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Circulation, Vol 89, 1068-1073, Copyright © 1994 by American Heart Association
SH Hohnloser, T Klingenheben, A van de Loo, E Hablawetz, H Just and PJ Schwartz
BACKGROUND: The autonomic nervous system has been demonstrated to play a
decisive role in the genesis of sudden cardiac death. The loss of
protective vagal reflexes, in particular, appears to be associated with an
increased incidence of malignant ventricular tachyarrhythmias. Two
clinically applicable methods for assessment of cardiac autonomic control
have been developed: determination of heart rate variability and evaluation
of baroreflex sensitivity. METHODS AND RESULTS: To compare the potential
predictive value of both methods, two groups of patients were studied.
Group 1 comprised 14 postinfarction patients who had experienced at least
one episode of ventricular fibrillation or sustained ventricular
tachycardia and who were studied after this event. Group 2 consisted of 14
postinfarction patients without tachyarrhythmic events after their infarct.
Both groups were carefully matched with respect to age, sex, infarct
location, extent of coronary artery disease, left ventricular ejection
fraction, blood pressure, and heart rate at rest. Heart rate variability
was assessed from 24-hour Holter recordings, and baroreflex sensitivity was
determined by means of the phenylephrine method. Indices of heart rate
variability were not significantly different between the two groups (SD of
the mean RR interval, 84 +/- 30 milliseconds versus 103 +/- 20
milliseconds; proportion of adjacent RR intervals > 50 milliseconds
different, 2.8 +/- 3.2% versus 5.0 +/- 4.1% in group 1 versus 2).
Baroreflex sensitivity, however, showed a striking difference: Group 1
patients had a mean value of 1.75 +/- 1.63 ms/mm Hg compared with 9.17 +/-
5.40 ms/mm Hg in group 2 (P = .0002). Eleven of 14 group 1 patients had a
baroreflex sensitivity < or = 3.0 ms/mm Hg. By contrast, only 1 of 14
group 2 patients had such a depressed value. CONCLUSIONS: The results of
this study indicate that postmyocardial infarction patients who develop
life- threatening ventricular tachyarrhythmias, compared with carefully
matched postinfarction patients without major arrhythmic episodes, differ
strikingly in terms of baroreflex sensitivity but not in terms of heart
rate variability. This finding may have implications for the risk
stratification of postinfarction patients and may lead to a differential
therapeutic strategy based on autonomic testing.
ARTICLES
Reflex versus tonic vagal activity as a prognostic parameter in patients with sustained ventricular tachycardia or ventricular fibrillation
Department of Cardiology, University of Freiburg, Germany.
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