Circadian variation of the QT interval and heart rate variability and their interrelationship

Abstract

Background: Whether the QT interval displays circadian rhythm after heart rate correction is unresolved and the relationship of QT interval to heart rate variability (HRV) is uncertain.

Objectives: To test the hypothesis that there is a circadian rhythm to QT interval and HRV and determine the relationship between QTc and HRV.

Methods: The hourly average ECG data from 24-h ECGs were examined in individuals (50 without medications and 9 on beta blockers only) with no evidence of coronary artery disease or structural heart disease. The QT duration of normal QRS complexes from a series of 30-s windows was measured. The presence of circadian rhythm was tested by the data analytic approach of goodness of fit to a cosine function.

Results: QT interval with and without heart rate correction showed a circadian rhythm for five heart rate adjustment formulae except for the Bazett formula. HRV also showed circadian rhythm but with different acrophages and nadirs depending on the HRV component. There were significant (p < 0.05) positive correlations of QTc with pNN50 rms-SD and SDNN and significant (p < 0.05) negative correlations with SDANN and Tri. The beta blocker group did not generally show circadian rhythm for QT interval or HRV.

Conclusion: QT, after heart rate adjustment, and HRV have circadian rhythmicity. There are significant correlations between QT interval and HRV indices. Circadian rhythm was blunted with beta blockers. The data are consistent with the concept of a predominance of parasympathetic activity to increase QTc and sympathetic activity to shorten QTc, even after 'correction' of the QT interval for heart rate.

Keywords: Circadian rhythm; Heart rate variability; QT interval.