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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

Signals Header Unaudited
Annotations
Audited
Annotations
Signal
Duration
VF Onset
Time (elapsed)
View
Waveform
30.dat 30.hea 30.ari 30.atr 24:33:17 07:54:33 30-waveform
31.dat 31.hea 31.ari 31.atr 13:58:40 14:42:24 31-waveform
32.dat 32.hea 32.ari 32.atr 24:20:00 16:45:18 32-waveform
33.dat 33.hea 33.ari   24:33:00 04:46:19 33-waveform
34.dat 34.hea 34.ari 34.atr 07:05:20 06:35:44 34-waveform
35.dat 35.hea 35.ari 35.atr 24:52:00 24:34:56 35-waveform
36.dat 36.hea 36.ari 36.atr 20:21:20 18:59:01 36-waveform
37.dat 37.hea 37.ari   25:08:00 01:31:13 37-waveform
38.dat 38.hea 38.ari   18:18:25 08:01:54 38-waveform
39.dat 39.hea 39.ari   05:47:00 04:37:51 39-waveform
40.dat 40.hea 40.ari   24:53:00 (paced, no VF) 40-waveform
41.dat 41.hea 41.ari 41.atr 03:56:00 02:59:24 41-waveform
42.dat 42.hea 42.ari   25:08:10 (no VF) 42-waveform
43.dat 43.hea 43.ari   23:07:50 15:37:11 43-waveform
44.dat 44.hea 44.ari   23:20:00 19:38:45 44-waveform
45.dat 45.hea 45.ari 45.atr 24:09:20 18:09:17 45-waveform
46.dat 46.hea 46.ari 46.atr 04:15:10 03:41:47 46-waveform
47.dat 47.hea 47.ari   23:35:50 06:13:01 47-waveform
48.dat 48.hea 48.ari   24:36:15 02:29:40 48-waveform
49.dat 49.hea 49.ari 49.atr 25:01:40 (paced, no VF) 49-waveform
50.dat 50.hea 50.ari   23:07:38 11:45:43 50-waveform
51.dat 51.hea 51.ari 51.atr 25:08:30 22:58:23 51-waveform
52.dat 52.hea 52.ari 52.atr 07:31:05 02:32:40 52-waveform


Clinical information

Subject # Gender Age History Medication Underling Cardiac Rhythm
30 Male 43   None available   Unknown   Sinus
31 Female 72   Heart failure   digoxin; quinidine gluconate   Sinus
32 N/A 62   Coronary bypass grafting;
  History of arrhythmia
  Procan SR; beta-blocker   Sinus with intermittent
  demand verntricular pacing;
  CPR at time of cardiac arrest  
33 Female 30   None available   Unknown   Sinus
34 Male 34   None available   Unknown   Sinus
35 Female 72   Mitral valve replacement   digoxin   Atrial fibrillation (AF)
36 Male 75   Cardiac surgery   digoxin; quinidine   AF
37 Female 89   N/A   N/A   AF
38 N/A N/A   N/A   N/A   Sinus
39 Male 66   Acute myelogenous leukemia   digoxin; quinidine   Sinus
40 Male 79   N/A   N/A   Paced
41 Male N/A   None available   Unknown   Sinus
42 Male 17   Hypertrophic cardiomyopathy;
  Positive family history of
  sudden death
  Unknown   Sinus
43 Male 35   Coronary artery disease   Unknown   Intermittent ventricular
  pacing
44 Male N/A   None available   Unknown   Sinus
45 Male 68   History of ventricular ectopy   digoxin; quinidine gluconate   Sinus
46 Female N/A   None available   Unknown   Sinus
47 Male 34   None available   Unknown   Sinus
48 Male 80   N/A   N/A   Sinus
49 Male 73   Coronary artery s/p
  myocardial infarction;
  History of ventricular
  tachycardia
  Unknown   Sinus
50 Female 68   Coronary artery bypass graft;
  Mitral valve replacement
  digoxin; quinidine;
  propranolol;
  potassium; diuretics
  AF
51 Female 67   N/A   N/A   Sinus with intermittent
  pacing  
52 Female 82   Heart failure   None listed   Sinus