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Ventricular gradient and nondipolar repolarization components increase at higher heart rate

Department of Cardiological Sciences, St. George's Hospital Medical School, London SW17 0RE, United Kingdom

Submitted 22 May 2003 ; accepted in final form 31 July 2003

Differences in action potential duration reflect differences in ion channel properties. These properties also determine rate dependence of action potential duration, and transmural dispersion was confirmed experimentally to increase with cycle length. While several electrocardiographic indexes characterizing repolarization abnormalities have been proposed, studies of their heart rate dependence are missing. This study therefore investigated rate relationship of two repolarization descriptors, namely, the so-called total cosine of the QRS-T angle (TCRT), proposed to characterize global repolarization heterogeneity, and the so-called relative T wave residuum (TWR), linked to regional repolarization dispersion. During 24-h holter recordings in 60 healthy subjects (27 males), a 12-lead ECG was obtained every 30 s. RR intervals, QT intervals, and TCRT and TWR were calculated in each ECG and averaged over RR interval bins ranging from 550 to 1,150 ms in 10-ms steps. Women had uniformly greater TCRT and TWR values than men did over the entire range of investigated RR intervals. Whereas the TCRT in both sexes showed marked rate dependence with higher values at long RR intervals (550 vs. 1,150 ms: women, 0.46 ± 0.31 vs. 0.76 ± 0.18, P = 9 x 10^–7; men, 0.08 ± 0.45 vs. 0.49 ± 0.35, P = 9 x 10^–8), the rate dependence of TWR was more marked in women than in men, showing higher values at shorter RR intervals (550 ms vs. 1,150 ms: women: 0.29 ± 0.14% vs. 0.08 ± 0.06%, P = 2 x 10^–8; men: 0.14 ± 0.12% vs. 0.04 ± 0.02%, P = 2 x 10^–15). This suggests that both global and regional repolarization heterogeneity are increased at faster heart rates. Whereas in women at all heart rates the sequence of repolarization more closely replicates the sequence of depolarization, localized repolarization is more heterogeneous than in men especially at fast heart rates.

repolarization heterogeneity; electrocardiogram; rate dependence; gender difference

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