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European Journal of Heart Failure 2006 8(7):716-722; doi:10.1016/j.ejheart.2006.01.008
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© 2006 European Society of Cardiology

Influence of cardiac-resynchronization therapy on heart rate and blood pressure variability: 1-year follow-up

Gianfranco Piccirilloa,*, Damiano Magría, Silvia di Carloa, Tiziana De Laurentisa, Alessia Torrinia, Sabrina Materaa, Marzia Magnantia, Leda Bernardib, Franco Barillàb, Raffaele Quaglioneb, Evaristo Ettorrea and Vincenzo Mariglianoa

a Dipartimento di Scienze dell'Invecchiamento, I Clinica Medica, Policlinico Umberto I, Università "La Sapienza", 00161 Rome, Italy
b Istituto del Cuore e dei Grossi Vasi "Attilio Reale", Policlinico Umberto I, Università "La Sapienza", Rome, Italy

* Corresponding author. Tel.: +39 064463301 2 3; fax: +39 064940594. E-mail address: gianfranco.piocirillo{at}uniromal.it (G.Piccirillo).


  Abstract

Background: Several studies have shown that cardiac-resynchronization therapy (CRT) improves haemodynamic function, cardiac symptoms, and heart rate variability (HRV) and reduces the risk of mortality and sudden death in subjects with chronic heart failure (CHF). In subjects with CHF, power spectral values for the low-frequency (LF) component of RR variability ≥13 ms2, are associated with an increased risk of sudden death.

Aims and methods: To assess whether spectral indexes obtained by power spectral analysis of HRV and systolic blood pressure (SBP) variability could predict malignant ventricular arrhythmias in patients with severe CHF treated with an implantable cardioverter–defibrillator (ICD) alone or with ICD+CRT. In addition, changes in non-invasive spectral indices using short-term power spectral analysis of HRV and SBP variability during controlled breathing in 15 patients with CHF treated with an ICD alone and 16 patients receiving ICD+CRT, were assessed pre-treatment and at 1 year.

Results: Arrhythmias necessitating an appropriate ICD shock were more frequent in subjects who had low LF power. CRT improved all spectral components, including LF power.

Conclusions: Low LF power values predict an increased risk of malignant ventricular arrhythmias; after 1 year of CRT most non-spectral and spectral data, including LF power, improved. Whether these improvements lead to better long-term survival in patients with CHF remains unclear.

Key Words: Chronic heart failure • Cardiac resynchronization therapy • Implantable cardioverter–defibrillator • Sudden death • Heart rate variability • Power spectral analysis

Received June 22, 2005; Revised November 14, 2005; Accepted January 18, 2006


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