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Am J Physiol Heart Circ Physiol (October 10, 2008). doi:10.1152/ajpheart.00625.2008
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Submitted on June 13, 2008
Revised on September 23, 2008
Accepted on October 8, 2008

Subject-Specific Profiles of QT/RR Hysteresis

Marek Malik1*, Katerina Hnatkova, Tomas Novotny, and Georg Schmidt

1 St. George's University of London

* To whom correspondence should be addressed. E-mail: marek.malik{at}btinternet.com.

The time-lag of the QT interval adaptation to heart rate changes (QT/RR hysteresis) was studied in 40 healthy subjects (18 females, mean age 30.4±8.1 years) with 3 separate day-time (>13 hour) 12-lead electrocardiograms (ECG) in each subject. In each recording, 330 individual 10-second ECG segments were measured including 100 segments preceded by 2 minutes of heart rate varying >±2bpm. Other segments were preceded by stable heart rate. In segments preceded by variable rate, QT/RR hysteresis was characterized by {lambda} parameters of exponential decay models. The intra-subject standard deviations (SD) of {lambda} values were compared with the inter-subject SD of the individual means. The {lambda} values were also correlated to individually optimized parameters of heart rate correction. Intra-subject SDs of {lambda} were substantially smaller than the population SD of individual means (0.390±0.197 vs 0.711, p<0.0001). The {lambda} values were unrelated to the QT/RR correction parameters. Compared to the QTc corrected for averaged RR intervals in 10-second ECGs, and to the averaged RR intervals in 2-minute history, QTc correction for QT/RR hysteresis led to substantially smaller SD of QTc values (11.36±2.00ms, 6.33±1.31ms, and 4.66±0.85ms, respectively, p<0.0001). Thus, the speed with which the QT interval adapts to heart rate changes is highly individual with intra-subject stability and inter-subject variability. QT/RR hysteresis is independent of the static QT/RR relationship and should be considered as a separate physiologic process. Combination of individual heart-rate correction with individual hysteresis correction of the QT interval is likely to lead to substantial improvements of cardiac repolarization studies.




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M. Malik, K. Hnatkova, A. Schmidt, and P. Smetana
Electrocardiographic QTc Changes Due to Moxifloxacin Infusion
J. Clin. Pharmacol., June 1, 2009; 49(6): 674 - 683.
[Abstract] [Full Text] [PDF]




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