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The Sudden Cardiac Death Holter Database

Introduction

An estimated 400,000 Americans and millions worldwide die suddenly each year. These events are most often initiated with a sustained ventricular tachyarrhythmia, including ventricular tachycardia (monomorphic or polymorphic), ventricular flutter, or ventricular fibrillation, with a smaller percentage related to a primary bradyarrhythmia. Sudden cardiac death syndrome may be due to a wide variety of different electrical and mechanical substrates, including acute myocardial infarction, chronic coronary disease with prior myocardial infarction(s), cardiomyopathies, myocarditis, valvular heart disease, right ventricular dysplasia, the long Q-T syndrome (acquired or congenital), Wolff- Parkinson-White pre-excitation, the Brugada syndrome, drug toxicity (e.g., proarrhythmic effects of cardioactive drugs; epinephrine, cocaine, and related stimulants), and so forth. Moreover, some individuals have no demonstrable electrical or mechanical predisposition.

Although understanding the basic mechanisms and identifying predictive features of life-threatening arrhythmias is a major public health priority, progress in this area has been impeded by the lack of relevant databases. Holter monitor records obtained during spontaneous episodes of sustained ventricular tachyarrhythmias or life-threatening bradyarrhythmias are relatively rare. Those tapes that do exist have sometimes been held in a "proprietary" fashion by investigators at different centers. Other investigators, while enthusiastic about sharing these invaluable datasets have, until now, not had a mechanism to bank their data. Since no single center is likely to accrue sufficient numbers of well-annotated recordings of this type to allow for more definitive evaluations, the ability to investigate the basis of spontaneous, life- threatening arrhythmias and to develop forecasting algorithms has been stymied.

PhysioNet is inaugurating a Sudden Cardiac Death (SCD) database to facilitate progress in this important area of electrophysiology by making available to the scientific community a collection of relevant recordings. We initiate this new component with 19 Holter records from the BIH/MIT collection, including 16 patients with underlying sinus rhythm and 3 with atrial fibrillation. All patients had a sustained ventricular tachyarrhythmia, and most an actual cardiac arrest.

These recordings were mainly obtained in the 1980s in Boston area hospitals, and were later compiled as part of a study of ventricular arrhythmias. Because of the retrospective nature of this collection, there are important limitations. Patient information is limited, and sometimes completely unavailable, including data regarding drug regimens and drug dosages. [George - what about mechanical issues re: tape quality, types of recordings, etc.??] Further, these cases may not be representative of spontaneous episodes of sudden death in what is likely a very heterogenous group of subjects. However, despite major shortcomings, these unique recordings may provide important clues to the pathogenesis of sudden death syndrome and serve as a nucleating point for other contributions from investigators worldwide who have access to similar records.

Preliminary analysis of data from some of these recordings has been described in the following publications:

1. Goldberger AL, Rigney DR, Mietus J, Antman EW, Greenwald S. Nonlinear dynamics in sudden cardiac death syndrome: heart rate oscillations and bifurcations. Experientia 1988; 44:983-987. (Analysis based on 16 subjects with underlying sinus rhythm.)
2. Courtemanche M, Glass L. Rosengarten MD, Goldberger AL. Beyond pure parasystole: promises and problems in modeling complex arrhythmias. Am J Physiol 1989; 257 (Heart Circ Physiol 26):H693-H706. (Case 2 in this report is based on data from subject 47 in the SCD database.)
3. Goldberger AL, Rigney DR. On the non-linear motions of the heart: fractals, chaos and cardiac dynamics. In: Goldbeter A, ed. Cell to Cell Signaling: From Experiments to Theoretical Models. San Diego: Academic Press, 1989, pp. 541-550. (Figure 4, showing complex periodic patterns of ventricular premature beats, is derived from data from subject ? in the SCD database.)

ECG data and beat annotations

Clinical information