Circulation, Vol 88, 2284-2289, Copyright © 1993 by American Heart Association
HR Arntz, SN Willich, M Oeff, T Bruggemann, R Stern, A Heinzmann, B Matenaer and R Schroder
BACKGROUND. Previous studies report a morning peak in the occurrence of
out-of-hospital sudden cardiac death but lack detailed information on
underlying arrhythmias. We used the documentation system of the
semiautomated defibrillators used by emergency medical technicians to
investigate the circadian pattern of defined arrhythmias and the influence
of demographic patient characteristics on this pattern. METHODS AND
RESULTS. From December 1988 to December 1990, 703 consecutive patients (63%
men; age, 67 +/- 17 years) with sudden cardiac death were registered in the
Klinikum Steglitz area of the Berlin emergency care system. Determination
of time of day of the event was based on the arrival time of the rescue
squad. A marked circadian variation (P < .0001) in the occurrence of
sudden cardiac death was observed with a primary morning peak (6 AM to
noon) and a secondary afternoon peak (3 to 7 PM). The subgroup of 294
patients with ventricular fibrillation as initially documented arrhythmia
showed a similar circadian variation (P < .0001). In significant
contrast (P < .01), patients with asystole (n = 260) or pulseless
bradyarrhythmias (n = 149) were more evenly distributed during the daytime
with a primary night trough. Multivariate logistic regression analysis
revealed that the circadian pattern of ventricular fibrillation was similar
in both gender groups but tended to differ with regard to age: patients
older than 65 years demonstrated a monophasic distribution, whereas
patients aged 65 years or less had a biphasic distribution with peaks in
the morning and in the afternoon. CONCLUSIONS. The circadian pattern of
sudden cardiac death reflects primarily a circadian variation in onset of
ventricular fibrillation. The different circadian patterns of ventricular
fibrillation, pulseless bradyarrhythmias, and asystole suggest different
pathophysiological mechanisms of causation of death. The age dependence of
the pattern of ventricular fibrillation may indicate different underlying
external or endogenous triggers.
ARTICLES
Circadian variation of sudden cardiac death reflects age-related variability in ventricular fibrillation
Department of Medicine, Klinikum Steglitz, Free University of Berlin, FRG.
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