Circulation, Vol 88, 180-185, Copyright © 1993 by American Heart Association
A Algra, JG Tijssen, JR Roelandt, J Pool and J Lubsen
BACKGROUND. Low heart rate variability has been implicated as a risk factor
for sudden death. However, no large epidemiological studies using sudden
death as an outcome event have been reported. METHODS AND RESULTS. A total
of 6,693 consecutive patients who underwent 24-hour ambulatory ECG were
followed up for 2 years; of these, 245 patients died suddenly. Clinical
data at the time of 24-hour ambulatory ECG were collected for all patients
who died suddenly and for a random sample of 268 patients from the study
cohort. In all patients in sinus rhythm with or without occasional
supraventricular arrhythmias at the 24-hour ECG (193 patients who died
suddenly and 230 patients from the sample), heart rate variability
parameters were derived. Patients with low short- term RR interval
variability (mean during 24 hours of per-minute standard deviations [SD] of
RR intervals < 25 msec) had a 4.1-fold higher risk (95% confidence
interval [CI], 2.6, 8.1) for sudden death than patients with high
short-term variability (> or = 40 msec); after adjustment for age,
evidence of cardiac dysfunction, and history of myocardial infarction, the
relative risk was 2.6 (95% CI, 1.4, 5.1). The crude relative risk of
long-term RR interval variability (SD during 24 hours of per-minute means
of RR intervals < 8 msec) was 4.4 (95% CI, 2.6, 7.7); after adjustment
for the same risk factors, it was 2.2 (95% CI, 1.2, 4.1). Patients with a
minimum heart rate > or = 65 beats per minute had a double risk of
sudden death compared with those with a minimum heart rate < 65 beats
per minute (adjusted relative risk, 2.1; 95% CI, 1.3, 3.6). CONCLUSIONS.
These findings support the theory that patients with low parasympathetic
activity (low short-term RR interval variability) have an increased risk
for sudden death independent of other risk factors.
ARTICLES
Heart rate variability from 24-hour electrocardiography and the 2-year risk for sudden death
Department of Cardiology, Erasmus University, Rotterdam, The Netherlands.
This article has been cited by other articles:
 |
|
 |
|
  V. Vaccarino, R. Lampert, J. D. Bremner, F. Lee, S. Su, C. Maisano, N. V. Murrah, L. Jones, F. Jawed, N. Afzal, et al. Depressive Symptoms and Heart Rate Variability: Evidence for a Shared Genetic Substrate in a Study of Twins Psychosom Med, July 1, 2008; 70(6): 628 - 636. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. C Parish and J. D Evans Inflammation in Chronic Heart Failure Ann. Pharmacother., July 1, 2008; 42(7): 1002 - 1016. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. K. Lahiri, P. J. Kannankeril, and J. J. Goldberger Assessment of autonomic function in cardiovascular disease: physiological basis and prognostic implications. J. Am. Coll. Cardiol., May 6, 2008; 51(18): 1725 - 1733. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Schaffer, T. Burkhardt, D. Muller-Vizentini, M. Rauh, M. Tomaske, R. A. Mieth, U. Bauersfeld, and E. Beinder Cardiac autonomic balance in small-for-gestational-age neonates Am J Physiol Heart Circ Physiol, February 1, 2008; 294(2): H884 - H890. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Galetta, F. Franzoni, P. Fallahi, L. Tocchini, L. Braccini, G. Santoro, and A. Antonelli Changes in heart rate variability and QT dispersion in patients with overt hypothyroidism Eur. J. Endocrinol., January 1, 2008; 158(1): 85 - 90. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. L. Burr, S. A. Motzer, W. Chen, M. J. Cowan, R. J. Shulman, and M. M. Heitkemper Heart Rate Variability and 24-hour Minimum Heart Rate. Biol Res Nurs, April 1, 2006; 7(4): 256 - 267. [Abstract] [PDF]
|
|
|
|
 |
|
 N. Nasr, A. Pavy-Le Traon, and V. Larrue Baroreflex Sensitivity Is Impaired in Bilateral Carotid Atherosclerosis Stroke, September 1, 2005; 36(9): 1891 - 1895. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Tahara, H. Takaki, A. Taguchi, K. Suyama, T. Kurita, W. Shimizu, S. Miyazaki, T. Kawada, and K. Sunagawa Pronounced HR variability after exercise in inferior ischemia: evidence that the cardioinhibitory vagal reflex is invoked by exercise-induced inferior ischemia Am J Physiol Heart Circ Physiol, March 1, 2005; 288(3): H1179 - H1185. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M.J. Reed, C.E. Robertson, and P.S. Addison Heart rate variability measurements and the prediction of ventricular arrhythmias QJM, February 1, 2005; 98(2): 87 - 95. [Full Text] [PDF]
|
|
|
|
 |
|
 Z.-G. Huang, X. Wang, C. Evans, A. Gold, E. Bouairi, and D. Mendelowitz Prenatal Nicotine Exposure Alters the Types of Nicotinic Receptors That Facilitate Excitatory Inputs to Cardiac Vagal Neurons J Neurophysiol, October 1, 2004; 92(4): 2548 - 2554. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Roach, W. Wilson, D. Ritchie, and R. Sheldon Dissection of long-range heart rate variability: Controlled induction of prognostic measures by activity in the laboratory J. Am. Coll. Cardiol., June 16, 2004; 43(12): 2271 - 2277. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Algra, P. C. Gates, A. J. Fox, V. Hachinski, and H. J.M. Barnett Side of Brain Infarction and Long-Term Risk of Sudden Death in Patients With Symptomatic Carotid Disease Stroke, December 1, 2003; 34(12): 2871 - 2875. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Hakansson, P. Gustavsson, A. Sastre, and B. Floderus Occupational Exposure to Extremely Low Frequency Magnetic Fields and Mortality from Cardiovascular Disease Am. J. Epidemiol., September 15, 2003; 158(6): 534 - 542. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. Manfrini, C. Pizzi, D. Trere, F. Fontana, and R. Bugiardini Parasympathetic failure and risk of subsequent coronary events in unstable angina and non-ST-segment elevation myocardial infarction Eur. Heart J., September 1, 2003; 24(17): 1560 - 1566. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. L. Rennie, H. Hemingway, M. Kumari, E. Brunner, M. Malik, and M. Marmot Effects of Moderate and Vigorous Physical Activity on Heart Rate Variability in a British Study of Civil Servants Am. J. Epidemiol., July 15, 2003; 158(2): 135 - 143. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. G. Priori, E. Aliot, C. Blomstrom-Lundqvist, L. Bossaert, G. Breithardt, P. Brugada, J. A. Camm, R. Cappato, S. M. Cobbe, C. Di Mario, et al. TASK FORCE ON SUDDEN CARDIAC DEATH, EUROPEAN SOCIETY OF CARDIOLOGY: Summary of Recommendations Europace, January 1, 2002; 4(1): 3 - 18. [Abstract] [PDF]
|
|
|
|
|
|
S.G. Priori, E. Aliot, C. Blomstrom-Lundqvist, L. Bossaert, G. Breithardt, P. Brugada, A.J. Camm, R. Cappato, S.M. Cobbe, C. Di Mario, et al. Task Force on Sudden Cardiac Death of the European Society of Cardiology Eur. Heart J., August 2, 2001; 22(16): 1374 - 1450. [PDF]
|
|
|
|
 |
|
 J D Schipke and M Pelzer Effect of immersion, submersion, and scuba diving on heart rate variability Br. J. Sports Med., June 1, 2001; 35(3): 174 - 180. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 X. Jouven, M. Zureik, M. Desnos, C. Guerot, and P. Ducimetiere Resting heart rate as a predictive risk factor for sudden death in middle-aged men Cardiovasc Res, May 1, 2001; 50(2): 373 - 378. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Giordano, D. Manzella, G. Paolisso, A. Caliendo, M. Varricchio, and C. Giordano Differences in heart rate variability parameters during the post-dialytic period in type II diabetic and non-diabetic ESRD patients Nephrol. Dial. Transplant., March 1, 2001; 16(3): 566 - 573. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Kornitzer Predictive value of electrocardiographic markers for autonomic nervous system dysfunction in healthy populations: more studies needed Eur. Heart J., January 2, 2001; 22(2): 109 - 112. [PDF]
|
|
|
|
|
|
H. V. Huikuri, T. Makikallio, K. E. J. Airaksinen, R. Mitrani, A. Castellanos, and R. J. Myerburg Measurement of heart rate variability: a clinical tool or a research toy? J. Am. Coll. Cardiol., December 1, 1999; 34(7): 1878 - 1883. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B M Pluim, C A Swenne, A H Zwinderman, A C Maan, A van der Laarse, J Doornbos, and E E Van der Wall Correlation of heart rate variability with cardiac functional and metabolic variables in cyclists with training induced left ventricular hypertrophy Heart, June 1, 1999; 81(6): 612 - 617. [Abstract] [Full Text]
|
|
|
|
|
|
F. Weber, H. Schneider, T. von Arnim, and W. Urbaszek Heart rate variability and ischaemia in patients with coronary heart disease and stable angina pectoris: Influence of drug therapy and prognostic value Eur. Heart J., January 1, 1999; 20(1): 38 - 50. [Abstract] [PDF]
|
|
|
|
 |
|
 M. J. Stevens, D. M. Raffel, K. C. Allman, F. Dayanikli, E. Ficaro, T. Sandford, D. M. Wieland, M. A. Pfeifer, and M. Schwaiger Cardiac Sympathetic Dysinnervation in Diabetes : Implications for Enhanced Cardiovascular Risk Circulation, September 8, 1998; 98(10): 961 - 968. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. E. Roach and R. S. Sheldon Information scaling properties of heart rate variability Am J Physiol Heart Circ Physiol, June 1, 1998; 274(6): H1970 - H1978. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Roach, A. Sheldon, W. Wilson, and R. Sheldon Temporally localized contributions to measures of large-scale heart rate variability Am J Physiol Heart Circ Physiol, May 1, 1998; 274(5): H1465 - H1471. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S.M. Horner, C.F. Murphy, B. Coen, D.J. Dick, F.G. Harrison, Z. Vespalcova, and M.J. Lab Contribution to Heart Rate Variability by Mechanoelectric Feedback: Stretch of the Sinoatrial Node Reduces Heart Rate Variability Circulation, October 1, 1996; 94(7): 1762 - 1767. [Abstract] [Full Text]
|
|
|
|
|
|
T. F. o. t. E. S. o. C. t. N. A. S. o. P. Electrophysiology Heart Rate Variability : Standards of Measurement, Physiological Interpretation, and Clinical Use Circulation, March 1, 1996; 93(5): 1043 - 1065. [Full Text]
|
|