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Heart rate variability monitored by the implanted device predicts response to CRT and long‐term clinical outcome in patients with advanced heart failure
Author(s) -
Landolina Maurizio,
Gasparini Maurizio,
Lunati Maurizio,
Santini Massimo,
Rordorf Roberto,
Vincenti Antonio,
Diotallevi Paolo,
Montenero Annibale S.,
Bonanno Carlo,
Santo Tiziana,
Valsecchi Sergio,
Padeletti Luigi
Publication year - 2008
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2008.08.011
Subject(s) - medicine , cardiology , heart failure , cardiac resynchronization therapy , heart rate variability , heart transplantation , heart rate , ejection fraction , blood pressure
Background: Few data exist on the long‐term changes and the prognostic value of heart rate variability (HRV) assessed by implanted devices in heart failure (HF) patients treated with resynchronization therapy (CRT). Aims: To analyze the long‐term changes in the standard deviation of 5‐minute median atrial–atrial sensed intervals (SDANN), and assess its role in predicting CRT efficacy and major cardiovascular events. Methods and results: We included 509 consecutive patients implanted with CRT devices. At 12‐month follow‐up, 44 patients had died and 86 patients had at least one HF hospitalisation. A significant increase in SDANN occurred after 4 weeks of CRT (from 69±22 ms to 82±27 ms, p <0.001). A further increase in SDANN was observed 6 months after implantation. Multivariable analysis identified SDANN as the sole predictor of major cardiovascular events ( p =0.03) among several baseline parameters. SDANN≤65 ms at the first week and SDANN≤76 ms after 4 weeks of CRT yielded the best prediction of all‐cause mortality and urgent heart transplantation on Kaplan–Meier analysis (log‐rank test p =0.015 and p =0.011, respectively for week 1 and 4 values). Moreover, relative reduction in LVESV after CRT significantly correlated with SDANN at week 1 ( r =−0.596, p =0.012), and week 4 ( r =−0.703, p=0.001). Conclusions: Device‐monitored HRV is a useful tool to identify, early after implantation, patients with a low likelihood of long‐term benefits from CRT and at high risk for cardiovascular events.