Changes in Heart Rate Variability, Quality of Life, and Activity in Cardiac Resynchronization Therapy Patients: Results of the HF‐HRV Registry

Gilliam, F. Roosevelt; Kaplan, Andrew; Black, James H.; Chase, Kellie J.; Mullin, Christopher M.

doi:10.1111/j.1540-8159.2007.00582.x

Cited by 33 publications

(20 citation statements)

References 23 publications

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“…Since the device-based HRV can only be measured after device implantation [5][6][7][8][9]18], it can not be excluded that the post-operative discomfort and the short stay in hospital may have influenced the trend data in the first days. However, previous studies with cross-over design [6,34] and data comparing de novo implantation with device replacement [5] have shown that HRV changes after CRT are a true treatment effect rather than a consequence of the implant procedure.…”

Section: Limitationsmentioning

confidence: 99%

“…However, the pathophysiological mechanisms by which CRT may improve HRV are not yet fully understood. Today, few data exist on the longterm changes and the prognostic value of HRV assessed by implanted devices in HF patients treated with CRT [5,[7][8][9], and the time-course of HRV and left ventricular functional changes have not been defined.…”

Section: Introductionmentioning

confidence: 99%

“…Depressed heart rate variability (HRV), a sign of autonomic dysfunction, has been found to be an independent predictor of mortality in HF patients [2][3][4]. It has been reported that cardiac resynchronization therapy (CRT) improves HRV reflecting a shift of cardiac autonomic balance toward a more favourable profile, less dependent on sympathetic activation [5][6][7]. These changes in autonomic cardiac control may contribute to the long-term benefits of CRT, including a reduction in mortality.…”

Section: Introductionmentioning

confidence: 99%

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Heart rate variability monitored by the implanted device predicts response to CRT and long‐term clinical outcome in patients with advanced heart failure

Landolina

Gasparini

Lunati

et al. 2008

European J of Heart Fail

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Background: Few data exist on the long-term changes and the prognostic value of heart rate variability (HRV) assessed by implanted devices in heart failure (HF) patients treated with resynchronization therapy (CRT). Aims: To analyze the long-term changes in the standard deviation of 5-minute median atrial-atrial sensed intervals (SDANN), and assess its role in predicting CRT efficacy and major cardiovascular events. Methods and results: We included 509 consecutive patients implanted with CRT devices. At 12-month follow-up, 44 patients had died and 86 patients had at least one HF hospitalisation. A significant increase in SDANN occurred after 4 weeks of CRT (from 69 ± 22 ms to 82 ± 27 ms, p b 0.001). A further increase in SDANN was observed 6 months after implantation. Multivariable analysis identified SDANN as the sole predictor of major cardiovascular events (p = 0.03) among several baseline parameters. SDANN ≤ 65 ms at the first week and SDANN ≤ 76 ms after 4 weeks of CRT yielded the best prediction of all-cause mortality and urgent heart transplantation on Kaplan-Meier analysis (log-rank test p = 0.015 and p = 0.011, respectively for week 1 and 4 values). Moreover, relative reduction in LVESV after CRT significantly correlated with SDANN at week 1 (r = −0.596, p = 0.012), and week 4 (r = −0.703, p = 0.001). Conclusions: Device-monitored HRV is a useful tool to identify, early after implantation, patients with a low likelihood of long-term benefits from CRT and at high risk for cardiovascular events.

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Section: Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Heart rate variability monitored by the implanted device predicts response to CRT and long‐term clinical outcome in patients with advanced heart failure

Landolina

Gasparini

Lunati

et al. 2008

European J of Heart Fail

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“…This method is expensive, time consuming and requires the expertise of qualified laboratory personnel. Currently, an increasing number of studies employ the more accessible resting heart rate variability (HRV) indicators as prognostic indicators of survival in patients and of training status in athletes (Gilliam et al, 2007;Achten and Jeukendrup, 2003). HRV represents the changes in instantaneous heart rate over a segment or the full length of an RR interval recording (tachogram), as controlled by the sympathetic and parasympathetic branches of the autonomic nervous system (ANS) (Task Force, 1996).…”

mentioning

confidence: 99%

Relationship between exercise capacity and heart rate variability: Supine and in response to an orthostatic stressor

Grant

Clark

Rensburg

et al. 2009

Autonomic Neuroscience

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A b s t r a c tThe study investigated whether supine-measured HRV indicators, and/or HRV indicators measured during orthostatic stress are related to conventional measures of exercise and performance ability such as VO 2max . Only two significant correlations (pb0.05) out of 30 tests were found between supinedetermined HRV indicators and conventional measures. In contrast, fifteen of the 30 relationships calculated during orthostatic stress were significant. Relationships were at best low to moderate (0.2b|corr|b0.4). As expected, the relationships obtained during orthostatic stress were reversed from that obtained in the supine position. In summary, although HRV indicators are related to cardiovascular fitness, correlations between VO 2max and these parameters are found only under very specific conditions. HRV parameters explain very little of the variance in VO 2max . In addition, estimating the exercise capacity from HRV indicators requires experience and extreme caution Maximal oxygen uptake (VO 2max ) is widely used as an indicator of exercise capacity and predictor of survival and performance in a variety of clinical and athletic populations (Stelken et al., 1996;Diamond, 2007). VO 2max is normally assessed in a laboratory setting by means of respiratory gas analysis equipment. This method is expensive, time consuming and requires the expertise of qualified laboratory personnel. Currently, an increasing number of studies employ the more accessible resting heart rate variability (HRV) indicators as prognostic indicators of survival in patients and of training status in athletes (Gilliam et al., 2007;Achten and Jeukendrup, 2003). HRV represents the changes in instantaneous heart rate over a segment or the full length of an RR interval recording (tachogram), as controlled by the sympathetic and parasympathetic branches of the autonomic nervous system (ANS) (Task Force, 1996). In this respect HRV analysis is used as a non-invasive indicator of ANS function and window on the clinical or training status of patients and athletes.In testing the assumption that HRV as determined by off-the-shelf HR monitors can be used in place of the more cumbersome and ten times more expensive than VO 2max assessment, correlations were found between resting HRV indicators and VO 2max. However, results are inconsistent and studies reported significant correlations as well as no correlations between VO 2max and the same HRV indicators (Bucheit and Gindre,

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“…Application of the heart rate variability (HRV) method for cardiovascular system state estimation in various pathological conditions including chronic heart failure (CHF) is more and more common in clinics [3,12]. β-Adrenoblockers, various in their pharmacokinetic and pharmacodynamic properties, hold one of central positions in contemporary CHF therapy.…”

mentioning

confidence: 99%

Heart Rate Variability in Rats with Experimental Chronic Heart Failure and Long-Term Exposure to β-Adrenoblockers

Сальников

2009

Bull Exp Biol Med

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Simulation of chronic heart failure in rats led to an increase in heart rate variability and decrease in heart rate. All beta-blockers also promoted the heart rate variability augmentation in ill animals. The most potent effects on heart rate variability were produced by pindolol, atenolol, and propranolol. Bisoprolol and metoprolol affected heart rate and heart rate variability in less extent, and nebivolol normalized a part of heart rate variability parameters.

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Changes in Heart Rate Variability, Quality of Life, and Activity in Cardiac Resynchronization Therapy Patients: Results of the HF‐HRV Registry

Abstract: In conclusion, these study results demonstrate that device measured HRV parameters and patient outcomes significantly improve after receipt of CRT.

Cited by 33 publications

References 23 publications

Heart rate variability monitored by the implanted device predicts response to CRT and long‐term clinical outcome in patients with advanced heart failure

Heart rate variability monitored by the implanted device predicts response to CRT and long‐term clinical outcome in patients with advanced heart failure

Relationship between exercise capacity and heart rate variability: Supine and in response to an orthostatic stressor

Heart Rate Variability in Rats with Experimental Chronic Heart Failure and Long-Term Exposure to β-Adrenoblockers

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