CIRCADIAN VARIATION OF VENTRICULAR ARRHYTHMIA RECURRENCES AFTER CARDIOVERTER-DEFIBRILLATOR IMPLANTATION IN PATIENTS WITH HEALED MYOCARDIAL INFARCTS

Past studies using Holter monitoring and retrospective reviews of death certificates have documented peak occurrence of sudden death and nonsustained ventricular tachycardia (Vr) in the morning hours, We used the Ventritex CadenceTM device (Ventritex, Sunnyvale, California) which documents the date and time of all stored arrhythmias leading to device therapy to evaluate the circadian pattern of sustained ventricular arrhythmia recurrence. Mean follow-up after defibrillator implantation was 628 +/- 285 days. All 390 patients had at least 1 episode (range 1 to 43) of sustained VT documented from analysis of the stored electrograms associated with an arrhythmia event. Stored electrograms were available for review and analysis in 3,041 device detections; 349 stored events were excluded because they did not fulfill the diagnostic criteria for VT or failed to document the onset of the ventricular arrhythmia at the beginning of the recorded event of the arrhythmia episode. Criteria for the diagnosis of VT or ventricular fibrillation were met in 2,692 arrhythmia episodes occurring in 390 patients. There was circadian variation for ventricular arrhythmia recurrence for the whole patient group with the data fit to the sinusoidal density function: f(t) = 126 - 51 x cos (-57 + 2 pi t/24) - 25 x sin (63 + 2 pi t/12) (p <0.0001). Ventricular arrhythmia occurrence rate was lowest between 2:00 and 3:00 A.M., and highest between 10:00 and 11:00 A.M. In addition, the same circadian pattern was demonstrated regardless of patient age, gender, left ventricular ejection fraction (<35% or greater than or equal to 35%), and VT cycle length (<300 or greater than or equal to 300 ms). There is a definite circadian distribution of ventricular arrhythmia occurrence in patients with implantable cardioverter-defibrillators. The circadian pattern is similar regardless of the patients' age, gender, election fraction, or VT cycle length.