© 2008 European Society of Cardiology
Heart rate variability monitored by the implanted device predicts response to CRT and long-term clinical outcome in patients with advanced heart failure
a Fondazione Policlinico S. Matteo IRCCS Pavia, Italy
b IRCCS Istituto Clinico Humanitas Rozzano, Milan, Italy
c Niguarda Hospital Milan, Italy
d S. Filippo Neri Hospital Rome, Italy
e S. Gerardo dei Tintori Monza, Italy
f Ospedale SS. Antonio e Biagio Alessandria, Italy
g IRCCS MultiMedica, Sesto S Giovanni Milan, Italy
h San Bortolo Hospital Vicenza, Italy
i Medtronic Italia, Rome, Italy
j Careggi Hospital Florence, Italy
* Corresponding author. Dipartimento di Cardiologia, Fondazione IRCCS Policlinico San Matteo, P.le Golgi 2, 27100-Pavia, Italy. Tel.: +39 0382 501276; fax: +39 0382 503161. E-mail address: elettrofisiologia{at}smatteo.pv.it (M. Landolina)
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Abstract |
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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<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 SDANN76 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.
Key Words: Heart rate variability • Resynchronization therapy • Remodelling • Heart failure
Received March 12, 2008; Revised June 25, 2008; Accepted August 28, 2008
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