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

Abstract

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.

The effects of cardiac resynchronization treatment on autonomic functions aside from functional status in heart failure

“…As we did not know the initial HRV and HRT parameters in CRT patients, we assumed that they had been improved with functional status. This assumption was strongly supported with the previous studies (13)(14)(15)(16) showing improved HRV and HRT parameters in CRT responders. Similarly, an improvement might be achieved in ICD patients with a placebo effect.…”

“…In studies, which investigated HRV and HRT parameters in CRT patients, improvement of functional capacity was accompanied with the improvement of HRV and HRT parameters in good responders to CRT (13)(14)(15)(16). However, we do not know whether there is an additional benefit of CRT on autonomic functions independent from the improvement in functional capacity.…”

eHealth in cardiovascular medicine: A clinical update

“…The application of eHealth and telemedicine for RPM with implanted devices may provide mechanism(s) for facilitating these tasks. [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] Data are promising and it can be expected that remote monitoring systems will develop into dedicated monitoring and therapy platforms. We expect that data retrieved from these systems will form an integral part of the electronic patient record in the future as more and more outpatient clinic care will shift to personalised care provided at a distance, in other words at patients' homes.…”

E-Health and Telemedicine: Current Situation and Future Challenges

“…This generates an enormous clinical workload which increases further when devices approach ERI, or in response to product advisories and recalls. The application of e-Health and Telemedicine for remote monitoring of patients with implanted devices may provide mechanism(s) for facilitating these tasks [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Data are promising and it can be expected that remote monitoring systems will develop into dedicated monitoring and therapy platforms.…”