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(Circulation. 2000;101:2398.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Heart Rate Dynamics at the Onset of Ventricular Tachyarrhythmias as Retrieved From Implantable Cardioverter-Defibrillators in Patients With Coronary Artery Disease

Etienne Pruvot, MD; Gilles Thonet, PhD; Jean-Marc Vesin, PhD; Guy van-Melle, PhD; Karlheinz Seidl, MD; Herwig Schmidinger, MD; Johannes Brachmann, MD; Werner Jung, MD; Ellen Hoffmann, MD; René Tavernier, MD; Michael Block, MD; Andrea Podczeck, MD; Martin Fromer, MD

From Centre Hospitalier Universitaire Vaudois (E.P., G.v.-M., M.F.), Lausanne, Switzerland; Ecole Polytechnique Fédérale de Lausanne (G.T., J.-M.V.), Lausanne, Switzerland; Klinikum der Stadt (K.S.), Ludwighafen, Germany; Allgemeines Krankenhaus (H.S.), Wien, Austria; Landkrankenhauses (J.B.), Coburg, Germany; Friedrich-Wilhems University (W.J.), Bonn, Germany; Klinikum Grosshadem (E.H.), München, Germany; Pacemaker Clinic (R.T.), UZ, Gent, Belgium; Stiftsklinik Augustinum (M.B.), München, Germany; and Wilhelminenspital (A.P.), Wien, Austria.

Correspondence to Dr Etienne Pruvot, Division of Cardiology, BH16, CHUV, 1011 Lausanne, Switzerland. E-mail etienne.pruvot{at}chuv.hospvd.ch

Background—The recent availability of implantable cardioverter-defibrillators (ICDs) that record 1024 R-R intervals preceding a ventricular tachyarrhythmia (VTA) provides a unique opportunity to analyze heart rate variability (HRV) before the onset of VTA.

Methods and Results—Fifty-eight post–myocardial infarction patients with an implanted ICD for recurrent VTA provided 2 sets of 98 heart rate recordings in sinus rhythm: (1) before a VTA and (2) during control conditions. Three subgroups were considered according to the antiarrhythmic (AA) drug regimen. A state of sympathoexcitation was suggested by the significant reduction in HRV before VTA onset compared with control conditions. ß-Blockers and dl-sotalol enhanced HRV in control recordings; nevertheless, HRV declined before VTA independent of AA drugs. A gradual increase in heart rate and decrease in sinus arrhythmia at VTA onset were specific findings of patients who received dl-sotalol.

Conclusions—The peculiar heart rate dynamics observed before VTA onset are suggestive of a state of sympathoexcitation that is independent of AA drugs.

Key Words: tachyarrhythmia • Fourier analysis • nervous system, autonomic • coronary disease

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