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European Heart Journal 1996 17(6):917-925;
Copyright © 1996 by the European Society of Cardiology.
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© 1996 The European Society of Cardiology

Sleep suppression of ventricular arrhythmias: a predictor of beta-blocker efficacy

M. V. Pitzalis, F. Mastropasqua*, F. Massari*, P. Totaro*, D. Scrutinio* and P. Rizzon

Institute of Cardiology, University of Bari Bari Italy
*Division of Cardiology, "Salvatore Maugeri" Foundation, IRCCS, Cassano Murge Bari, Italy

Received 19 September 1995; accepted 25 October 1995.

Correspondence: Maria Vittoria Pitzalis, Institute of Cardiology—University of Bari, Policlinico, Piazza Giulio Cesare II, 70124 Bari, Italy

Abstract

It has been reported that the frequency of premature ventricular contractions in some patients tend to decrease during the hours of sleep when modifications in autonomic tone and bradycardia occur. The aim of this study was to evaluate whether the phenomenon of sleep suppression may be a sensitive and specific parameter for predicting the antiarrhythmic effect of beta-blockers on premature ventricular contractions. The presence of sleep suppression was evaluated in 45 patients (mean age 50±17 years) with frequent premature ventricular contractions at two baseline Holter recordings. Sleep suppression was defined as >50% reduction in the number of nighttime as opposed to day time premature ventricular contractions. Three groups of patients were identified: those with sleep suppression at both Holter recordings (group 1); those with sleep suppression at only one Holter recording (group 2); and those without sleep suppression at either Holter recording (group 3). A third Holter was performed 5 days after nadolol administration. In group 1, nadolol led to a mean reduction in the number of premature ventricular contractions of 90% (>70% in 21/23 patients). In group 2, the mean reduction was 76% (>70% in three out of six patients). In group 3, there was a mean increase in the number of premature ventricular contractions of 33%. The positive predictive accuracy of sleep suppression in relation to the antiarrhythmic efficacy of nadolol is very high (88%) when sleep suppression is present during two baseline Holter recordings. Sleep suppression is a sensitive parameter for identifying the premature ventricular contractions likely to benefit from beta-blocker administration.

Key Words: Premature ventricular contractions • heart rate • autonomic nervous system • beta-blockers • nadolol • sleep • sleep suppression • circadian variability


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