Circulation, Vol 87, 1220-1228, Copyright © 1993 by American Heart Association
HV Huikuri, JO Valkama, KE Airaksinen, T Seppanen, KM Kessler, JT Takkunen and RJ Myerburg
BACKGROUND. Low heart rate variability (HRV) is associated with an
increased risk of arrhythmic death and ventricular tachycardia (VT). The
purpose of this study was to examine whether there is a temporal relation
between changes in HRV and the onset of spontaneous episodes of VT in
patients at high risk of life-threatening arrhythmias. METHODS AND RESULTS.
Components of HRV in the frequency domain were analyzed before the onset of
28 episodes of nonsustained VT (more than four impulses; duration < 30
seconds) and 12 episodes of sustained VT (> 30 seconds or requiring
defibrillation) in 18 patients with coronary artery disease. Seven patients
had survived cardiac arrest not associated with acute myocardial
infarction, and 11 had a history of sustained VT. All frequency domain
measures of HRV, i.e., total power (p < 0.001), high-frequency power (p
< 0.05), low-frequency power (p < 0.01), very-low-frequency power (p
< 0.01), and ultralow-frequency power (p < 0.05), were significantly
lower before the onset of sustained VT than before nonsustained VT. Total
power of HRV was also lower during the 1-hour period before the onset of
sustained VT than the average 24-hour HRV (p < 0.05). An indirect
correlation existed between the length of VT and the total power of HRV
analyzed during the 15 minutes before the onset of VT (r = 0.54, p <
0.01). HRV had a trend toward increasing values before the onset of
nonsustained VT (p < 0.01) but not before the sustained VT episodes. The
ratio between low- frequency and high-frequency powers increased
substantially before both nonsustained and sustained VT episodes (p = 0.06
and p = 0.05, respectively). The rate of VT or the coupling interval
initiating the VT did not differ significantly between the nonsustained and
sustained VT. CONCLUSIONS. Spontaneous episodes of VT are preceded by
changes in HRV in the frequency domain. Divergent dynamics of HRV before
the onset of nonsustained and sustained VT episodes may reflect differences
in factors that can facilitate the perpetuation of these arrhythmias.
ARTICLES
Frequency domain measures of heart rate variability before the onset of nonsustained and sustained ventricular tachycardia in patients with coronary artery disease
Department of Medicine, Oulu University Central Hospital, Finland.
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