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To the Editor:We read the article by Adamson et al with great interest.1 In a prospective manner, they have convincingly shown that (1) a measure of long-term heart rate variability (HRV), SDAAM, is a predictor of mortality and hospitalization in patients with congestive heart failure and (2) reductions in SDAAM precede clinical deterioration. Although we do not question the prognostic value of this measure, SDAAM is not simply a marker of the autonomic nervous system.The closest conventional HRV measure to SDAAM (the standard deviation of a 5-minute median atrial-atrial sensed interval) is SDANN (the standard deviation of a 5-minute mean normal RR interval).1 The spectral correlate of SDANN is the ultralow-frequency (ULF) power (<0.0033 Hz; the inverse of 5 minutes)2 and not the very-low-frequency band (VLF; 0.0033 to 0.04 Hz) suggested by the authors. Although VLF likely reflects both autonomic and neurohumoral influences, ULF and SDANN have not been shown to do so. Indeed, Bigger et al found these to be among …

circulation

Letter Regarding Article by Adamson et al, “Continuous Autonomic Assessment in Patients With Symptomatic Heart Failure: Prognostic Value of Heart Rate Variability Measured by an Implanted Cardiac Resynchronization Device”