[Circadian and weekly distribution of malignant ventricular arrhythmias in patients with coronary heart disease or dilatative cardiomyopathy who have an implanted cardioverter-defibrillator].
OBJECTIVE
Epidemiological studies have demonstrated a circadian distribution of sudden cardiac death (SD) and acute myocardial infarction (AMI), with a maximum frequency of events during the morning hours. Recently an analysis of computer recordings of implanted cardioverter/defibrillators has confirmed these findings with respect to SD. The majority of these studies concerned patients with coronary heart disease. In a prospective study we evaluated the circadian and weekly distribution of malignant ventricular tachyarrhythmias (VTA) in patients with a nonischaemic cardiac disease, namely dilated cardiomyopathy (CMP), and those with coronary heart disease (CHD).


METHODS
Over a mean period of 25 +/- 9 months computer-stored data and cardiac electrograms recorded from the implanted cardioverter/defibrillators (ICD) were analysed in 28 patients with CHD and 11 with DCMP. The circadian and weekly distribution of VTA was obtained, using customary arrhythmia classification and the stored and timed events.


RESULTS
Patients with CHD had a maximal frequency of VTA or ventricular fibrillation (VF) during the morning, with a peak between 9 and 10 o/c, while those with DCMP were at a higher risk of VTA or VF in the later afternoon and early evening. Regarding the frequency of events during the week, a significantly higher incidence of VTA was recorded on Saturdays in those with CHD, but on Mondays and Wednesdays in those with DCMP.


CONCLUSIONS
The circadian and weekly distribution of VTA differs significantly between patients with CHD and those with DCMP. A possible reason for this difference may be different trigger mechanisms in the two types of cardiac disease, since transient ischaemia is unlikely to be the cause in patients with nonischaemic DCMP.
Wolpert
C
C
Medizinische Klinik und Poliklinik, Rheinischen Friedrich-Wilhelms-Universität Bonn.
Jung
W
W
Spehl
S
S
Schumacher
B
B
Omran
H
H
Schimpf
R
R
Lüderitz
B
B
D002311:Cardiomyopathy, Dilated / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D002940:Circadian Rhythm; D016000:Cluster Analysis; D003327:Coronary Disease / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D006801:Humans; D015994:Incidence; D011446:Prospective Studies; D017180:Tachycardia, Ventricular / Q000453:epidemiology / Q000503:physiopathology*; D014693:Ventricular Fibrillation / Q000453:epidemiology / Q000503:physiopathology
Zirkadiane und wöchentliche Verteilung maligner ventrikulärer Tachyarrhythmien bei Patienten mit koronarer Herzkrankheit oder dilatativer Kardiomyopathie mit implantiertem Kardioverter-Defibrillator.