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• W613785587 abstract "The autonomic nervous system is an important modulator of ventricular repolarization and arrhythmia vulnerability. This series of investigations aimed to characterize the effects of standardized cardiovascular autonomic function tests on ventricular repolarization and repolarization heterogeneity, with a special reference to congenital arrhythmogenic disorders typically associated with stress-induced fatal ventricular arrhythmias. Effects of autonomic adaptation on QT intervals in a 12-lead electrocardiogram and in multichannel magnetocardiography were studied in 10 healthy adults during mental stress, Valsalva manoeuvre, sustained handgrip, deep breathing, voluntary hyperventilation and cold pressor testing. Based on the experience gained from the studies on healthy subjects, a series of tests consisting of deep breathing, Valsalva manoeuvre, mental stress, sustained handgrip and mild supine exercise testing was subsequently performed in two patient groups, while a 25-lead body surface electrocardiogram was recorded. The first series comprised 9 asymptomatic patients with LQT1 subtype of the hereditary long QT syndrome and 8 healthy controls whereas the second series comprised 9 patients with arrhythmogenic right ventricular dysplasia (ARVD) and 9 healthy controls. Automated QT interval measurements with a validated computer-based method were used in all studies. Even strong sympathetic activation had no effects on spatial QT interval dispersion in healthy subjects, but deep respiratory efforts and Valsalva manoeuvre influenced it in ways that were opposite in electrocardiographic and magnetocardiographic recordings. LQT1 patients showed blunted QT interval and sinus nodal responses to sympathetic challenge, as well as an exaggerated QT prolongation during the recovery phases. LQT1 patients showed a QT interval recovery overshoot in 2.4 ± 1.7 tests compared with 0.8 ± 0.7 in healthy controls (P = 0.02). Valsalva strain prolonged the T wave peak to T wave end interval only in the LQT1 patients, considered to reflect the arrhythmogenic substrate in this syndrome. ARVD patients showed signs of abnormal repolarization in the right ventricle, modulated by abrupt sympathetic activation. An electrocardiographic marker reflecting interventricular dispersion of repolarization was introduced. It showed that LQT1 patients exhibit a repolarization gradient from the left ventricle towards the right ventricle, which was significantly larger than in controls. In contrast, ARVD patients showed a repolarization gradient from the right ventricle towards the left. Valsalva strain amplified the repolarization gradient in LQT1 patients whereas it transiently reversed the gradient in patients with ARVD. In conclusion, intrathoracic volume and pressure changes influence regional electrocardiographic and magnetocardiographic QT interval measurements differently. Especially recovery phases of standard cardiovascular autonomic functions tests and Valsalva manoeuvre reveal the abnormal repolarization in asymptomatic LQT1 patients. Both LQT1 and ARVD patients have abnormal interventricular repolarization gradients, which are modulated by abrupt sympathetic activation. Autonomic testing and in particular the Valsalva manoeuvre are potentially useful in unmasking abnormal repolarization in congenital arrrhythmogenic syndromes." @default.
• W613785587 created "2016-06-24" @default.
• W613785587 creator A5044710867 @default.
• W613785587 date "2008-06-06" @default.
• W613785587 modified "2023-09-28" @default.
• W613785587 title "Ventricular repolarization during cardiovascular autonomic function testing" @default.
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