Autonomic regulation therapy suppresses quantitative T-wave alternans and improves baroreflex sensitivity in patients with heart failure enrolled in the ANTHEM-HF study

Abstract

Chronic ART in patients with symptomatic heart failure improves cardiac electrical stability, as reflected by reduced TWA levels and heart rate, suppresses VT, and increases baroreceptor sensitivity. These observations deserve study in a larger population.

Novel method to assess intrinsic heart rate recovery in ambulatory ECG recordings tracks cardioprotective effects of chronic autonomic regulation therapy in patients enrolled in the ANTHEM‐HF study

“…A sizeable body of evidence suggests that impaired HRR relates to reduced baroreflex sensitivity, which in turn blunts the vagally mediated postexercise heart rate slowing (Coote, 2010;Lauer, 2016). In a prior secondary subanalysis of ANTHEM-HF patients, (Libbus et al, 2016) we found abnormally low baseline high-frequency HRV indicating depression in parasympathetic activity, which is consistent with impairment of intrinsic HRR observed in this study. Thus, the results of quantitatively assessed intrinsic HRR in AECG recordings concur with those obtained following exercise and may be conceptually related to baroreflex sensitivity.…”

“…Also reported in ANTHEM-HF patients, (Libbus et al, 2016) VNS improved high-frequency HRV and rMSSD HRV, both reflecting parasympathetic activity, as well as HRT slope, and lowered heart rate. These changes were accompanied by decreased TWA and occurrence of VT (Libbus et al, 2016).…”

“…In fact, indices of cardiac function such as LVEF and NYHA Class were significantly improved by chronic VNS in ANTHEM-HF patients (Premchand et al, 2014(Premchand et al, , 2015. Also reported in ANTHEM-HF patients, (Libbus et al, 2016) VNS improved high-frequency HRV and rMSSD HRV, both reflecting parasympathetic activity, as well as HRT slope, and lowered heart rate. These changes were accompanied by decreased TWA and occurrence of VT (Libbus et al, 2016).…”

“…Several clinical studies have demonstrated the beneficial effects of VNS in patients with heart failure, including but not limited to a significant improvement in left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), New York Heart Association (NYHA) class, (De Ferrari et al, 2011;Premchand et al, 2014Premchand et al, , 2015 and autonomic balance by heart rate variability (Libbus, Nearing, Amurthur, KenKnight, & Verrier, 2016). VNS has a proven safety profile with low incidence of side effects and adverse events in the management of more than 100,000 patients with epilepsy or depression, (Conway, Colijn, & Schachter, 2015) and therefore promises to provide a reasonable device-based solution for treatment of symptomatic heart failure in the presence of guideline-directed medical therapy.…”

Utility of heart rate turbulence and T‐wave alternans to assess risk for readmission and cardiac death in hospitalized heart failure patients

“…[2][3][4]12 in HF patients. 8,18 Also, the manifestation of TWA is associated with cardiac electrical instability. 8,18 Also, the manifestation of TWA is associated with cardiac electrical instability.…”