Assessing QT prolongation and electrocardiography restitution using a beat-to-beat method

Abstract

Historically, the heart rate corrected QT (QTc) interval has been the standard method to assess for impaired ventricular repolarization, particularly for drug development. However, QTc does not reflect changes in autonomic state or QT-RR hysteresis which can also affect the interpretation of arrhythmogenic risk. With the advent of more accurate algorithms to automatically measure the QT interval from continuously collected digital ECG data, usage of heart rate corrected functions is no longer necessary. The dynamic beat-to-beat QT interval method compares the QT interval to individual cardiac cycles from all normal autonomic states at similar RR intervals, thus eliminating the need for correction functions. The upper 97.5% reference boundary of these beat-to-beat QT interval values is defined across the entire 24-hour RR interval range. Beats with QT intervals exceeding this limit are flagged as outlier beats for further arrhythmia vulnerability assessment. The same beat-to-beat technique can also be used to assess the QT-TQ interval relationship known as ECG restitution. This analysis potentially provides an additional means to quantify cardiac stress or arrhythmia vulnerability as the heart works more in relationship to each rest cycle.