Clinical value of using heart rate variability biofeedback before elective CT coronary angiography to reduce heart rate and the need for beta-blockers

Abstract

Objectives: The value of biofeedback before elective coronary computed tomography angiography (CCTA) to reduce patients’ heart rates (HR) was investigated in the current work. Methods: 60 patients who received CCTA to exclude coronary artery disease were included in our study and separated into two groups: with biofeedback (W-BF) and without biofeedback (WO-BF). The W-BF group used a biofeedback device for 15 min before CCTA. HR was determined in each patient at five measurement time points (MTP): during the pre-examination interview (MTP1), positioning on the CT patient table (MTP2), immediately before CCTA (MTP3), CCTA image acquisition (MTP4), and after completing CCTA (MTP5). If necessary, beta-blockers were administered in both groups after MTP3 until a HR of less than 65 bpm was achieved. Two board-certified radiologists subsequently assessed the image quality and analyzed the findings. Results: Overall, the need for beta-blockers was significantly lower in patients in W-BF group than in WO-BF group (p=0.032). In patients with a HR of 81-90, beta-blockers were not required in 4 of 6 cases in the W-BF group, whereas in the WO-BF group all patients needed beta-blockers (p=0.03). We found a significant decrease in HR between MTP1 and MTP2 in W-BF as compared to WO-BF. There was no significant difference between the W-BF and WO-BF groups regarding image quality (p=0.179). Conclusion: By using biofeedback prior to elective CCTA beta-blocker use can be significantly decreased due to effective reduction of HR, especially in patients with a HR above 80 bpm, without compromising CT image quality and analysis.