Europace Advance Access published online on November 3, 2009
Europace, doi:10.1093/europace/eup344
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CLINICAL RESEARCH
The relationship between high resting heart rate and ventricular arrhythmogenesis in patients referred to ambulatory 24 h electrocardiographic recording
1 Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest University School of Medicine, 2000 West First Street, Piedmont Plaza 2, Suite 505, Winston-Salem, NC 27104, USA; 2 National Heart Institute, Imbaba, Egypt
Aims: High resting heart rate (HR) has been associated with sudden cardiac death (SCD). This association is not fully explained by the reported association between HR with coronary heart disease (CHD) or left ventricular systolic dysfunction, the major pathological substrates for SCD. Ventricular arrhythmia is the most common antecedent event before SCD. Examining associations between resting HR and ventricular arrhythmogenesis may enhance our understanding of the association between high resting HR and SCD.
Methods and results: This study included 867 patients (age 54 ± 5, 57% females) who underwent 24 h ambulatory electrocardiographic (ECG) recording (Holter) in the period from 1998 to 2000. We examined the unadjusted and multivariable-adjusted associations between resting HR with factors involved in ventricular arrhythmogenesis [ventricular late potentials (LPs) detected by signal-averaged ECG, heart rate variability (HRV), and premature ventricular complexes (PVCs)]. Linear regression models were used for continuous outcomes and logistic regression analysis was used for categorical outcomes. The multivariable models included first age and sex, then history of hypertension, diabetes, hypercholesterolaemia, CHD, heart failure, left ventricular ejection fraction (LVEF), smoking, body mass index, the use of anti-arrhythmic drugs, and ST-depression in the 24 h ambulatory ECG recording (Holter) were included in the final models. In the unadjusted and multivariable-adjusted analysis, high resting HR was significantly associated with positive ventricular LPs, depressed HRV indices, and increased prevalence of PVCs/24 h independently from demographic and clinical variables including LVEF, history of CHD, and the presence of ST-depression in Holter (P-value <0.05 in all comparisons and models).
Conclusion: High resting HR is independently associated with ventricular arrhythmogenesis, the major cause of SCD. These findings could partially explain the reported association between increased HR and SCD.
Key Words: Resting heart rate, Sudden cardiac death, Signal-averaged electrocardiogram, Holter, Heart rate variability
* Corresponding author. Tel: +1 336 716 8632, Fax: +1 336 716 0834, Email: esoliman{at}wfubmc.edu
Manuscript submitted 7 July 2009. Accepted after revision 9 October 2009.
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