Dynamic changes in the QT-R-R relationship during head-up tilt test in patients with vasovagal syncope.
BACKGROUND
QT interval is influenced by preceding R-R intervals and autonomic nervous tone. Changes in QT intervals during vasovagal reflex might reflect autonomic modulation of ventricular repolarization; however, this issue has not been fully elucidated. This study aimed to evaluate dynamic response of QT interval to transient changes in R-R interval during vasovagal syncope (VVS) induced by head-up tilt test.


METHODS
Eighteen patients with VVS and 18 age-and sex-matched controls were studied. All patients with VVS had a positive mixed-type response to head-up tilt and all controls had a negative response. CM5-lead digital electrocardiogram (ECG) was recorded and QT intervals were analyzed using Holter ECG analyzer. Using scatter plots of consecutive QT and the preceding R-R intervals, QT-R-R relations during tilt-up and tilt-back or during vasovagal reflex were independently fitted to an exponential curve: QT (second) = A + B x exp[k x R-R (second)].


RESULTS
During the tilt-up, A, B, and k did not differ between patients with VVS and controls. During the tilt back, k showed equivalent positive value compared to the tilt-up (4.1 +/- 1.3 vs -4.6 +/- 0.9) in controls. However, k remained negative (-1.3 +/- 1.5) during vasovagal reflex in patients with VVS. In six patients, in whom metoprolol was effective in eliminating VVS, QT-R-R relationship during the tilt-back became similar to that in controls.


CONCLUSIONS
In patients with VVS, hysteresis of the QT-R-R relation is similarly shown during tilt-up as in controls, whereas this hysteresis is no longer evident and failure of QT prolongation is observed during VVS.
Mizumaki
Koichi
K
Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, Sugitani, Toyama, Japan. kmizu@ms.toyanna-mpu.ac.jp
Fujiki
Akira
A
Sakabe
Masao
M
Nishida
Kunihiro
K
Sugao
Masataka
M
Tsuneda
Takayuki
T
Nagasawa
Hidehiko
H
Inoue
Hiroshi
H
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology; D000328:Adult; D001341:Autonomic Nervous System / Q000187:drug effects / Q000503:physiopathology*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000494:pharmacology; D019462:Syncope, Vasovagal / Q000503:physiopathology*; D018667:Tilt-Table Test
D000319:Adrenergic beta-Antagonists; D008790:Metoprolol