Abstract MP081: Short-long-short Sequence of RR Intervals is Associated With Increased Risk of Sudden Cardiac Death: the Atherosclerosis Risk in Community Study
Introduction: A Short-long-short sequence of RR’ intervals frequently precedes ventricular tachyarrhythmia. However, an association of RR’ alternans with sudden cardiac death (SCD) in the general population has not been previously studied.
Hypothesis: We hypothesized that RR’ alternans is associated with SCD.
Methods: We analyzed baseline visit 10-second ECG in 14,250 participants of the Atherosclerosis Risk in Communities (ARIC) cohort (mean age 54.1±5.87y; 45% men; 74% white). Only normal sinus beats were included in the semi-automated analysis. Digital 12-lead ECG was transformed into orthogonal ECG, from which respiratory signal was derived. Joint symbolic analysis was used to assess increase or decrease in successive RR’ intervals and R-instant respiratory phases calculated using the Hilbert transform. Short-long-short or long-short-long RR’ sequence was defined as RR’ alternans. RR’ alternans occurring during respiratory phase transitions were not considered. SCD, non-SCD, and non-cardiac death served as competing outcomes. Three competing risks models were constructed. Model 1 was adjusted for age, sex, race, and study center. Model 2 was in addition adjusted for prevalent CVD. Model 3 was further adjusted for subclinical CVD, its risk factors, including traditional ECG predictors, and medications affecting SA or AV nodes.
Results: Over median follow-up of 24.4 years, there were 497 SCDs (incidence 1.66 [95%CI 1.52-1.82], 742 non-sudden cardiac deaths (incidence 2.48 [95%CI 2.31-2.67], and 3,753 non-cardiac deaths (incidence 12.6 [95%CI 12.1-13.0]) per 1,000 person-years. RR alternans was present in 1,679(11.8%) participants. In competing risks analysis (Table) the presence of RR’ alternans, excluding those occurring due to respiratory phase changes, was independently associated with increased risk of SCD.
Conclusion: In competing risks analysis the presence of RR’ alternans that are not due to respiratory phase transition is associated with SCD. Further study of RR’ alternans is warranted.
Author Disclosures: M. Kabir: None. J. Thomas: None. G. Sedaghat: None. J. Waks: None. S.V. Mukundan: None. C. Henrikson: None. W. Post: None. N. Sotoodehnia: None. S. Solomon: None. E. Soliman: None. D. Siscovick: None. A. Buxton:None. M. Josephson: None. L.G. Tereshchenko: B. Research Grant; Significant; Medtronic, Inc, Gilead, Boston Scientific. G. Consultant/Advisory Board; Significant; Medtronic, Gilead.
- © 2017 by American Heart Association, Inc.