Author + information
- Received October 27, 2016
- Revision received April 25, 2017
- Accepted May 4, 2017
- Published online November 20, 2017.
- Christina Y. Miyake, MD, MSa,b,∗ (, )
- S. Yukiko Asaki, MDa,
- Gregory Webster, MDc,
- Richard J. Czosek, MDd,
- Joseph Atallah, MD, CM, SMd,
- Kishor Avasarala, MDe,f,
- Sri O. Rao, MDg,
- Patricia E. Thomas, MDh,
- Jeffrey J. Kim, MDa,
- Santiago O. Valdes, MDa,
- Caridad de la Uz, MDa,
- Yunfei Wang, PhDa,
- Xander H.T. Wehrens, MD, PhDc and
- Dominic Abrams, MDi,j
- aDepartment of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
- bDepartment of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, Texas
- cDepartment of Pediatrics, Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- dDepartment of Pediatrics, The Heart Center, Cincinnati Children’s Medical Center, Cincinnati, Ohio
- eDepartment of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
- fDepartment of Pediatrics, Children’s Hospital Oakland, Oakland, California
- gDepartment of Pediatrics, Alaska Children’s Heart Center, Anchorage, Alaska
- hDepartment of Pediatrics, Ochsner Medical Center for Children, New Orleans, Louisiana
- iDepartment of Cardiology, Children’s Hospital Boston, Boston, Massachusetts
- jDepartment of Pediatrics, Harvard Medical School, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Christina Y. Miyake, Department of Pediatrics, Texas Children’s Hospital, 6621 Fannin Street, MC 19345-C, Houston, Texas 77030.
Objectives The aim of this paper was to investigate whether ventricular arrhythmias in children with catecholaminergic polymorphic ventricular tachycardia (CPVT) show circadian patterns.
Background Circadian arrhythmic patterns have been established in long QT, Brugada, and early repolarization, but have not been investigated in CPVT.
Methods This is a multicenter, retrospective review of pediatric CPVT patients, age <21 years at diagnosis. Timing of ventricular tachycardia (VT ≥3 beats) was assessed during 24-h continuous monitoring (Holter, implantable loop recorder, implantable cardioverter defibrillator) and by eliminating sleep hours, in addition to sporadic exercise stress tests. Morning was defined as 6:00 am to 11:59 am, afternoon 12:00 pm to 5:59 pm, and evening 6:00 pm to 11:59 pm. Distribution of VT events was compared by time of day, day of week, age, and sex.
Results Eighty patients (53% male), 61% with an ICD, experienced 423 VT events during a median follow-up time of 6 years (interquartile range: 2 to 10 years). When compared to morning hours, VT was more likely to occur in the afternoon (odds ratio [OR]: 2.54; 95% confidence interval [CI]: 1.69 to 3.83) or evening hours (OR: 2.91; 95% CI: 1.82 to 4.67). The predominance of afternoon/evening events persisted regardless of age, gender, or day of the week. Among 50 patients who underwent exercise stress tests, VT was significantly more likely to occur in the afternoon (OR: 3.00; 95% CI: 1.39 to 6.48).
Conclusions In pediatric CPVT patients, ventricular arrhythmias are more likely to occur in the afternoon and evening hours. Because children’s activity levels peak in both the morning and afternoon, the lack of arrhythmias in the morning hours raises questions whether factors other than adrenergic stimulation influence arrhythmia induction in pediatric patients with CPVT.
Supported by PACES, Pediatric and Adult Congenital Electrophysiology Society Paul C. Gillette grant funding, NIH-NHLBI grants (R01-HL089598, R01-HL091947, R01-HL117641, R41-HL129570), NIH-LRP grant funding, the American Heart Association (13EIA14560061), and the Juanita P. Quigley endowed chair in cardiology.
Dr. Kim has received fellowship support from Medtronic Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Drs. Miyake and Asaki contributed equally to this this paper and are co-first authors.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received October 27, 2016.
- Revision received April 25, 2017.
- Accepted May 4, 2017.