We have analyzed the electrocardiographic data collected during continuous 7-day ambulatory recordings in patients with frequent premature ventricular complexes (PVCs). We analyze the dependence of the frequency and patterns of PVCs on the heart rate and the time of the day. Patients display rhythms of a complex yet consistent structure. In a given patient, the pattern remains robust over different days and particular repetitive patterns appear at specific heart rates, suggesting the appearance of bifurcations in the dynamics. Over the course of 24 h, we find that in some patients, patterns appear to depend only on the heart rate, whereas in others, both the time of the day and the heart rate play a role in controlling the dynamics. Identifying parameter values at which bifurcations occur facilitates the development of dynamical models for arrhythmia. The use of powerful recording and analysis techniques will enable improved analysis of data and better understanding of mechanisms of arrhythmia in individual patients.
REFERENCES
1.
J. A.
Gomes
, Heart Rhythm Disorders: History, Mechanisms, and Management Perspectives
(Springer Nature
, 2020
).2.
M. N.
Kotler
, B.
Tabatznik
, M. M.
Mower
, and S.
Tominaga
, “Prognostic significance of ventricular ectopic beats with respect to sudden death in the late postinfarction period
,” Circulation
47
, 959
–966
(1973
). 3.
D. S.
Echt
, P. R.
Liebson
, L. B.
Mitchell
, R. W.
Peters
, D.
Obias-Manno
, A. H.
Barker
, D.
Arensberg
, A.
Baker
, L.
Friedman
, H. L.
Greene
et al., “Mortality and morbidity in patients receiving encainide, flecainide, or placebo: The cardiac arrhythmia suppression trial
,” N. Engl. J. Med.
324
, 781
–788
(1991
). 4.
J. W.
Dukes
, T. A.
Dewland
, E.
Vittinghoff
, M. C.
Mandyam
, S. R.
Heckbert
, D. S.
Siscovick
, P. K.
Stein
, B. M.
Psaty
, N.
Sotoodehnia
, J. S.
Gottdiener
et al., “Ventricular ectopy as a predictor of heart failure and death
,” J. Am. Coll. Cardiol.
66
, 101
–109
(2015
). 5.
M.
Haïssaguerre
, M.
Shoda
, P.
Jaïs
, A.
Nogami
, D. C.
Shah
, J.
Kautzner
, T.
Arentz
, D.
Kalushe
, D.
Lamaison
, M.
Griffith
et al., “Mapping and ablation of idiopathic ventricular fibrillation
,” Circulation
106
, 962
–967
(2002
). 6.
R.
Latchamsetty
and F.
Bogun
, “Premature ventricular complexes and premature ventricular complex induced cardiomyopathy
,” Curr. Probl. Cardiol.
40
, 379
–422
(2015
). 7.
L.
Schamroth
and H. J.
Marriot
, “Concealed ventricular extrasystoles
,” Circulation
27
, 1043
–1049
(1963
). 8.
M.
Levy
, D.
Adler
, and J.
Levy
, “Three variants of concealed bigeminy
,” Circulation
51
, 646
–655
(1975
). 9.
M. N.
Levy
, I.
Mori
, and N.
Kerin
, “Two variants of concealed trigeminy
,” Am. Heart J.
93
, 183
–188
(1977
). 10.
G.
Moe
, J.
Jalife
, W.
Mueller
, and B.
Moe
, “A mathematical model of parasystole and its application to clinical arrhythmias
,” Circulation
56
, 968
–979
(1977
). 11.
S.
Kinoshita
, “Mechanisms of ventricular parasystole
,” Circulation
58
, 715
–722
(1978
). 12.
N.
Ikeda
, S.
Yoshizawa
, and T.
Sato
, “Difference equation model of ventricular parasystole as an interaction between cardiac pacemakers based on the phase response curve
,” J. Theor. Biol.
103
, 439
–465
(1983
). 13.
L.
Glass
, A.
Goldberger
, and J.
Belair
, “Dynamics of pure parasystole
,” Am. J. Physiol. Heart Circ. Physiol.
251
, H841
–H847
(1986
). 14.
M.
Courtemanche
, L.
Glass
, M. D.
Rosengarten
, and A.
Goldberger
, “Beyond pure parasystole: Promises and problems in modeling complex arrhythmias
,” Am. J. Physiol. Heart Circ. Physiol.
257
, H693
–H706
(1989
). 15.
V.
Schulte-Frohlinde
, Y.
Ashkenazy
, P. C.
Ivanov
, L.
Glass
, A. L.
Goldberger
, and H. E.
Stanley
, “Noise effects on the complex patterns of abnormal heartbeats
,” Phys. Rev. Lett.
87
, 068104
(2001
). 16.
V.
Schulte-Frohlinde
, Y.
Ashkenazy
, A. L.
Goldberger
, P. C.
Ivanov
, M.
Costa
, A.
Morley-Davies
, H. E.
Stanley
, and L.
Glass
, “Complex patterns of abnormal heartbeats
,” Phys. Rev. E
66
, 031901
(2002
). 17.
D.
Hamon
, M. A.
Swid
, P. S.
Rajendran
, A.
Liu
, N. G.
Boyle
, K.
Shivkumar
, and J. S.
Bradfield
, “Premature ventricular contraction diurnal profiles predict distinct clinical characteristics and beta-blocker responses
,” J. Cardiovasc. Electrophysiol.
30
, 836
–843
(2019
). 18.
G. G.
Berntson
, J.
Thomas Bigger, Jr.
, D. L.
Eckberg
, P.
Grossman
, P. G.
Kaufmann
, M.
Malik
, H. N.
Nagaraja
, S. W.
Porges
, J. P.
Saul
, P. H.
Stone
et al., “Heart rate variability: Origins, methods, and interpretive caveats
,” Psychophysiology
34
, 623
–648
(1997
). 19.
F.
Shaffer
and J.
Ginsberg
, “An overview of heart rate variability metrics and norms
,” Front. Public Health
5
, 258
(2017
). 20.
R.
Winkle
, “The relationship between ventricular ectopic beat frequency and heart rate
,” Circulation
66
, 439
–446
(1982
). 21.
A. M.
Gillis
, C.
Guilleminault
, M.
Partinen
, S. J.
Connolly
, and R. A.
Winkle
, “The diurnal variability of ventricular premature depolarizations: Influence of heart rate, sleep, and wakefulness
,” Sleep
12
, 391
–399
(1989
).22.
S.
Tsumabuki
, M.
Ito
, M.
Arita
, T.
Saikawa
, and S.
Ito
, “Day-to-day variation of the frequency of ventricular premature contractions depends on variation of heart rates
,” Jpn. Circ. J.
52
, 1231
–1239
(1988
). 23.
T.
Inoue
, K.
Koumatsu
, M.
Ito
, M.
Arita
, and T.
Saikawa
, “Heart rate-dependent alteration of the frequency and coupling interval of ventricular arrhythmias as measured by 24-hour ECG monitoring
,” Jpn. Circ. J.
55
, 942
–950
(1991
). 24.
M.
Ito
, Y.
Maeda
, M.
Arita
, S.
Ito
, T.
Saikawa
, I.
Omura
, T.
Fujino
, T.
Fukumoto
, Y.
Kikuchi
, K.
Yamada
et al., “Effects of oral diltiazem on ventricular premature contractions
,” J. Electrocardiol.
19
, 59
–66
(1986
). 25.
D.
Acanfora
, L.
De Caprio
, A.
Di Palma
, G.
Furgi
, F. M.
Ing
, M.-L.
Migaux
, and F.
Rengo
, “Relationship between ventricular ectopic beat frequency and heart rate: Study in patients with severe arrhythmias
,” Am. Heart J.
125
, 1022
–1029
(1993
). 26.
M. V.
Pitzalis
, F.
Mastropasqua
, F.
Massari
, P.
Totaro
, M.
Di Maggio
, and P.
Rizzon
, “Holter-guided identification of premature ventricular contractions susceptible to suppression by -blockers
,” Am. Heart J.
131
, 508
–515
(1996
). 27.
M. V.
Pitzalis
, F.
Mastropasqua
, F.
Massari
, A.
Passantino
, C.
Forleo
, G.
Luzzi
, P.
Totaro
, M.
De Nicolò
, P.
Rizzon
et al., “Dependency of premature ventricular contractions on heart rate
,” Am. Heart J.
133
, 153
–161
(1997
). 28.
D.
Hamon
, G.
Abehsira
, K.
Gu
, A.
Liu
, M. B.-F.
Sadron
, S.
Billet
, T.
Kambur
, M. A.
Swid
, N. G.
Boyle
, G.
Dandamudi
et al., “Circadian variability patterns predict and guide premature ventricular contraction ablation procedural inducibility and outcomes
,” Heart Rhythm
15
, 99
–106
(2018
). 29.
D.
Acanfora
, G. D.
Pinna
, M.
Gheorghiade
, L.
Trojano
, G.
Furgi
, R.
Maestri
, C.
Picone
, G. L.
Iannuzzi
, F.
Marciano
, and F.
Rengo
, Effect of beta-blockade on the premature ventricular beats/heart rate relation and heart rate variability in patients with coronary heart disease and severe ventricular arrhythmias
,” Am. J. Ther.
7
, 229
–236
(2000
). 30.
A. H.
Mullis
, K.
Ayoub
, J.
Shah
, M.
Butt
, J.
Suffredini
, M.
Czarapata
, B.
Delisle
, G. O.
Ogunbayo
, Y.
Darrat
, and C. S.
Elayi
, “Fluctuations in premature ventricular contraction burden can affect medical assessment and management
,” Heart Rhythm
16
, 1570
–1574
(2019
). 31.
G.
Nilsson
, S.
Bandh
, T.
Ahren
, K.
Carlson
, T.
Jonasson
, and I.
Ringqvist
, “Distribution patterns of ventricular premature complexes at different heart rates
,” Am. J. Cardiol.
59
, 857
–861
(1987
). 32.
C.
Antzelevitch
, M. J.
Bernstein
, H. N.
Feldman
, and G. K.
Moe
, “Parasystole, reentry, and tachycardia: A canine preparation of cardiac arrhythmias occurring across inexcitable segments of tissue
,” Circulation
68
, 1101
–1115
(1983
). 33.
C.
Lerma
, T.
Krogh-Madsen
, M.
Guevara
, and L.
Glass
, “Stochastic aspects of cardiac arrhythmias
,” J. Stat. Phys.
128
, 347
–374
(2007
). 34.
J. S.
Bradfield
, M.
Homsi
, K.
Shivkumar
, and J. M.
Miller
, “Coupling interval variability differentiates ventricular ectopic complexes arising in the aortic sinus of valsalva and great cardiac vein from other sources: Mechanistic and arrhythmic risk implications
,” J. Am. Coll. Cardiol.
63
, 2151
–2158
(2014
). 35.
I.
Nault
, P.
André
, B.
Plourde
, F.
Leclerc
, J.-F.
Sarrazin
, F.
Philippon
, G.
O’Hara
, F.
Molin
, C.
Steinberg
, K.
Roy
et al., “Validation of a novel single lead ambulatory ECG monitor—Cardiostat—compared to a standard ECG Holter monitoring
,” J. Electrocardiol.
53
, 57
–63
(2019
). 36.
J.
Jalife
and G. K.
Moe
, “Effect of electrotonic potentials on pacemaker activity of canine Purkinje fibers in relation to parasystole
,” Circ. Res.
39
, 801
–808
(1976
). 37.
A. D.
Kistin
and M.
Landowne
, “Retrograde conduction from premature ventricular contractions, a common occurrence in the human heart
,” Circulation
3
, 738
–751
(1951
). 38.
E.
Prystowsky
, W.
Jackman
, R.
Rinkenberger
, J.
Heger
, and D.
Zipes
, “Effect of autonomic blockade on ventricular refractoriness and atrioventricular nodal conduction in humans. Evidence supporting a direct cholinergic action on ventricular muscle refractoriness
,” Circ. Res.
49
, 511
–518
(1981
). 39.
D. M.
Roden
and J. C.
Denny
, “Integrating electronic health record genotype and phenotype datasets to transform patient care
,” Clin. Pharmacol. Ther.
99
, 298
–305
(2016
). © 2020 Author(s).
2020
Author(s)
You do not currently have access to this content.