TY - JOUR
T1 - Circadian Variation of Ventricular Arrhythmias in Catecholaminergic Polymorphic Ventricular Tachycardia
AU - Miyake, Christina Y.
AU - Asaki, S. Yukiko
AU - Webster, Gregory
AU - Czosek, Richard J.
AU - Atallah, Joseph
AU - Avasarala, Kishor
AU - Rao, Sri O.
AU - Thomas, Patricia E.
AU - Kim, Jeffrey J.
AU - Valdes, Santiago O.
AU - de la Uz, Caridad
AU - Wang, Yunfei
AU - Wehrens, Xander H.T.
AU - Abrams, Dominic
N1 - Funding Information:
Supported by PACES, Pediatric and Adult Congenital Electrophysiology Society Paul C. Gillette grant funding, NIH-NHLBI grants (R01-HL089598, R01-HL091947, R01-HL117641, R41-HL129570), NIH-LRP grant funding, the American Heart Association (13EIA14560061), and the Juanita P. Quigley endowed chair in cardiology.
Funding Information:
Dr. Kim has received fellowship support from Medtronic Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2017 American College of Cardiology Foundation
PY - 2017/11
Y1 - 2017/11
N2 - Objectives The aim of this paper was to investigate whether ventricular arrhythmias in children with catecholaminergic polymorphic ventricular tachycardia (CPVT) show circadian patterns. Background Circadian arrhythmic patterns have been established in long QT, Brugada, and early repolarization, but have not been investigated in CPVT. Methods This is a multicenter, retrospective review of pediatric CPVT patients, age <21 years at diagnosis. Timing of ventricular tachycardia (VT ≥3 beats) was assessed during 24-h continuous monitoring (Holter, implantable loop recorder, implantable cardioverter defibrillator) and by eliminating sleep hours, in addition to sporadic exercise stress tests. Morning was defined as 6:00 AM to 11:59 AM, afternoon 12:00 PM to 5:59 PM, and evening 6:00 PM to 11:59 PM. Distribution of VT events was compared by time of day, day of week, age, and sex. Results Eighty patients (53% male), 61% with an ICD, experienced 423 VT events during a median follow-up time of 6 years (interquartile range: 2 to 10 years). When compared to morning hours, VT was more likely to occur in the afternoon (odds ratio [OR]: 2.54; 95% confidence interval [CI]: 1.69 to 3.83) or evening hours (OR: 2.91; 95% CI: 1.82 to 4.67). The predominance of afternoon/evening events persisted regardless of age, gender, or day of the week. Among 50 patients who underwent exercise stress tests, VT was significantly more likely to occur in the afternoon (OR: 3.00; 95% CI: 1.39 to 6.48). Conclusions In pediatric CPVT patients, ventricular arrhythmias are more likely to occur in the afternoon and evening hours. Because children's activity levels peak in both the morning and afternoon, the lack of arrhythmias in the morning hours raises questions whether factors other than adrenergic stimulation influence arrhythmia induction in pediatric patients with CPVT.
AB - Objectives The aim of this paper was to investigate whether ventricular arrhythmias in children with catecholaminergic polymorphic ventricular tachycardia (CPVT) show circadian patterns. Background Circadian arrhythmic patterns have been established in long QT, Brugada, and early repolarization, but have not been investigated in CPVT. Methods This is a multicenter, retrospective review of pediatric CPVT patients, age <21 years at diagnosis. Timing of ventricular tachycardia (VT ≥3 beats) was assessed during 24-h continuous monitoring (Holter, implantable loop recorder, implantable cardioverter defibrillator) and by eliminating sleep hours, in addition to sporadic exercise stress tests. Morning was defined as 6:00 AM to 11:59 AM, afternoon 12:00 PM to 5:59 PM, and evening 6:00 PM to 11:59 PM. Distribution of VT events was compared by time of day, day of week, age, and sex. Results Eighty patients (53% male), 61% with an ICD, experienced 423 VT events during a median follow-up time of 6 years (interquartile range: 2 to 10 years). When compared to morning hours, VT was more likely to occur in the afternoon (odds ratio [OR]: 2.54; 95% confidence interval [CI]: 1.69 to 3.83) or evening hours (OR: 2.91; 95% CI: 1.82 to 4.67). The predominance of afternoon/evening events persisted regardless of age, gender, or day of the week. Among 50 patients who underwent exercise stress tests, VT was significantly more likely to occur in the afternoon (OR: 3.00; 95% CI: 1.39 to 6.48). Conclusions In pediatric CPVT patients, ventricular arrhythmias are more likely to occur in the afternoon and evening hours. Because children's activity levels peak in both the morning and afternoon, the lack of arrhythmias in the morning hours raises questions whether factors other than adrenergic stimulation influence arrhythmia induction in pediatric patients with CPVT.
KW - arrhythmia
KW - catecholaminergic polymorphic ventricular tachycardia
KW - children
KW - circadian
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U2 - 10.1016/j.jacep.2017.05.004
DO - 10.1016/j.jacep.2017.05.004
M3 - Article
C2 - 29759629
AN - SCOPUS:85028549987
SN - 2405-5018
VL - 3
SP - 1308
EP - 1317
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 11
ER -