Abnormal Heart Rate Turbulence Predicts the Initiation of Ventricular Arrhythmias

Iwasa, Atsushi; Hwa, Michael; Hassankhani, Alborz; Liu, Taylor; Narayan, Sanjiv M.

doi:10.1111/j.1540-8159.2005.50186.x

Cited by 31 publications

(21 citation statements)

References 34 publications

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“…Presently available data do not allow us to propose a gold-standard protocol for such studies although is seems obvious that they should include repeated ventricular extrastimuli with different coupling intervals. In patients with implanted defibrillators, frequent assessment of provoked HRT might also predict the likelihood of impending tachyarrhythmias (131,132).…”

Section: Future Directionsmentioning

confidence: 99%

Heart Rate Turbulence: Standards of Measurement, Physiological Interpretation, and Clinical Use

Bauer¹,

Malík

Schmidt³

et al. 2008

Journal of the American College of Cardiology

394

432

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This consensus statement has been compiled on behalf of the International Society for Holter and Noninvasive Electrophysiology. It reviews the topic of heart rate turbulence (HRT) and concentrates on technologies for measurement, physiologic background and interpretation, and clinical use of HRT. It also lists suggestions for future research. The phenomenon of HRT refers to sinus rhythm cycle-length perturbations after isolated premature ventricular complexes. The physiologic pattern of HRT consists of brief heart rate acceleration (quantified by the so-called turbulence onset) followed by more gradual heart rate deceleration (quantified by the so-called turbulence slope) before the rate returns to a pre-ectopic level. Available physiologic investigations confirm that the initial heart rate acceleration is triggered by transient vagal inhibition in response to the missed baroreflex afferent input caused by hemodynamically inefficient ventricular contraction. A sympathetically mediated overshoot of arterial pressure is responsible for the subsequent heart rate deceleration through vagal recruitment. Hence, the HRT pattern is blunted in patients with reduced baroreflex. The HRT pattern is influenced by a number of factors, provocations, treatments, and pathologies reviewed in this consensus. As HRT measurement provides an indirect assessment of baroreflex, it is useful in those clinical situations that benefit from baroreflex evaluation. The HRT evaluation has thus been found appropriate in risk stratification after acute myocardial infarction, risk prediction, and monitoring of disease progression in heart failure, as well as in several other pathologies.

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Section: Future Directionsmentioning

confidence: 99%

Heart Rate Turbulence: Standards of Measurement, Physiological Interpretation, and Clinical Use

Bauer¹,

Malík

Schmidt³

et al. 2008

Journal of the American College of Cardiology

394

432

View full text Add to dashboard Cite

show abstract

“…Such methods include counting the number of PVCs [1,7], heart rate turbulence (which measures the short-term effect of isolated PVCs upon the heart rate) [15,41] and fractal measures that are sensitive to the time clustering of PVCs [4]. However, those methods cannot provide more subtle information about the mechanisms of arrhythmia.…”

Section: Analysis Of Ventricular Arrhythmiasmentioning

confidence: 99%

“…In addition to their primary clinical role to reduce the incidence of sudden cardiac death, data that were recorded in ICDs and subsequently downloaded have also been used to analyze the conditions that precede the onset of VT and VF [5, 8-11, 20, 25, 28, 30, 31, 34, 37, 39, 43, 46]. The data derived from ICDs complement data from other sources that have analyzed heart rate variability (HRV) [8,17,19,28,36,48,49,51], premature ventricular complexes (PVCs) [1,4,7,15,26,40,41,44], and T-wave alternans [18,23,35,38] in assessment of factors that lead to the initiation of ventricular tachycardia and confer an increased risk for sudden cardiac death. Many factors including increased heart rate [16,19,20,24,27,31,34], reduced HRV [11,17,19,22,28,30,31,36,43,45,48,49], increased incidence of PVCs [4,7,16,40,44], and T-wave alterna...…”

Section: Introductionmentioning

confidence: 99%

Ventricular arrhythmias and changes in heart rate preceding ventricular tachycardia in patients with an implantable cardioverter defibrillator

Lerma

Wessel

Schirdewan

et al. 2008

Med Biol Eng Comput

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The objective was to determine the characteristics of heart rate variability and ventricular arrhythmias prior to the onset of ventricular tachycardia (VT) in patients with an implantable cardioverter defibrillator (ICD). Sixty-eight beat-to-beat time series from 13 patients with an ICD were analyzed to quantify heart rate variability and ventricular arrhythmias. The episodes of VT were classified in one of two groups depending on whether the sinus rate in the 1 min preceding the VT was greater or less than 90 beats per minute. In a subset of patients, increased heart rate and reduced heart rate variability was often observed up to 20 min prior to the VT. There was a non-significant trend to higher incidence of premature ventricular complexes (PVCs) before VT compared to control recordings. The patterns of the ventricular arrhythmias were highly heterogeneous among different patients and even within the same patient. Analysis of the changes of heart rate and heart rate variability may have predictive value about the onset of VT in selected patients. The patterns of ventricular arrhythmia could not be used to predict onset of VT in this group of patients.

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“…Conversely, depressed HRT may predict adverse cardiovascular outcome and the risk for ventricular tachyarrhythmias. 56 Although not considered in detail in this chapter, a recent consensus document from the International Society for Holter and Noninvasive Electrophysiology outlines standards for measuring HRT, and reviews the literature supporting its conclusions. 57 …”

Section: Heart Rate Turbulence (Hrt)mentioning

confidence: 98%

Advanced Signal Processing Applications of the ECG: T-Wave Alternans, Heart Rate Variability, and the Signal Averaged ECG

Sastry

Narayan²

2010

Practical Signal and Image Processing in Clinical Cardiology

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Abnormal Heart Rate Turbulence Predicts the Initiation of Ventricular Arrhythmias

Abstract: (PACE 2005; 28:1189-1197 ventricular arrhythmias, sudden cardiac death, T-wave alternans, premature ventricular contraction, electrophysiologic study, autonomic tone

Cited by 31 publications

References 34 publications

Heart Rate Turbulence: Standards of Measurement, Physiological Interpretation, and Clinical Use

Heart Rate Turbulence: Standards of Measurement, Physiological Interpretation, and Clinical Use

Ventricular arrhythmias and changes in heart rate preceding ventricular tachycardia in patients with an implantable cardioverter defibrillator

Advanced Signal Processing Applications of the ECG: T-Wave Alternans, Heart Rate Variability, and the Signal Averaged ECG

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