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Effects of Depression on QT Interval Variability After Myocardial Infarction

From the Departments of Psychiatry (R.M.C., K.E.F.) and Medicine (P.K.S.), Washington University School of Medicine, St. Louis, Missouri; Department of Psychiatry (L.L.W.), Duke University, Durham, North Carolina; Department of Biostatistics (D.C.), University of North Carolina, Chapel Hill; Department of Medicine (A.S.J.), Mayo Clinic, Rochester, Minnesota; and Department of Psychiatry (V.K.Y.), Wayne State University School of Medicine.

Address reprint requests to: Robert M. Carney, PhD, Behavioral Medicine Center, 4625 Lindell Blvd., Suite 420, St. Louis, MO 63108. Email: carneyr{at}bmc.wustl.edu

OBJECTIVES: Clinical depression is a risk factor for cardiac mortality in patients with coronary heart disease. High QT interval variability is a risk factor for arrhythmic events, including sudden cardiac death. The purpose of this study was to determine whether depression is associated with increased QT variability in patients recovering from myocardial infarction.

METHODS: Twenty patients with major depression recovering from a recent myocardial infarction were matched with 20 nondepressed post–myocardial infarction patients on age and sex, and all underwent 24-hour Holter monitoring.

RESULTS: There were no differences between groups on average heart rate, heart rate variability, or other electrocardiographic measures. However, the QT interval showed significantly greater variability in the depressed than in the nondepressed group, especially at midnight and at 6:00 AM.

CONCLUSIONS: Depressed post–myocardial infarction patients may be at greater risk for sudden cardiac death as a result of abnormalities in ventricular repolarization. More work is needed to determine the clinical and prognostic significance of QT variability in these patients.

Key Words: psychiatric depression, • myocardial infarction, • QT interval.

Abbreviations: ANOVA = analysis of variance;; BDI = Beck Depression Inventory;; CHD = coronary heart disease;; DISH = Depression Interview and Structured Hamilton;; ECG = electrocardiographic;; ENRICHD = Enhancing Recovery in Coronary Heart Disease;; HR = heart rate;; HRm = mean heart rate;; HRv = detrended heart rate variance;; HRV = heart rate variability;; MI = myocardial infarction;; PVC = premature ventricular contraction;; QTm = mean QT interval;; QTv = detrended QT variance;; QTvi = heart rate–corrected QT variability index;; QTvm = QT variance corrected for mean QT.

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