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Ventricular ectopy during REM sleep: implications for nocturnal sudden cardiac death

Nature Clinical Practice Cardiovascular Medicine volume 4, pages 284–288 (2007)Cite this article

Abstract

Background A young adult female presented with syncope and periodic weakness. A 12-lead electrocardiogram showed frequent premature ventricular contractions and prolonged QU interval. Repetitive runs of nonsustained ventricular tachycardia were recorded at night.

Investigations Electromyography, muscle biopsy, MRI, echocardiography, exercise stress testing using Bruce protocol with microvolt T-wave alternans testing, 24 h Holter monitoring, electrophysiological testing and examination of the effects of sleep and sleep stage on the patient's ventricular arrhythmias.

Diagnosis Type 1 Andersen–Tawil syndrome, (also known as type 7 long QT syndrome). Severe ventricular arrhythmia was observed, predominantly during rapid eye movement sleep. We speculate that the autonomic instability present during rapid eye movement sleep precipitates increasing vulnerability to sleep-related ventricular tachycardia.

Management β-blocker therapy alone, subsequently combined with mexiletine treatment.

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Figure 1: A standard 12-lead electrocardiogram, characteristic of Andersen–Tawil syndrome
Figure 2: Polysomnograms from the patient
Figure 3: Twenty-four hour Holter monitoring demonstrating the patient's ventricular ectopy

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Acknowledgements

Dr Somers is supported by NIH grants HL-65176, HL-70302, HL-73211 and M01-RR00585, and Dr Ackerman's research program is supported by the Mayo Clinic Windland Smith Rice Comprehensive Sudden Cardiac Death Program, the Dr Scholl Foundation, the CJ Foundation for SIDS, the Hannah Wernke Memorial Foundation, the AHA (Established Investigator Award), and the NIH (HD42569).

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Authors and Affiliations

  1. VK Somers is Professor of Medicine in the Division of Cardiovascular Diseases and Director of the General Clinical Research Center Sleep and Cardiovascular Core Laboratories, A Garcia-Touchard, T Kara and A Shamsuzzaman are Assistant Professors of Medicine, J Nykodym is a Biomedical Engineer and a Research Collaborator, and MJ Ackerman is an Associate Professor of Medicine, Pediatrics and Molecular Pharmacology, and Director of the Long QT Syndrome Clinic and Mayo Clinic Windland Smith Rice Sudden Death Genomics Laboratory, at the Mayo Clinic College of Medicine, Rochester, MN, USA.,

    Arturo Garcia-Touchard, Virend K Somers, Tomas Kara, Jiri Nykodym, Abu Shamsuzzaman & Michael J Ackerman

  2. A Garcia-Touchard is also a Cardiology Consultant at Puerta de Hierro University Hospital, Madrid, Spain,

    Arturo Garcia-Touchard

  3. T Kara is also Director of the International Clinical Research Center, Brno, Czech Republic,

    Tomas Kara

  4. P Lanfranchi is an Assistant Professor of Medicine at Sacré-Coeur Hospital, University of Montreal, Montreal, QC, Canada.,

    Paola Lanfranchi

Authors
  1. Arturo Garcia-Touchard
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  2. Virend K Somers
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  3. Tomas Kara
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  4. Jiri Nykodym
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  5. Abu Shamsuzzaman
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  6. Paola Lanfranchi
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  7. Michael J Ackerman
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Corresponding author

Correspondence to Michael J Ackerman.

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The authors declare no competing financial interests.

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Garcia-Touchard, A., Somers, V., Kara, T. et al. Ventricular ectopy during REM sleep: implications for nocturnal sudden cardiac death. Nat Rev Cardiol 4, 284–288 (2007). https://doi.org/10.1038/ncpcardio0877

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