Prognostic Significance of Heart Rate Variability Among Patients Treated With Cardiac Resynchronization Therapy
Open accessAbstract
Objectives This study sought to evaluate the prognostic value of heart rate variability (HRV) for death or heart failure in patients with mildly symptomatic heart failure undergoing cardiac resynchronization therapy with a defibrillator (CRT-D).Background There are limited data regarding the prognostic value of HRV as a means of identifying high-risk patients treated with CRT-D.Methods We analyzed the relationship between pre-implant time-domain (SD of all normal-to-normal RR intervals [SDNN], SDs of averaged 5-min normal-to-normal RR intervals, root mean square of successive differences, and mean of the SDs of all normal-to-normal RR intervals for all 5-min segments of the entire recording), and frequency-domain (low-frequency power, very-low-frequency power [VLF], high-frequency power, low-frequency power/low-frequency power ratio) HRV parameters, and the end point of death or heart failure and death alone. Study subjects include 719 patients in normal sinus rhythm enrolled in MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy); outcomes of CRT-D patients with low HRV (lower tertile) were compared with CRT-D patients with preserved HRV (2 upper tertiles) and with patients receiving implantable cardioverter-defibrillators only.Results During a mean 3.4 ± 0.9 years of follow-up, 124 patients reached the primary end point of death or heart failure, and 47 died. In multivariate analysis, low SDNN (≤93 ms) was associated with significantly higher risk of death or heart failure (hazard ratio [HR] 1.63 [95% confidence interval (CI): 1.12 to 2.36]; p = 0.010) and mortality (HR 2.10 [95% CI: 1.14 to 3.87]; p = 0.017) compared with higher SDNN (>93 ms). Similarly, low VLF (≤179 ms 2) was associated with an increased risk of death or heart failure (HR 2.14 [95% CI: 1.46 to 3.13]; p < 0.001) and death alone (HR 2.49 [95% CI: 1.35 to 4.57]; p = 0.003). There was no significant difference in outcome between low HRV patients treated with CRT-D and patients receiving an implantable cardioverter-defibrillator only.Conclusions Our findings indicate that autonomic dysfunction (quantified by low SDNN and low VLF) identified patients with no benefit or limited benefit from cardiac resynchronization therapy. Pre-implant HRV analysis might help in optimizing qualifications for this treatment.
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HRV in patients with mildly symptomatic HF can help to identify individuals with limited benefit from cardiac resynchronization therapy.
“HRV in patients with mildly symptomatic HF can help to identify individuals with limited benefit from cardiac resynchronization therapy63.”
From Smart wearable devices in cardiovascular care: Where we are and how to move forward (2021) · cites this paper as [63]
Wearable monitoring devices capable of estimating HRV show promise and might identify those who benefit from cardiac resynchronization therapy.
“Wearable monitoring devices capable of estimating HRV show promise and might identify those who benefit from cardiac resynchronization therapy.34,35”
From Unlocking Tomorrow’s Health Care: Expanding the Clinical Scope of Wearables by Applying Artificial Intelligence (2024) · cites this paper as [35]
In the UK-HEART, patients with low HRV quantified using a standard deviation of all normal R-R intervals during a 24-hour period had a lower survival rate particularly if < 50 ms.
“In the United Kingdom Heart Failure Evaluation and Risk Trial (UK-HEART), patients with low HRV quantified using a standard deviation of all normal R-R intervals during a 24-hour period had a lower survival rate particularly if < 50 ms.”
From Unlocking Tomorrow’s Health Care: Expanding the Clinical Scope of Wearables by Applying Artificial Intelligence (2024) · cites this paper as [35]
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Smart wearable devices in cardiovascular care: Where we are and how to move forward
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- Authors
- Sherazi, S., Kutyifa, V., McNitt, S., Aktas, M. K., Couderc, J.-P., Peterson, B., Bloch Thomsen, P. E., Kautzner, J., Moss, A. J., & Zareba, W.
- Affiliations
- University of Rochester Medicine (US)
- Institute of Clinical and Experimental Medicine (CZ)
- Corresponding author
- Sherazi, Saadia
- ORCID
- Venue
- JACC: Clinical Electrophysiology
- Publisher
- Elsevier BV
- Published
- 2015-03
- Volume
- 1
- Issue
- 1-2
- Pages
- 74-80
- ISSN
- 2405-500X (ISSN-L)
- OpenAlex
- W1912695814
- Cited by
- 13
- References
- 27
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 3 · 2021: 2 · 2020: 1 · 2019: 1 · 2018: 2 · 2016: 1 · 2015: 1
- FWCI
- 0.97
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- JACC. Clinical electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Funders
- Boston Scientific Corporation
- School of Medicine and Dentistry, University of Rochester
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- heart rate variability, cardiac resynchronization therapy, CRT-D, implantable cardioverter-defibrillator, heart failure, mortality, autonomic dysfunction, SDNN, very low frequency power, time-domain HRV, frequency-domain HRV, MADIT-CRT, patient selection
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