Barorefiex sensitivity and heart rate variability in the identification of patients at risk for life-threatening arrhythmias: Implications for clinical trials

M. T. La Rovere, G. D. Pinna, S. H. Hohnloser, F. I. Marcus, A. Mortara, R. Nohara, Jr Bigger J.T., A. J. Camm, P. J. Schwartz

Research output: Contribution to journalArticle

Abstract

Background - The need for accurate risk stratification is heightened by the expanding indications for the implantable cardioverter defibrillator. The Multicenter Automatic Defibrillator Implantation Trial (MADIT) focused interest on patients with both depressed left ventricular ejection fraction (LVEF) and the presence of nonsustained ventricular tachycardia (NSVT). Meanwhile, the prospective study Autonomic Tone and Reflexes After Myocardial Infarction (ATRAMI) demonstrated that markers of reduced vagal activity, such as depressed baroreflex sensitivity (BRS) and heart rate variability (HRV), are strong predictors of cardiac mortality after myocardial infarction. Methods and Results - We analyzed 1071 ATRAMI patients after myocardial infarction who had data on LVEF, 24-hour ECG recording, and BRS. During follow-up (21±8 months), 43 patients experienced cardiac death, 5 patients had episodes of sustained VT, and 30 patients experienced sudden death and/or sustained VT. NSVT, depressed BRS, or HRV were all significantly and independently associated with increased mortality. The combination of all 3 risk factors increased the risk of death by 22×. Among patients with LVEF

Original languageEnglish
Pages (from-to)2072-2077
Number of pages6
JournalCirculation
Volume103
Issue number16
Publication statusPublished - Apr 24 2001

Keywords

  • Arrhythmia
  • Autonomic
  • Baroreceptors
  • Heart rate
  • Myocardial infarction
  • Nervous system

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

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