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Long‐term cardiac arrhythmia and chronotropic evaluation in patients with severe anorexia nervosa (LACE‐AN): A pilot study
Author(s) -
Farasat Morteza,
Watters Ashlie,
Bendelow Tiffany,
Schuller Joseph,
Mehler Philip S.,
Krantz Mori J.
Publication year - 2020
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.14338
Subject(s) - medicine , cardiology , bradycardia , supraventricular tachycardia , anorexia nervosa , sudden cardiac death , sinus rhythm , body mass index , heart rate , tachycardia , atrial fibrillation , blood pressure , eating disorders , psychiatry
Background Anorexia nervosa (AN) is associated with autonomic dysfunction and carries a high risk of sudden death, putatively attributed to ventricular tachyarrhythmias. To date, long‐term cardiac monitoring has not been performed to confirm this speculation. Methods and Results We assessed the safety and acceptability of an insertable cardiac monitor (ICM) in patients with severe AN with markedly reduced body mass index (BMI), and investigated heart rate (HR) and rhythm before and after weight restoration. Autonomic function was assessed as HR response to a standardized activity protocol at baseline and four additional visits over 360 days. The Florida Patient Acceptance Survey (FPAS) was used to measure ICM acceptability. During a mean follow‐up of 10 months, no ICM‐related complications occurred and ICM was well‐accepted by the 11 study participants (nine women, aged 19‐59 years, baseline BMI = 12.7 ± 1.6 kg/m 2 ). Both resting and peak HR increased with weight restoration and were directly associated with BMI (both P < .001). No ventricular tachyarrhythmias occurred during the study period, but two participants (18%) experienced eight sinus pauses (3.0‐7.0 seconds) and three runs of supraventricular tachycardia. Conclusions Long‐term cardiac rhythm monitoring with an ICM is feasible, safe, and acceptable in patients with severe AN. Autonomic dysfunction in AN results in not only profound resting bradycardia, but also some degree of chronotropic incompetence, both of which improve with weight restoration. Clinically significant bradyarrhythmias are more common than ventricular tachyarrhythmias in AN, and may represent a competing underlying mechanism for the high risk of sudden death in this population.