Effect of Inpatient Cardiac Rehabilitation on QT Dispersion in Patients with Acute Myocardial Infarction
-
Zahra Ansari
,
Sina Rafat
,
Mohammad Vahid Jorat
,
Mahdieh Ghanbari-Firoozabadi
,
Masoud Mirzaei
,
Mohammadtaghi Sarebanhassanabadi
Abstract
QT dispersion is an indicator of lack of ventricular repolarization homogeneity and an independent predictor for ventricular arrhythmia and sudden cardiac death. In this study, we evaluated the effect of inpatient cardiac rehabilitation on QT dispersion in patients admitted to Afshar hospital CCU with diagnosis of acute myocardial infarction (AMI), including ST elevation or non-ST elevation MI. Sixty patients with diagnosis of AMI were randomly divided into two 30-subject groups. The subjects in the first group were undergone inpatient cardiac rehabilitation, and the subjects in the control group received only conventional treatments. QT interval dispersion was measured in two occasions: once in the first day of admission and once before discharge from hospital. In this study there was a significant reduction in QT dispersion in patients undergoing inpatient cardiac rehabilitation (48.4 vs. 42.4 ms, P0.05). The reduction was not significantly different regarding gender. The effectiveness of the rehabilitation on the reduction of QT dispersion was not affected by such variables as age, gender, hypertension, positive family history, hyperlipidemia, type of AMI (with ST-elevation or non-ST-elevation) and left ventricular ejection fraction. Diabetes caused a resistance to the beneficial effects of inpatient cardiac rehabilitation, so as non-diabetic patients showed more reduction in QT dispersion in response to inpatient cardiac rehabilitation comparing non-diabetic patients and the difference was statistically significant.
Randomized trial of intravenous streptokinase, oral aspirin, both or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Lancet 1988;2(8607):349–60.
O’Murchu B, Gersh BJ, Reeder GS, Bailey KR, Holmes DR Jr: Late outcome after percutaneous transluminal coronary angioplasty during acute myocardial infarction. Am J Cardiol 1993;72(9):634–39.
3-The Multicenter Post infarction Research Group: Risk stratification and survival after myocardial infarction. N Engl J Med 1983;309(6):331–6.
Oikarinen L, Viitasalo M, Toivonen L. Dispersion of the QT interval in post myocardial infarction patients presenting with ventriculartachycardia or with ventricular fibrillation. Am J Cardiol 1998;81(6):694–7.
Farrell TG, Bashir Y, Cripps T, Malik M, Poloniecki J, Bennett ED, Ward DE, Camm AJ. Risk stratification for arrhythmic events in post infarction patients based on heart rate variability, ambulatory electrocardiographic variablesm and the signal-averaged electrocardiogram. J Am Coll Cardiol 1991;18(3):687–97.
Roberto O. Bonow. Braunwald 's, Heart Disease: a textbook of cardiovascular medicine. 9th ed. Philadelphia : Elsevier Saunders, 2012. 7. Sheehan J, Perry IJ, Reilly M, Salim A, Collins M, Twomey EM, Daly A, Loingsigh SN, Elwood P, Ben-Shlomo Y, Davey-Smith G. QT dispersion, QT maximum and risk of cardiac death in the Caerphilly Heart Study. Eur J Cardiovasc Prev Rehabil 2004;11(1):63-8.
Malfatto G, Facchini M, Bragato R, Branzi G, Sala L, Leonetti G. Short and long term effects of exercise training on the tonic autonomicmodulation of heart rate variability after myocardial infarction. Eur Heart J 1996;17(4):532–8.
O’Connor GT, Buring JE, Yusuf S, Goldhaber SZ, Olmstead EM, Paffenbarger RS, Hennekens Jr and CH. An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation 1989; 80(2):234–44.
Fujimoto S, Uemura S, Tomoda Y, Yamamoto H, Matsukura Y, Horii M, Iwamoto E, Hashimoto T, Dohi K. Effect of exercise training on the heart rate variability and QT dispersion of patients with acute myocardial infarction. Jpn Circ J 1999;63(8):577-82.
Kalapura T, Lavie CJ, Jaffrani W, Chilakamarri V, Milani RV. Effect of cardiac rehabilitation and exercise training on indexes of dispersion of ventricular repolarization in patients after acute myocardial infarction. Am J Cardiol 2003;92(3):292-4.
Vasheghani-Farahani A, Asef-Kabiri L, Masoudkabir F, Davoodi G, Nejatian M, Saadat S, Yazdani T, Mehdipoor B, Yaminisharif A. Effect of exercise-based cardiac rehabilitation following coronary artery bypass surgery on ventricular repolarization indices. J Cardiopulm Rehabil prev 2011;31(4):239-44.
Kalka D, Sobieszczanska M, Markuszewski L, Bak A, Chorebala A, Rusiecki L, Adamus J, Janocha A. Effect of Cardiac Rehabilitation on QT Dispersion in Patients with Previous Myocardial Infarction Treated with PTCA. Abstract meeting in 33rd International Congress on Electrocardiology. Cologne, 28.06.- 01.07.2006. Düsseldorf, Köln: German Medical Science; 2007.
Macfarlane PW, McLaughlin SC, Rodger JC. Influence of lead selection and population on automated measurement of QT dispersion. Circulation 1998;98(20):2160-7.
Das MK, Zipes DP: Fragmented QRS: A predictor of mortality and sudden cardiac death. Heart Rhythm 2009;6(3 Suppl):S8-14.
Rautaharju PM, Surawicz B, Gettes LS, Bailey JJ, Childers R, Deal BJ, Gorgels A, Hancock EW, Josephson M, Kligfield P, Kors JA, Macfarlane P, Mason JW, Mirvis DM, Okin P, Pahlm O, van Herpen G, Wagner GS, Wellens H. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part IV: the ST segment, T and U waves, and the QT interval: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol 2009;53(11):982-91.
Antzelevitch C, Oliva A. Amplification of spatial dispersion of repolarization underlies sudden cardiac death associated with catecholaminergic polymorphic VT, long OT, short OT and Brugada syndromes. J Intern Med 2006;259(1):48-58.
Malik M, Batchvarov VN. Measurement, interpretation and clinical potential of QT dispersion. J Am Coll Cardiol 2000;36(6):1749-66.
| Files | ||
| Issue | Vol 51, No 9 (2013) | |
| Section | Original Article(s) | |
| Keywords | ||
| Acute myocardial infarction Cardiovascular risk factors QT dispersion Inpatient cardiac rehabilitation | ||
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