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European Journal of Heart Failure 2003 5(2):175-178; doi:10.1016/S1388-9842(02)00257-X
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© 2002 European Society of Cardiology

Effect of biventricular pacing on heart rate variability in patients with chronic heart failure

Efthimios G. Livanis*, Panagiota Flevari, George N. Theodorakis, Fotis Kolokathis, Dionyssios Leftheriotis and Dimitrios Th. Kremastinos

Second Department of Cardiology, Onassis Cardiac Surgery Center 356 Syngrou Avenue, 17674 Athens, Greece

* Corresponding author. Tel.: +30-10-9493-372; fax: +30-10-9493-373 E-mail address: elbee{at}ath.forthnet.gr


  Abstract

Background: Biventricular pacing is emerging as a long-term therapy for symptomatic heart failure. Analysis of heart rate variability (HRV) has become an important predictive tool in this syndrome.

Aim of the study: To assess whether chronic resynchronization therapy can affect HRV in patients with heart failure.

Methods and results: Thirteen patients with heart failure were studied (mean age±1 S.E. 65±2.2 years, QRS 195±5.3 ms, NYHA class 3.2±0.1, LVEF 21±1.7%). The protocol included a preliminary no pacing period for 1 month following device implantation. Twenty-four hour Holter ECG recordings were performed at the end of this period (baseline) and after 3 months of biventricular stimulation (VDD mode). Prior to and following pacing patients underwent NYHA class evaluation, 6-min walk test, Quality of Life Assessment and a cardiopulmonary exercise test. Biventricular pacing improved functional class (P<0.0001) and Quality of life (P<0.0001), increased 6-min walk distance, (P=0.008) and exercise duration (P<0.0001) but had no significant effect on peak exercise VO2. Resynchronization therapy increased mean 24-h RR (922±58 vs. 809±41 ms at baseline, P=0.006), SDNN (111±11 vs. 83±8 ms, P=0.003), SDNN-I (56±10 vs. 40±5 ms, P=0.02), rMSSD (66±14 vs. 41±8 ms, P=0.003), Total Power (5724±1875 vs. 2074±553 ms2, P=0.03), Ultra Low Frequency Power (1969±789 vs. 653±405 ms2, P=0.03) and Very Low Frequency Power (2407±561 vs. 902±155 ms2, P=0.004).

Conclusion: Biventricular pacing in heart failure improves autonomic function by increasing HRV. This may have important prognostic implications.

Key Words: Biventricular pacing • Heart rate variability • Heart failure

Received August 2, 2002; Revised October 18, 2002; Accepted December 5, 2002


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