title: Slower heart rate and altered rate dependence of ventricular repolarization in patients with lone atrial fibrillation.
abstract: BACKGROUND
  Electrophysiological alterations in atrial fibrillation (AF) may be genetically based and may lead to changes in ventricular repolarization. Short QT syndrome is a rare channelopathy with abbreviated ventricular repolarization and a propensity for AF.
  
  
  OBJECTIVE
  To determine if minor unrecognized forms of short QT syndrome can explain some cases of lone AF.
  
  
  METHODS
  We prospectively compared QT intervals in 66 patients with idiopathic lone AF and 132 age- and sex-matched controls. QT intervals were measured during sinus rhythm in each of the 12 surface electrocardiogram leads and corrected using Bazett's formula (QTc). QT intervals were also corrected using other formulae. Uncorrected QT and heart rate regression lines were compared between AF patients and controls.
  
  
  RESULTS
  AF patients presented with a slower resting heart rate (64 ± 10 beats per minute [bpm] vs 69 ± 9 bpm; P=0.0006). QTc intervals were shorter in AF patients in 11/12 electrocardiogram leads (significant in 7/12, borderline in 2/12; mean QTc 381 ± 21 ms vs 388 ± 22 ms; P=0.02). QTc intervals were also shorter in AF patients, significantly or not, using other correction formulae. For similar heart rates, uncorrected QT intervals were shorter in patients when heart rates were greater than 70 bpm and longer when heart rates were less than 60 bpm. AF patients displayed steeper QT/heart rate regression line slopes than controls (P=0.009).
  
  
  CONCLUSIONS
  Heart rate is significantly slower and the rate dependence of ventricular repolarization is significantly altered in patients with lone AF compared with controls. Further study is warranted to determine if AF induces subsequent ventricular repolarization changes or if these modifications are caused by an underlying primary electrical disease.
authors: Federation of Cardiology, University Hospital Rangueil, Toulouse, France. mauryjphil@hotmail.com
authors: Philippe
authors: P
authors: Maury
authors: Guillaume
authors: G
authors: Caudron
authors: Frédéric
authors: F
authors: Bouisset
authors: Joëlle
authors: J
authors: Fourcade
authors: Alexandre
authors: A
authors: Duparc
authors: Pierre
authors: P
authors: Mondoly
authors: Anne
authors: A
authors: Rollin
authors: Sébastien
authors: S
authors: Hascoët
authors: Nicolas
authors: N
authors: Detis
authors: Christelle
authors: C
authors: Cardin
authors: Marc
authors: M
authors: Delay
authors: Olivier
authors: O
authors: Lairez
authors: Jérome
authors: J
authors: Roncalli
authors: Michel
authors: M
authors: Galinier
authors: Didier
authors: D
authors: Carrié
authors: Meyer
authors: M
authors: Elbaz
authors: Jean
authors: J
authors: Ferrières
authors: Jean-Marie
authors: JM
authors: Fauvel
authors: Marc
authors: M
authors: Zimmermann
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology*; D001919:Bradycardia / Q000175:diagnosis / Q000503:physiopathology*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D004562:Electrocardiography; D005602:France; D006329:Heart Conduction System / Q000503:physiopathology*; D006339:Heart Rate; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012044:Regression Analysis; D013557:Switzerland; D013997:Time Factors