Document Detail

Control of rapid heart rate changes for electrocardiographic analysis: implications for thorough QT studies.
MedLine Citation:
PMID:  17190179     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Following an abrupt change in heart rate (HR), QT adaptation is achieved within a delayed time frame. HYPOTHESIS: The exclusion of electrocardiograms (ECGs) showing rapid HR changes influences the level of a drug-induced QT prolongation. METHODS: Continuous 12-lead ECG-Holter monitoring was performed in 31 healthy subjects. Using the "bin" method, we evaluated moxifloxacin effects on (1) QT interval duration at different RR intervals and (2) on the rate dependence of QT interval. These endpoints were calculated separately for five types of ECG analysis: classification of cardiac complexes based on (a) the single preceding RR interval (RR-1) and (b) RR filters excluding rapid HR changes according to the formula RR-1 = RR[time-window] +/- threshold, where the time-window could be 30 or 60 s (R30 and R60) and the threshold 15 or 30 ms (th15 or th30). RESULTS: Moxifloxacin-induced QT prolongation was consistently higher using the stable models when compared with the RR-1 model. Moxifloxacin-induced QT prolongation at RR = 1000 ms was 8.2 +/- 11.2 vs. 10.9 +/- 10.4 ms using the RR-1 and R60th15 stable models, respectively (p < 0.05). Moxifloxacin-induced QT prolongation was more pronounced at slow than at fast HR. This so-called "reverse rate-dependent" effect was more pronounced when assessed using stable HR models (0.023 IC95% [0.019;0.027] vs. 0.015 IC95% [0.012;0.017] using the RR-1 model). CONCLUSION: The exclusion of ECGs with rapid HR changes influences the magnitude of drug-induced QT changes. The hysteresis phenomenon should not be neglected when dedicated QT studies are performed.
Fabrice Extramiana; Pierre Maison-Blanche; Abdeddayem Haggui; Fabio Badilini; Philippe Beaufils; Antoine Leenhardt
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Clinical cardiology     Volume:  29     ISSN:  0160-9289     ISO Abbreviation:  Clin Cardiol     Publication Date:  2006 Dec 
Date Detail:
Created Date:  2006-12-27     Completed Date:  2007-02-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7903272     Medline TA:  Clin Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  534-9     Citation Subset:  IM    
Lariboisière University Hospital, Paris, France.
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MeSH Terms
Anti-Infective Agents / pharmacology
Aza Compounds / pharmacology
Electrocardiography, Ambulatory / drug effects*,  methods
Heart Conduction System / drug effects*
Heart Rate*
Middle Aged
Quinolines / pharmacology
Reg. No./Substance:
0/Anti-Infective Agents; 0/Aza Compounds; 0/Quinolines; 0/moxifloxacin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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