| Research Abstract |
[Background] There is considerable evidence that the presence of ventricular ectopies (VEs) predicts mortality after acute myocardial infarction or other heart diseases. Those results, however, were obtained from the study population only to patients with the ordinary sinus rhythm and excluded patients with atrial fibrillation (AF), since the diagnosis of wide QRS complexes in AF as aberrant ventricular conductions or as VEs was difficult by surface electrocardiograms (ECGs). If we can diagnose the wide QRS complexes in AF by non-invasive method, the ventricular arrhythmias in AF can be studied more precisely and the clinical pictures of patients with ventricular arrhythmias in AF would be also elucidated. In a previous study, we introduced a non-invasive method that allowed us to differentiate aberrant ventricular conductions and VEs in AF using an RR-interval scatter diagram. The RR- interval scatter diagram is obtained by successively plotting the sequential pairs of RR-intervals re
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corded on Holter ECG monitoring. Since the plotting of aberrant ventricular conductions and VEs distributes differently on the RR- interval scatter diagram, we can diagnose the wide QRS complexes non-invasively. Furthermore, this method enables us to analyze the detailed characteristics of VEs in AF.The aim of this investigation was to analyze the modality of occurrence of ventricular arrhythmias in AF precisely using the RR-interval scatter diagram and to discover any relationship between the characteristics of ventricular arrhythmias and the clinical pictures of the AF- patients with VEs, especially one which would indicate the severity of cardiac function.
[Methods] We successively plotted the points on X-Y plane as (X,Y)=(RRn, RRn+1), from the consecutive RR intervals in Holier ECG.We diagnosed 80 VEs from 175 AF-patients based on the different plotting patterns of VEs and aberration.
[Results] The variability of coupling intervals of VEs observed in sinus rhythm also existed in those of VEs in AF, ie., fixed coupling (n=43) and variable coupling (n=37). Severe arrhythmias like sustained ventricular tachycardia and ventricular fibrillation occurred more frequently in the patients with variable coupling VEs than in those with fixed coupling VEs. Furthermore, analyzing the influence of a preceding sequence of RR-intervals on the occurrence of VEs, two types of preceding sequences existed, i.e., a short-long RR sequence (n=50) and no regular RR sequence (n=30) before VEs. Severe arrhythmias occurred in the group without regular preceding RR-interval sequence.
[Conclusions) The RR-interval plotting enables us to differentiate the variable types of VEs and to analyze the relation between the types of VEs and the clinical characteristics in AF.Certain types of VEs in coupling interval and preceding RR-interval related to the severe ventricular arrhythmias. Less
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