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. 2016 May;5(1):31-6.
doi: 10.15420/aer.2015:30:2.

Periodic Repolarisation Dynamics: A Natural Probe of the Ventricular Response to Sympathetic Activation

Konstantinos D Rizas  1 , Wolfgang Hamm  1 , Stefan Kääb  1 , Georg Schmidt  2 , Axel Bauer  1
Affiliations

Periodic Repolarisation Dynamics: A Natural Probe of the Ventricular Response to Sympathetic Activation

Konstantinos D Rizas et al. Arrhythm Electrophysiol Rev. 2016 May.

Abstract

Periodic repolarisation dynamics (PRD) refers to low-frequency (≤0.1Hz) modulations of cardiac repolarisation instability. Spontaneous PRD can be assessed non-invasively from 3D high-resolution resting ECGs. Physiological and experimental studies have indicated that PRD correlates with efferent sympathetic nerve activity, which clusters in low-frequency bursts. PRD is increased by physiological provocations that lead to an enhancement of sympathetic activity, whereas it is suppressed by pharmacological β-blockade. Electrophysiological studies revealed that PRD occurs independently from heart rate variability. Increased PRD under resting conditions is a strong predictor of mortality in post-myocardial infarction (post-MI) patients, yielding independent prognostic value from left-ventricular ejection fraction (LVEF), heart rate variability, the Global Registry of Acute Coronary Events score and other established risk markers. The predictive value of PRD is particularly strong in post-MI patients with preserved LVEF (>35 %) in whom it identifies a new high-risk group of patients. The upcoming Implantable Cardiac Monitors in High-Risk Post-Infarction Patients with Cardiac Autonomic Dysfunction and Moderately Reduced Left Ventricular Ejection Fraction (SMART-MI) trial will test prophylactic strategies in high-risk post-MI patients with LVEF 36-50 % identified by PRD and deceleration capacity of heart rate (NCT02594488).

Keywords: myocardial infarction; periodic repolarisation dynamics; risk stratification; spatial dispersion of repolarisation; sudden death; sympathetic nervous system.

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Figures

Figure 1.
Figure 1.. Calculation of Periodic Repolarisation Dynamics
Figure 2:
Figure 2:. Calculation of the Angle dT° Between Two Successive Repolarisation Vectors T1 and T2
Figure 3:
Figure 3:. Periodic Repolarisation Dynamics in post-MI Patients
Figure 4:
Figure 4:. PRDPRSA as Predictor of Mortality after Myocardial Infarction
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See this image and copyright information in PMC

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