiarrhythmic therapy: Studies in the long-term efficacy and toxicity of tocainide. The American Journal of Cardiology 43: 612–618.
Sami M, Kraemer H, Harrison DC, Houston N, Shunasaki C and DeBusk RF. 1980. A new method for evaluating antiarrhythmic drug efficacy. Circulation 62: 1172–1179.
Ruberman W, Weinblatt E, Goldberg JD, Frank CW and Shapiro S. 1977. Ventricular premature beats and mortality after myocardial infarction. New England Journal of Medicine 297: 750–757.
Michelson EL and Morganroth J. 1980. Spontaneous variability of complex ventricular arrhythmias detected by long-term electrocardiographic recording. Circulation 61: 690695.
Thanavaro S, Kleiger RE, Hieb BR, Krone RJ, deMello VR and Oliver GC. 1980. Effect of electrocardiographic recording duration on ventricular dysrhythmic detection after myocardial infarction. Circulation 62: 262–265.
Winkle RA, Peters F and Hall R. 1981. Characterization of ventricular tachyarrhythmias on ambulatory ECG recordings in post-myocardial infarction patients: Arrhythmia detection and duration of recording, relationship between arrhythmia frequency and complexity, and day-to-day reproducibility. American Heart Journal 102: 162–169.
Astrand I. 1965. Exercise electrocardiogram recorded twice with an 8-year interval in a group of 204 women and men 48–63 years old. Acta Medica Scandinavica 178: 27–39.
Jelinek MV and Lown B. 1974. Exercise stress testing for exposure of cardiac arrhythmia. Progress in Cardiovascular Diseases 16: 497–522.
Faris JV, McHenry PL, Jordan JW and Morris SN. 1976. Prevalence and reproducibility of exercise-induced ventricular arrhythmias during maximal exercise testing in normal men. The American Journal of Cardiology 37: 617–622.
DeBaker G, Jacobs D, Prineas R, Crow R, Vilandre J and Blackburn H. 1978. Ventricular premature beats. Cardiology 63: 53–63.
Sheps DL, Ernst JC, Briese FR, Lopez LU, Conde CA, Castellanos A and Meyerburg RJ. 1977. Decreases frequency of exercise-induced ventricular ectopic activity in the second of two consecutive treadmill tests. Circulation 55: 892–895.
Sami M, Kraemer H and DeBusk RF. 1979. Reproducibility of exercise-induced ventricular arrhythmia after myocardial infarction. The American Journal of Cardiology 43: 724–730.
Han J, DeFragha J, Millet D and Moe GK. 1966. Incidence of ectopie beats as a function of basic rate in the ventricle. American Heart Journal 72: 632–639.
Winkle RA. The relationship between ventricular ectopic beat frequency and heart rate. (In press).
Tzivoni D and Stern S. 1973. Electrocardiographic pattern during sleep in healthy subjects and in patients with ischemic heart disease. Journal of Electrocardiography 6: 225–229.
Khatri IM and Freis ED. 1967. Hemodynamic changes during sleep. Journal of Applied Physiology 22: 867–873.
Shahaway ME. 1970. Arrhythmias and the varieties of sleep (letter). New England Journal of Medicine 282: 815.
Lown B, Tykocinski M, Garfein A and Brooks P. 1973. Sleep and ventricular premature beats. Circulation 48: 691–701.
Winkle RA, Lopes MG, Fitzgerald JW, Goodman DJ, Schroeder JS, and Harrison DC. 1975. Arrhythmias in patients with mitral valve prolapse. Circulation 52: 73–81.
Pickering TG, Goulding L and Cobern BA. 1977. Diurnal variations in ventricular ectopic beats and heart rate. Cardiovascular Medicine 2: 1013.
Rosenblatt G, Hartmann E and Zwilling GR. 1973. Cardiac irritability during sleep and dreaming. Journal of Psychosomatic Research 17: 129–134.
Smith R, Johnson L, Rothfield D, Zir L and Tharp B. 1972. Sleep and cardiac arrhythmias. Archives of Internal Medicine 130: 751–753.
Winkle RA. 1978. “Circadian variations in ventricular ectopic activity,” in Management of Ventricular Tachycardia — Role of Mexilitine. Edited by Sande E, Julian DG and Bell JW. Excerpta Medica, pg. 165–169.
Calvert A, Lown B and Gorlin R. 1977. Ventricular premature beats and anatomically defined coronary artery disease. The American Journal of Cardiology 39: 627–634.
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© 1982 Martinus Nijhoff Publishers, The Hague
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Connolly, S.J., Winkle, R.A. (1982). The Spontaneous Variability of Ventricular Arrhythmias. In: Roelandt, J., Hugenholtz, P.G. (eds) Long-Term Ambulatory Electrocardiography. Developments in Cardiovascular Medicine, vol 20. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-7570-5_14
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DOI: https://doi.org/10.1007/978-94-009-7570-5_14
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