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Am J Physiol Heart Circ Physiol (August 28, 2003). doi:10.1152/ajpheart.00479.2003
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Submitted on May 22, 2003
Accepted on July 31, 2003

Ventricular gradient and non-dipolar repolarisation components increase at higher heart rate

Peter Smetana1, Velislav Batchvarov1, Katerina Hnatkova1, John A. Camm1, and Marek Malik1*

1 Department of Cardiological Sciences, St. George's Hospital Medical School, London, United Kingdom

* To whom correspondence should be addressed. E-mail: m.malik{at}sghms.ac.uk.

Differences in APD reflect differences in ion channel properties. These properties determine rate dependence of APD and transmural dispersion was confirmed experimentally to increase with cycle length. While several electrocardiographic indices characterising repolarisation abnormalities have been proposed, studies of their heart rate dependence are missing. This study therefore investigated rate relationship of two repolarisation descriptors, namely the so-called total cosine of the QRS-T angle (TCRT), proposed to characterise global repolarisation heterogeneity, and the so-called relative T wave residuum (TWR) linked to regional repolarisation dispersion. During 24-hour holter recordings in 60 healthy subjects (27 males), a 12-lead ECG was obtained every 30 seconds. RR intervals, QT intervals, TCRT and TWR were calculated in each ECG and averaged over RR interval bins ranging from 550 to 1150 ms in 10 ms steps. Women had uniformly greater TCRT and TWR values than men over the entire range of investigated RR intervals. While TCRT in both sexes showed marked rate dependence with higher values at long RR intervals (550 ms vs. 1150 ms: women: 0.46±0.31 vs. 0.76±0.18, p=9x10-7; men: 0.08±0.45 vs. 0.49±0.35, p=9x10-8), rate dependence of TWR was more marked in women than in men, showing higher values at shorter RR intervals (550 ms vs. 1150 ms: women: 0.29±0.14 % vs. 0.08±0.06 %, p=2x10-8; men: 0.14±0.12 % vs. 0.04±0.02 %, p=2x10-15). This suggests that both global and regional repolarisation heterogeneities are increased at faster heart rates. Whereas in women at all heart rates, the sequence of repolarisation more closely replicates the sequence of depolarisation, localised repolarisation is more heterogeneous than in men especially at fast heart rates.




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