Heart Rate Variability in Risk Stratification of Cardiac Patients |
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Authors: | Heikki V Huikuri Phyllis K Stein |
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Institution: | 1. Institute of Clinical Medicine, Department of Internal Medicine, University of Oulu, and University Hospital of Oulu, Oulu, Finland;2. Division of Cardiology, Washington University School of Medicine, St. Louis, MO, USA |
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Abstract: | Heart rate (HR) variability has been extensively studied in cardiac patients, especially in patients surviving an acute myocardial infarction (AMI) and also in patients with congestive heart failure (CHF) or left ventricular (LV) dysfunction. The majority of studies have shown that patients with reduced or abnormal HR variability have an increased risk of mortality within a few years after an AMI or after a diagnosis of CHF/LV dysfunction. Various measures of HR dynamics, such as time-domain, spectral, and non-linear measures of HR variability have been used in risk stratification. The prognostic power of various measures, except of those reflecting rapid R–R interval oscillations, has been almost identical, albeit some non-linear HR variability measures, such as short-term fractal scaling exponent have provided somewhat better prognostic information than the others. Abnormal HR variability predicts both sudden and non-sudden cardiac death. Because of remodeling of the arrhythmia substrate after AMI, early measurement of HR variability to identify those at high risk should likely be repeated later in order to assess the risk of fatal arrhythmia events. Future randomized trials using HR variability/turbulence as one of the pre-defined inclusion criteria will show whether routine measurement of HR variability/turbulence will become a routine clinical tool for risk stratification of cardiac patients. |
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Keywords: | AMI acute myocardial infarction ATRAMI Autonomic Tone and Reflexes After Myocardial Infarction BHAT Beta-Blocker Heart Attack Trial CABG coronary artery bypass grafting CARISMA Cardiac Arrhythmias and RIsk Stratification after Myocardial infArction CHF congestive heart failure DEFINITE Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation DIAMOND Danish Investigations of Arrhythmia and Mortality ON Dofetilide DYNAMIT Defibrillator in Acute Myocardial Infarction Trial HF high frequency HR heart rate ICD implantable cardioverter defibrillator LF low frequency LV left ventricular LVEF left ventricular ejection fraction MI myocardial infarction MPIP Multicenter Post-Infarction Project REFINE Risk Estimation After Infarction Noninvasive Evaluation SDNN standard deviation of N&ndash N intervals |
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