Medical-Grade ECG Sensor for Long-Term Monitoring.

The recent trend in electrocardiogram (ECG) device development is towards wireless body sensors applied for patient monitoring. The ultimate goal is to develop a multi-functional body sensor that will provide synchronized vital bio-signs of the monitored user. In this paper, we present an ECG sensor for long-term monitoring, which measures the surface potential difference between proximal electrodes near the heart, called differential ECG lead or differential lead, in short. The sensor has been certified as a class IIa medical device and is available on the market under the trademark Savvy ECG. An improvement from the user's perspective-immediate access to the measured data-is also implemented into the design. With appropriate placement of the device on the chest, a very clear distinction of all electrocardiographic waves can be achieved, allowing for ECG recording of high quality, sufficient for medical analysis. Experimental results that elucidate the measurements from a differential lead regarding sensors' position, the impact of artifacts, and potential diagnostic value, are shown. We demonstrate the sensors' potential by presenting results from its various areas of application: medicine, sports, veterinary, and some new fields of investigation, like hearth rate variability biofeedback assessment and biometric authentication.

Simple cardiovagal and adrenergic function tests in carotid artery stenosis patients as a potential tool for determining a transient autonomic dysfunction.

PURPOSE: The arterial baroreflex depends on the integrity of the afferent limb, which can be quantified using the baroreceptor's sensitivity (BRS) during the Valsalva maneuver (VM). The aim of this study was to evaluate, using autonomic nervous system tests, the autonomic function in patients after a carotid artery angioplasty (CAS). METHODS: We evaluated the changes in blood pressure (BP) during the VM (Valsalva ratio, BRS, sympathetic indexes) in 41 patients with symptomatic, unilateral, internal carotid artery stenosis. RESULTS: The Valsalva ratio between the baseline and the post-procedural day (1.3 ± 0.1 vs 1.44 ± 0.3; P = 0.002) and the post-procedural day and a month later (1.44 ± 0.3 vs 1.3 ± 0.3; P = 0.0002) revealed significant differences. This was confirmed with a cardiovagal BRS test. However, the adrenergic BRS did not reveal any differences. Sympathetic indexes [BP fall (SI1) and recovery during phase 2 (SI2)] showed differences for the periods before and a day after the treatment (36.9 ± 18.0 vs 27.2 ± 21.4 and 7.1 ± 13.1 vs 3.0 ± 8.2, respectively; P = 0.004) and for SI1 a day and a month after the treatment (27.2 ± 21.4 vs 37.1 ± 21.8; P = 0.036). The dynamic ranges between S1 and S3 (the difference in the BP between the baseline and the end of phase 2) were also different (P = 0.007 and P = 0.044, respectively). CONCLUSION: We found heterogeneous responses in the BP regulation obtained with the Valsalva maneuver in our patients; however, we could not confirm that CAS provoked any long-term autonomic dysfunction, except for 1 day after the procedure.

Knee temperatures measured in vivo after arthroscopic ACL reconstruction followed by cryotherapy with gel-packs or computer controlled heat extraction.

PURPOSE: To obtain in vivo data about intra- and extra-articular knee temperatures to assess the effectiveness of two cryotherapeutic methods-conventional cooling with gel-packs and computer controlled cryotherapy following anterior cruciate ligament (ACL) reconstructive surgery. METHODS: Twenty patients were arbitrarily assigned for cryotherapy after ACL reconstruction: 8 patients with frozen gel-packs and 12 patients with computer controlled cryotherapy with constant temperatures of the cooling liquid in the knee pads. The treatment was performed for 12 h. Temperatures were measured with two thermo sensors in catheters placed intraarticularly and subcutaneously, four sensors on the skin and one sensor under protective bandage, every second for 16 h after surgery. RESULTS: In the first 2 h of treatment, there were no significant differences (n.s.) between the groups in temperatures in the intracondylar notch. After 4 h of cryotherapy, the temperatures were significantly lower on the skin (24.6 ± 2.8 and 31.4 ± 1.3 °C, p < 0.01) and in the subcutaneous tissue (28.6 ± 5.7 and 34.6 ± 1.4 °C, p = 0.01), and the difference between the temperature in the intracondylar notch and the subcutaneous tissue was significantly greater (4.0 ± 3.0 and 0.8 ± 0.6 °C, p = 0.01) in the computer controlled cryotherapy group compared to the gel-pack group. CONCLUSIONS: The cooling effect of the arthroscopy irrigation fluid on the knee temperature is evident in the first 2 h of treatment. The energy extraction is significantly more effective and controllable by computer controlled cryotherapy than with frozen gel-packs. LEVEL OF EVIDENCE: Prospective comparative study, Level II.

Exact parallel maximum clique algorithm for general and protein graphs.

A new exact parallel maximum clique algorithm MaxCliquePara, which finds the maximum clique (the fully connected subgraph) in undirected general and protein graphs, is presented. First, a new branch and bound algorithm for finding a maximum clique on a single computer core, which builds on ideas presented in two published state of the art sequential algorithms is implemented. The new sequential MaxCliqueSeq algorithm is faster than the reference algorithms on both DIMACS benchmark graphs as well as on protein-derived product graphs used for protein structural comparisons. Next, the MaxCliqueSeq algorithm is parallelized by splitting the branch-and-bound search tree to multiple cores, resulting in MaxCliquePara algorithm. The ability to exploit all cores efficiently makes the new parallel MaxCliquePara algorithm markedly superior to other tested algorithms. On a 12-core computer, the parallelization provides up to 2 orders of magnitude faster execution on the large DIMACS benchmark graphs and up to an order of magnitude faster execution on protein product graphs. The algorithms are freely accessible on http://commsys.ijs.si/~matjaz/maxclique.

Asynchronous master-slave parallelization of differential evolution for multi-objective optimization.

In this paper, we present AMS-DEMO, an asynchronous master-slave implementation of DEMO, an evolutionary algorithm for multi-objective optimization. AMS-DEMO was designed for solving time-intensive problems efficiently on both homogeneous and heterogeneous parallel computer architectures. The algorithm is used as a test case for the asynchronous master-slave parallelization of multi-objective optimization that has not yet been thoroughly investigated. Selection lag is identified as the key property of the parallelization method, which explains how its behavior depends on the type of computer architecture and the number of processors. It is arrived at analytically and from the empirical results. AMS-DEMO is tested on a benchmark problem and a time-intensive industrial optimization problem, on homogeneous and heterogeneous parallel setups, providing performance results for the algorithm and an insight into the parallelization method. A comparison is also performed between AMS-DEMO and generational master-slave DEMO to demonstrate how the asynchronous parallelization method enhances the algorithm and what benefits it brings compared to the synchronous method.

Hemodynamic responses to low-level transcutaneous auricular nerve stimulation in young volunteers.

Objectives: The aim of this study was to characterize cardiovascular autonomic responses during two constant current intensities below sensory threshold of transcutaneous auricular nerve stimulation (taNS). On this basis, a protocol for taNS with autonomic modulatory potential could be proposed. Subjects and methods: We included 26 men and 24 women, mean age 26. Data were collected during three randomly allocated 20-minute right tragus stimulation sessions - a) no-stimulation (sham), b) 90 µA (arbitrary), and c) 130 µA (near the lowest sensory threshold in majority). Stimulation was 20 Hz, rectangular pulse width of 2 ms, duty cycle 2-second on/off. To assess autonomic responses, we continuously recorded ECG, non-invasive arterial blood pressure (BP) and thoracic impedance cardiography data. Ten-minute data were compared. Fast Fourier transform of RR intervals was performed on 10-minute recordings as well. Low frequency and high frequency power spectra were calculated. Friedman test or one-way ANOVA for repeated measurements and Mann-Whitney or Wilcoxon's signed-rank test, or t-test were carried out. P < 0.05 was considered significant. Results: At 130 µA stimulation, cardiac output significantly decreased (p < 0.05), driven by significant heart rate drop in women, and stroke volume and contractility drop in men, pointing to a gender-related autonomic responses. We observed no significant changes in BP, or variability parameters. Significantly higher body size and BP were found in men, as expected. Conclusions: It seems that tested taNS protocol has a potential for cardiac autonomic modulation in majority of young healthy men as well as women. Further studies are however needed to prove the therapeutic potential of this stimulation protocol in different patient groups.

Parallel-ProBiS: fast parallel algorithm for local structural comparison of protein structures and binding sites.

The ProBiS algorithm performs a local structural comparison of the query protein surface against the nonredundant database of protein structures. It finds proteins that have binding sites in common with the query protein. Here, we present a new parallelized algorithm, Parallel-ProBiS, for detecting similar binding sites on clusters of computers. The obtained speedups of the parallel ProBiS scale almost ideally with the number of computing cores up to about 64 computing cores. Scaling is better for larger than for smaller query proteins. For a protein with almost 600 amino acids, the maximum speedup of 180 was achieved on two interconnected clusters with 248 computing cores. Source code of Parallel-ProBiS is available for download free for academic users at http://probis.cmm.ki.si/download.

Two proximal skin electrodes--a respiration rate body sensor.

We propose a new body sensor for extracting the respiration rate based on the amplitude changes in the body surface potential differences between two proximal body electrodes. The sensor could be designed as a plaster-like reusable unit that can be easily fixed onto the surface of the body. It could be equipped either with a sufficiently large memory for storing the measured data or with a low-power radio system that can transmit the measured data to a gateway for further processing. We explore the influence of the sensor’s position on the quality of the extracted results using multi-channel ECG measurements and considering all the pairs of two neighboring electrodes as potential respiration-rate sensors. The analysis of the clinical measurements, which also include reference thermistor-based respiration signals, shows that the proposed approach is a viable option for monitoring the respiration frequency and for a rough classification of breathing types. The obtained results were evaluated on a wireless prototype of a respiration body sensor. We indicate the best positions for the respiration body sensor and prove that a single sensor for body surface potential difference on proximal skin electrodes can be used for combined measurements of respiratory and cardiac activities.

Framework for Personalized Real-Time Control of Hidden Temperature Variables in Therapeutic Knee Cooling.

The paper formalizes, implements and evaluates a framework for personalized real-time control of inner knee temperature during cryotherapy after knee surgery. Studies have shown that the cryotherapy should be controlled depending on the individual patient's feedback on the cooling, which raises the need for smart personalized therapy. The framework is based on the feedback control loop that uses predicted instead of measured inner temperatures because measurements are not feasible or would introduce invasiveness into the system. It uses machine learning to construct a predictive model for estimation of the controlled inner temperature variable based on other variables whose measurement is more feasible - temperatures on the body surface. The machine learning method uses data generated from computer simulation of the therapeutic treatment for different input simulation parameters. A fuzzy proportional-derivative controller is designed to provide adequate near real-time control of the inner knee temperature by controlling the cooling temperature. The framework is evaluated for robustness and controllability. The results show that controlled cooling is essential for small-sized (and large-sized) knees that are significantly more (less) sensitive to the cooling compared to average-sized knees. Moreover, the framework recognizes dynamic physiological changes and potential changes in the system settings, such as extreme changes in the blood flow or changed target inner knee temperature, and consequently adapts the cooling temperature to reach the target value.

Cardiovascular responses to low-level transcutaneous vagus nerve stimulation.

AIMS: The aim was to determine cardiovascular responses to an arbitrary protocol of transcutaneous low-level vagus nerve electrical stimulation (tVNS). METHODS: Study was performed in 15 male volunteers, mean age 23 years. Data were collected during two sessions - sham stimulation (no stimulation) and stimulation. Each session included one-hour resting phase followed by 15-min autonomic nervous system testing phase (Valsalva, deep breathing, wet-cold face tests), all in supine position. The right tragus stimulation parameters were: 20 Hz, constant current at sensation threshold, 1 ms rectangular pulse width. The ECG, noninvasive arterial blood pressure and thoracic impedance cardiography measurements were recorded and analyzed continuously with the Task Force® Monitor (CNSystems Medizintechnik GmbH, Graz, Ver. 2.2.10.0). t-Test for paired samples, paired Wilcoxon signed-rank, and one-way ANOVA for repeated measurements were carried out. P < 0.05 was considered significant. RESULTS: We demonstrated significant reductions of left ventricular contractility and output parameters, a trend for heart rate reduction, and resulting beneficial reduction of left ventricular work load. However, significant increases of blood pressure and total peripheral resistance were recognized, possibly as a reflex response. CONCLUSION: It seems that our tVNS protocol has a potential for cardiac autonomic modulation. This gives us opportunity to advance our stimulation parameters with participant-specific adjustments. Further studies are however needed to prove the therapeutic potential of such approach in different patient groups.

A model for potential non-contact ski injuries of the knee.

Broadly accepted is that most knee injuries result from increased vertical forces, usually induced by an incidental ski fall, collision, or a high jump. We present a new non-contact knee injury mechanism that can happen during a ski turn. Such an injury is governed by a sudden inward turn of the inner ski and consequent swing of the inner leg followed by a nearly instant stop when locked by hip and knee joints. The model provides predictive results for a lateral tibial plateau compression fracture because several simplifications have been made. We confirmed that the modelled compression stresses at typical skiing conditions and with typical skiing equipment can provoke serious knee injuries. The awareness of skiers and skiing equipment industry of the described knee injury mechanism can act as an important injury-prevention factor.

Cardiac autonomic regulation and PR interval determination for enhanced atrial fibrillation risk prediction after cardiac surgery.

BACKGROUND: Changes in cardiac autonomic regulation and P-wave characteristics are associated with the occurrence of atrial fibrillation. The purpose of this study was to evaluate whether combined preoperative non-invasive determination of cardiac autonomic regulation and PR interval allows for the identification of patients at risk of new-onset atrial fibrillation after cardiac surgery. METHODS: RR, PR and QT intervals, and linear and non-linear heart rate variability parameters from 20 min high-resolution electrocardiographic recordings were determined one day before surgery in 150 patients on chronic beta blockers undergoing elective coronary artery bypass grafting, aortic valve replacement, or both, electively. RESULTS: Thirty-one patients (21%) developed postoperative atrial fibrillation. In the atrial fibrillation group, more arterial hypertension, a greater age, a higher EuroSCORE II, a higher heart rate variability index (pNN50: 9 ±â€¯20 vs. 4 ±â€¯10, p = 0.050), a short PR interval (156 ±â€¯23 vs. 173 ±â€¯31 ms; p = 0.011), and a reduced short-term scaling exponent of the detrended fluctuation analysis (DFA1, 0.96 ±â€¯0.36 vs. 1.11 ±â€¯0.30 ms; p = 0.032) were found compared to the sinus rhythm group. Logistic regression modeling confirmed PR interval, DFA1 and age as the strongest preoperative predictors of postoperative atrial fibrillation (area under the receiver operating characteristic curve = 0.804). CONCLUSIONS: Patients developing atrial fibrillation after cardiac surgery presented with severe cardiac autonomic derangement and a short PR interval preoperatively. The observed state characterizes both altered heart rate regulation and arrhythmic substrate and is strongly related to an increased risk of postoperative atrial fibrillation.

Computer-simulated alternative modes of U-wave genesis.

OBJECTIVE: Several hypotheses for the origin of the U wave in electrocardiograms have been proposed. We have set out to explore and test alternative modes for U-wave genesis via computer simulations. METHODS AND RESULTS: A spatial model of a left ventricle has been constructed from 12 layers composed of cubic cells. Each cell is assigned its own time-dependent action potential with its own contribution to the electrical potential at arbitrary points where ECGs are measured. Simulated ECGs show that U waves can be generated using various combinations of action potentials (APs) across the different layers of the ventricular wall. We demonstrate a new mode of U-wave genesis, even with small differences in the repolarization. CONCLUSION: The U wave can be generated in the presence of strong intercellular coupling. Myocardial layers with prolonged action potentials, like M cells, are not necessarily needed for U-wave genesis.

Ventricular repolarization dynamicity and arrhythmic disturbances after beating-heart and arrested-heart revascularization.

BACKGROUND: Arrhythmias attributable to altered autonomic modulation of the heart, with elevated sympathetic and depressed vagal modulation, occur to a similar extent after surgery performed on beating or arrested hearts. Coronary artery bypass grafting (CABG) with cardiopulmonary bypass has been associated with more frequent occurrence of arrhythmic events than surgery performed without CABG, even with comparable levels of postoperative cardiac autonomic (dis) regulation after arrested- and beating-heart revascularization. We explored the effects of arrested- and beating-heart revascularization procedures on the dynamics of ventricular repolarization and on increased postoperative arrhythmic events. METHODS: Study participants included 57 CABG patients; 28 underwent on-pump and 29 underwent off-pump procedures. The 2 groups were comparable regarding clinical and postoperative characteristics. With high-quality 15-minute digital electrocardiograms, we assessed ventricular repolarization dynamics using RR and QT intervals and analyzed QT variability (QTV) and QT-RR interdependence. RR and QT intervals were determined from stationary 5-minute segments. QT-interval variability was determined by a T-wave template-matching algorithm. We used linear regression to compute the slope/correlation of the QT/RR interval. The Fisher exact test, nonpaired t-test, and ANOVA were applied to test the results; P <.05 was considered significant. RESULTS: Postoperative arrhythmic events were significantly more frequent in both groups. One week postoperatively these events were significantly more frequent in the on-pump group. In both groups, the RR interval was shorter after CABG (P <.001). The QT variability index increased from -1.2 + or - 0.6 to -0.8 + or - 0.4 after off-pump CABG and from -1.3 + or - 0.5 to -0.5 + or - 0.6 on day 4 after surgery (P <.05), further deteriorating to -0.2 + or - 0.6 one week after CABG in the on-pump group only (P <.05). QT-RR correlations decreased from 0.39 to 0.24 in the off-pump vs 0.34 to 0.17 in the on-pump group (P <.05), and in both groups they remained significantly reduced for as long as 4 weeks after CABG. CONCLUSIONS: For both on- and off-pump CABG, beat-to-beat heart-rate changes and rate-dependent ventricular repolarization adaptation showed disparities that worsened after surgery. The observed repolarization lability after CABG procedures seems to be transient but more pronounced after on-pump CABG. The association of arrhythmic events with ventricular repolarization lability changes in the setting of faster heart rates offers novel insights into the mechanisms of perioperative proarrhythmia after beating- and arrested-heart revascularization.

Computer simulation of topical knee cooling.

Local topical cooling with gel-packs or cryo-cuffs is often used after surgery or after knee injuries. Mostly beneficial, but some deleterious effects have been reported in literature. The spatial distribution of heat/cold through different tissues of the knee in time may be responsible for different effects of cooling on the traumatized or inflamed tissue and have yet to be studied. Parallel computer simulation was used to study, non-invasively, temperature changes in the knee during cooling. A 3-D computer model of the knee, with a spatial resolution of 1mm, was derived from cross sections available in the visible human dataset. Heat transfer in a non-homogenous knee tissue was modeled with a diffusion equation, which was solved by the explicit finite difference method. The heat transfer between blood and tissue and tissue metabolism have also been modeled and simulated. Two different simulations were performed: cooling with a liquid at constant temperature (cryo-cuff) and topical cooling with frozen gel-packs. The simulated results were analyzed and compared with relevant measurements.

Continuous remote monitoring of COPD patients-justification and explanation of the requirements and a survey of the available technologies.

Remote patient monitoring should reduce mortality rates, improve care, and reduce costs. We present an overview of the available technologies for the remote monitoring of chronic obstructive pulmonary disease (COPD) patients, together with the most important medical information regarding COPD in a language that is adapted for engineers. Our aim is to bridge the gap between the technical and medical worlds and to facilitate and motivate future research in the field. We also present a justification, motivation, and explanation of how to monitor the most important parameters for COPD patients, together with pointers for the challenges that remain. Additionally, we propose and justify the importance of electrocardiograms (ECGs) and the arterial carbon dioxide partial pressure (PaCO2) as two crucial physiological parameters that have not been used so far to any great extent in the monitoring of COPD patients. We cover four possibilities for the remote monitoring of COPD patients: continuous monitoring during normal daily activities for the prediction and early detection of exacerbations and life-threatening events, monitoring during the home treatment of mild exacerbations, monitoring oxygen therapy applications, and monitoring exercise. We also present and discuss the current approaches to decision support at remote locations and list the normal and pathological values/ranges for all the relevant physiological parameters. The paper concludes with our insights into the future developments and remaining challenges for improvements to continuous remote monitoring systems. Graphical abstract ᅟ.

Effects of beating- versus arrested-heart revascularization on cardiac autonomic regulation and arrhythmias.

BACKGROUND: Altered autonomic regulation after cardiac operations precipitates cardiac arrhythmias, affects repolarization, and increases the risk of sudden cardiac death. We sought to clarify how the 2 different techniques of coronary artery bypass grafting (CABG), namely conventional CABG using cardiopulmonary bypass (on-pump) and beating-heart CABG without cardiopulmonary bypass (off-pump), affect cardiac autonomic regulation and arrhythmic disturbances postoperatively. METHODS: We included 57 consecutive patients, 28 in the on-pump group and 29 in the off-pump group. The electro-cardiographic recordings were performed on the preoperative day and the fourth, seventh, and twenty-eighth day after operation. Fifteen-minute digital recordings were taken; one channel was used to record electrocardiogram and the other breathing. Detailed analyses of arrhythmia, heart rate, and heart rate variability indices were performed on respective days to assess sympathetic and parasympathetic modulation of the heart and relate it to detected arrhythmic disturbances. RESULTS: Total power, low-frequency power, which indicates baroreceptor-mediated sympathetic modulation, and high-frequency power, indicating parasympathetic vagal modulation, declined significantly in both groups after CABG (P < .001); however, 7 days after CABG, total and high-frequency power were better preserved in the off-pump group. Mean RR interval was longer in the off-pump group at 7 (P= .006) and 28 days (P= .008) after surgery. The total incidence of arrhythmic events was higher in the on-pump group on the seventh day (P = .017, adjusted odds ratio = 8.6, 95% confidence interval 1.4-80.3). CONCLUSIONS: The results show profound impairment of cardiac autonomic regulation after CABG, showing better preserved cardiac autonomic modulation 7 days after beating-heart revascularization. Evidence suggests that slower restoration of heart rate and increased incidence of arrhythmic events after CABG using cardiopulmonary bypass are the result not only of impaired cardiac autonomic regulation but also of the involvement of additional factors of nonautonomic origin.

3D heart model for computer simulations in cardiac surgery.

For a satisfactory computer simulation, a model, which imitates a natural situation, is needed. The Human heart is an irregular 3D object and thus difficult to reproduce. Basic data was taken from Visible Human Dataset (VHD), National Library of Medicine. The heart area was cut out of the original cross-sections and different tissues segmented. All the slices also had to be aligned to assure precise overlapping of the structures. A 3D computer heart model with the resolution of 1mm was designed. The heart model was dedicated to simulations of heat transfer during heart surgery however, it is applicable also to other medical simulations.

Position-dependent changes in vagal modulation after coronary artery bypass grafting.

Reduced cardiac vagal modulation increases propensity to arrhythmias. Right decubitus position is a vagal enhancer in coronary and congestive heart disease. We evaluated vagal modulation before and after coronary artery bypass grafting (CABG) in 30 patients. Heart rate variability (HRV) indexes in frequency domain were calculated from 10-min digital electrocardiograms. Kolmogorov-Smirnov and paired t-tests were applied, p<0.05 was considered significant. The HRV indexes decreased after CABG. Higher LF/HF ratio and shorter mean RR were observed in right recumbent position postoperatively. Right lateral decubitus position did not give rise to higher vagal modulation after heart surgery.

Assessment of cardiac autonomic regulation and ventricular repolarization after off-pump coronary artery bypass grafting.

BACKGROUND: Altered autonomic regulation precipitates cardiac arrhythmias and increases the risk of sudden cardiac death. This risk is further increased by changes in ventricular repolarization. Autonomic regulation is deranged in patients after myocardial on-pump revascularization. We aimed to clarify how off-pump coronary artery bypass grafting (CABG) affects postoperative cardiac autonomic regulation and ventricular repolarization within 4 weeks after CABG. METHODS: Forty-two patients (mean age, 61.9 +/- 9.3 years; mean EURO score 2.6 +/- 1.9) were electively admitted for off-pump CABG. The electrocardiographic and respiratory waveform recordings were performed in the afternoon in the supine position for 10 minutes. Autonomic modulation was assessed using heart rate variability analysis. Power spectra were computed from 5-minute stable RR intervals using Fourier Transform analysis. Total power of spectra was defined in the range of 0.01 to 0.40 Hz, high-frequency power within 0.15 to 0.40 Hz, and low-frequency power within 0.04 to 0.15 Hz. Normalized power was defined as a ratio of power in each band/total power. The high- and low-frequency power as well as their normalized values indicated cardiac vagal and sympathetic modulation, respectively. Ventricular repolarization was assessed using QT interval, QT interval variability, and QT-RR interdependence analysis. QT intervals were determined from the beginning of the 5-minute segments. QT interval variability was evaluated by a T-wave template-matching algorithm. Pearson correlation between length of RR and QT interval was applied to study QT-RR characteristics. The results were tested for significance using the Fisher exact test, nonpaired t test, and analysis of variance; a P <.05 was considered significant. RESULTS: The frequency of arrhythmic events and heart rate increased from the fourth to the seventh postoperative day and returned to preoperative levels 4 weeks after CABG. Heart rate variability measures indicating autonomic modulation remained depressed even 4 weeks after the procedure. QT variability index increased from -1.2 +/- 0.5 to -0.8 +/- 0.4 on the fourth day after the operation (P <.05) and returned to -1.0 +/- 0.5 4 weeks after CABG (P = not significant). QT-RR correlation decreased from 0.41 to 0.23 (P <.05) and remained significantly impaired as long as 4 weeks after CABG. CONCLUSIONS: Observed faster heart rates until 1 week after off-pump CABG imply excessive adrenergic activation, which is comparable to on-pump CABG procedure rates. The results indicate profound autonomic derangement and loss of rate-dependent regulation after off-pump CABG even 4 weeks after operation. Restituted repolarization as assessed by QT variability index 4 weeks postoperatively corresponded with decreased frequency of rhythm disturbances 4 weeks after CABG. The loss of coupling between QT and RR intervals shows increased electrical instability postoperatively, which may serve as an additional promoter for postoperative arrhythmias, especially at higher heart rates.