[The automatic, beat-to-beat determination of the QT interval and analysis of its spontaneous variability under basal conditions].

OBJECTIVES

An analysis is made of the automatic beat-by-beat measurement of QT and other intervals related to ventricular repolarization. The variability pattern of these intervals is investigated in normal subjects at rest, along with their relation to RR cycle variability.

MATERIAL AND METHODS

The electrocardiographic signals (LII) from 11 normal subjects (mean age 31 +/- 10 years) were recorded over 5 min and processed by applying specific algorithms to determine beat-by-beat the RR, QT, RT, QTm and RTm intervals (Tm = peak of T wave). An analysis was made of the variability of these intervals in the time (standard deviation, variation coefficient, difference between maximum and minimum values) and frequency domains (spectral analysis applying the Fourier transform).

RESULTS

The differences between the automatic measurements and those performed by two observers (n = 110) were respectively -1.3 +/- 6.4 and -3.7 +/- 6.5 ms for QT, - 1.0 +/- 1.4 and -1.0 +/- 2.3 ms for QTm, -0.3 +/- 1.4 and -0.2 +/- 1.8 ms for RTm, and 0.7 +/- 6.5 and -2.8 +/- 10.3 ms for RT. The QT and RT intervals exhibited greater variability (SD = 6 +/- 1 ms) than QTm and RTm (SD = 3 +/- 1 ms, p < 0.0001). These differences persisted on comparing the corresponding variation coefficients. The differences between the maximum and minimum measurements were 45 +/- 24 ms for QT and RT, the values being significantly less in the case of QTm (21 +/- 26 ms, p < 0.05) and RTm (20 +/- 27 ms, p < 0.05). In the frequency domain, the high- (HF) and low-frequency (LF) band energies were low in the series formed by the ventricular repolarization intervals, and the LF band normalized amplitude was significantly lower than in the RR series. There were no significant differences in the frequencies of the maximum values of the LF and HF bands of the RR series with respect to the QT series. The correlations between the RR intervals and the subsequent repolarization intervals obtained in each subject were not significant in 7 of the 11 subjects studied.

CONCLUSIONS

The automatic beat-by-beat determination of the ventricular repolarization intervals is precise, particularly when considering the intervals defined by the T wave peak. Repolarization variability during the sinus rhythm at rest is small, and is not linearly related to modifications of the previous RR interval. Neurovegetative and humoral influences are postulated to explain QT variations. The neurovegetative and humoral influences that regulate cardiac cycle and ventricular repolarization variability at rest, are found to be quantitatively different.