Heart Rate Variability and Arrhythmic Burden in Pulmonary Hypertension

Abstract

A growing body of evidence indicates that sudden cardiac death constitutes a major cause of mortality in pulmonary hypertension (PH). As validated method to evaluate cardiac autonomic system dysfunction, alterations in heart rate variability (HRV) are predictive of arrhythmic events, particularly in left ventricular disease. Here, we sought to determine the clinical value of HRV assessment in PH. Sixty-four patients were allocated to different PH-subgroups in this prospectively conducted trial: 25 patients with pulmonary arterial hypertension (PAH), 11 patients with chronic thromboembolic PH (CTEPH), and 28 patients with COPD-induced PH. All patients underwent 24-h Holter electrocardiogram for HRV assessment by time- and frequency-domain analysis. Arrhythmic burden was evaluated by manual analysis and complementary automatic measurement of premature atrial and ventricular contractions. The results were compared to 31 healthy controls. The PAH patients offered a significantly higher mean heart rate (78.6 ± 10.4 bpm vs. 70.1 ± 10.3 bpm, p = 0.04), a higher burden of premature ventricular contractions (p < 0.01), and decreases in HRV (SDNN: p < 0.01; SDANN: p < 0.01; very low frequency: p < 0.01; low frequency/high frequency ratio: p < 0.01; total power: p = 0.02). In CTEPH patients, only the amount of premature ventricular contractions differed from controls (p < 0.01), whereas in COPD both premature atrial contraction count and frequency-domain-based HRV manifested significant differences. In conclusion, PAH appears to be primarily affected by HRV alterations and ventricular arrhythmic burden, indicating a high risk for malignant arrhythmic events.

Atrial Arrhythmias in Pulmonary Hypertension: Pathogenesis, Prognosis and Management

“…In a recent study using 24-hour Holter monitoring in 36 patients with PAH or CTEPH, paroxysmal AF was detected in nearly one in three patients, suggesting that the true prevalence of asymptomatic arrhythmia may be much higher. 14…”

Heart Rhythm Complexity Impairment in Patients with Pulmonary Hypertension

“…reported decreased HRV and increased ventricular ectopy in patients with PAH 27 , and Bienias and Witte et al . also reported worse linear HRV in patients with pulmonary hypertension 23,24 . In the current study, we demonstrated similar results which highlight the prominent autonomic dysregulation in patients with pulmonary hypertension.…”

“…Instead, severe bradycardia and pulseless electrical activity are the most common causes of sudden cardiac death in PAH 22 . A possible predisposing factor for arrhythmia in PAH is modulation of autonomic activity 9,22,24 . Elevated levels of serum norepinephrine and its association with pulmonary vascular resistance 25 support the hypothesis of increased sympathetic activity in patients with PAH.…”

Parameters of Spectral and Temporal Analysis of Heart Rate Variability in the Conditions of Disregulation of Apoptotic Activity in Bronchopulmonary Pathology and Comorbidity With Arterial Hypertension

“…Проблемі вивчення варіабельності серцевого ритму (ВСР) у хворих з АГ присвячена досить велика кількість публікацій [7], в яких описуються деякі особливості співвідношення тонусу симпатичного і парасимпатичного відділів вегетативної нервової системи порівняно з такими в осіб з нормальним артеріальним тиском. Більшістю авторів продемонстровано зниження ВСР на фоні гіпертонічної хвороби, переважно за рахунок показників SDNN, pNN50 і RMSSD, що вказує на зменшення парасимпатичних впливів на ритм серця і відносне збільшення симпатичного тонусу.…”