Autonomic nervous system and sudden cardiac death

Department of Medicine and Cardiovascular Research Institute, Unversity of California-San Francisco, USA.

In the United States, sudden cardiac death is a major public health problem, accounting for approximately 300,000 deaths annually. Accurate identification of those patients at highest risk for this event has been problematic. The use of signal-averaged electrocardiography, Holter monitoring and assessment of left ventricular function have been shown to be predictive of future arrhythmic events in patients after a myocardial infarction. However, the clinical utility of these tests has been limited by their low sensitivity and positive predictive value. It has become increasingly clear that the autonomic nervous system is extremely important in the pathogenesis of ventricular arrhythmias and sudden cardiac death. The two most important techniques used to study the autonomic nervous system--heart rate variability and baroreflex sensitivity--are reviewed, and the clinical and experimental data suggesting that these techniques are powerful predictors of future arrhythmic events are discussed in depth.

This article has been cited by other articles:

				F. Iellamo, M. Pagani, and M. Volterrani Cardiac Rehabilitation and Prevention of Cardiovascular Disease: A Role for Autonomic Cardiovascular Regulation J. Am. Coll. Cardiol., September 23, 2008; 52(13): 1105 - 1105. [Full Text] [PDF]

				N. K. Wenger Reply J. Am. Coll. Cardiol., September 23, 2008; 52(13): 1105 - 1106. [Full Text] [PDF]

				C.-Y. Chen, D. Chow, N. Chiamvimonvat, K. A. Glatter, N. Li, Y. He, K. E. Pinkerton, and A. C. Bonham Short-term secondhand smoke exposure decreases heart rate variability and increases arrhythmia susceptibility in mice Am J Physiol Heart Circ Physiol, August 1, 2008; 295(2): H632 - H639. [Abstract] [Full Text] [PDF]

				M. I. Travin A Potential Key Role for Radionuclide Imaging in the Prediction and Prevention of Sudden Arrhythmic Cardiac Death J. Nucl. Med., February 1, 2008; 49(2): 173 - 175. [Full Text] [PDF]

				R. Ranpuria, M. Hall, C. T. Chan, and M. Unruh Heart rate variability (HRV) in kidney failure: measurement and consequences of reduced HRV Nephrol. Dial. Transplant., February 1, 2008; 23(2): 444 - 449. [Abstract] [Full Text] [PDF]

				W. G. Tingley, L. Pawlikowska, J. G. Zaroff, T. Kim, T. Nguyen, S. G. Young, K. Vranizan, P.-Y. Kwok, M. A. Whooley, and B. R. Conklin Gene-trapped mouse embryonic stem cell-derived cardiac myocytes and human genetics implicate AKAP10 in heart rhythm regulation PNAS, May 15, 2007; 104(20): 8461 - 8466. [Abstract] [Full Text] [PDF]

				Y. Zhong, K.-M. Jan, K. H. Ju, and K. H. Chon Quantifying cardiac sympathetic and parasympathetic nervous activities using principal dynamic modes analysis of heart rate variability Am J Physiol Heart Circ Physiol, September 1, 2006; 291(3): H1475 - H1483. [Abstract] [Full Text] [PDF]

				B. Eryonucu, K. Uzun, N. Guler, M. Tuncer, and C. Sezgi Comparison of the Short-term Effects of Salmeterol and Formoterol on Heart Rate Variability in Adult Asthmatic Patients Chest, September 1, 2005; 128(3): 1136 - 1139. [Abstract] [Full Text] [PDF]

				A. J.M. Broadley, A. Korszun, E. Abdelaal, V. Moskvina, C. J.H. Jones, G. B. Nash, C. Ray, J. Deanfield, and M. P. Frenneaux Inhibition of Cortisol Production With Metyrapone Prevents Mental Stress-Induced Endothelial Dysfunction and Baroreflex Impairment J. Am. Coll. Cardiol., July 19, 2005; 46(2): 344 - 350. [Abstract] [Full Text] [PDF]

				A. J.M. Broadley, M. P. Frenneaux, V. Moskvina, C. J.H. Jones, and A. Korszun Baroreflex Sensitivity Is Reduced in Depression Psychosom Med, July 1, 2005; 67(4): 648 - 651. [Abstract] [Full Text] [PDF]

				J. H. Christensen, S. Riahi, E. B. Schmidt, H. Mølgaard, A. K. Pedersen, F. Heath, J. C. Nielsen, and E. Toft n-3 Fatty acids and ventricular arrhythmias in patients with ischaemic heart disease and implantable cardioverter defibrillators Europace, January 1, 2005; 7(4): 338 - 344. [Abstract] [Full Text] [PDF]

				R. Bauernschmitt, H. Malberg, N. Wessel, B. Kopp, E.U. Schirmbeck, and R. Lange Impairment of cardiovascular autonomic control in patients early after cardiac surgery Eur. J. Cardiothorac. Surg., March 1, 2004; 25(3): 320 - 326. [Abstract] [Full Text] [PDF]

				T. Cogliati, D. J. Good, M. Haigney, P. Delgado-Romero, M. A. Eckhaus, W. J. Koch, and I. R. Kirsch Predisposition to Arrhythmia and Autonomic Dysfunction in Nhlh1-Deficient Mice Mol. Cell. Biol., July 15, 2002; 22(14): 4977 - 4983. [Abstract] [Full Text] [PDF]

				I. S. Anand, V. G. Florea, and L. Fisher Surrogate end points in heart failure J. Am. Coll. Cardiol., May 1, 2002; 39(9): 1414 - 1421. [Abstract] [Full Text] [PDF]

				G. Grassi, G. Seravalle, G. Bertinieri, M. L. Stella, C. Turri, and G. Mancia Sympathetic Response to Ventricular Extrasystolic Beats in Hypertension and Heart Failure Hypertension, April 1, 2002; 39(4): 886 - 891. [Abstract] [Full Text] [PDF]

				T. Wakabayashi, T. Nakata, A. Hashimoto, S. Yuda, K. Tsuchihashi, M. I. Travin, and K. Shimamoto Assessment of Underlying Etiology and Cardiac Sympathetic Innervation to Identify Patients at High Risk of Cardiac Death J. Nucl. Med., December 1, 2001; 42(12): 1757 - 1767. [Abstract] [Full Text] [PDF]

				P. J. Gheeraert, J. P. S. Henriques, M. L. De Buyzere, M. De Pauw, Y. Taeymans, and F. Zijlstra Preinfarction angina protects against out-of-hospital ventricular fibrillation in patients with acute occlusion of the left coronary artery J. Am. Coll. Cardiol., November 1, 2001; 38(5): 1369 - 1374. [Abstract] [Full Text] [PDF]

				H. Hemingway, M. Malik, and M. Marmot Social and psychosocial influences on sudden cardiac death, ventricular arrhythmia and cardiac autonomic function Eur. Heart J., July 1, 2001; 22(13): 1082 - 1101. [PDF]

				B. Eryonucu, K. Uzun, N. Guler, and M. Bilge Comparison of the acute effects of salbutamol and terbutaline on heart rate variability in adult asthmatic patients Eur. Respir. J., May 1, 2001; 17(5): 863 - 867. [Abstract] [Full Text] [PDF]

				M. Kornitzer Predictive value of electrocardiographic markers for autonomic nervous system dysfunction in healthy populations: more studies needed Eur. Heart J., January 2, 2001; 22(2): 109 - 112. [PDF]

				E.A. Whitsel, T.E. Raghunathan, R.M. Pearce, D. Lin, P.M. Rautaharju, R. Lemaitre, and D.S. Siscovick RR interval variation, the QT interval index and risk of primary cardiac arrest among patients without clinically recognized heart disease Eur. Heart J., January 2, 2001; 22(2): 165 - 173. [Abstract] [PDF]

				H. V. Barron T-wave alternans and serious ventricular arrhythmias: a tale of two T-waves J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2254 - 2256. [Full Text] [PDF]

				F. Iellamo, J. M. Legramante, M. Massaro, G. Raimondi, and A. Galante Effects of a Residential Exercise Training on Baroreflex Sensitivity and Heart Rate Variability in Patients With Coronary Artery Disease : A Randomized, Controlled Study Circulation, November 21, 2000; 102(21): 2588 - 2592. [Abstract] [Full Text] [PDF]

				J. Merot, V. Probst, M. Debailleul, U. Gerlach, N. S. Moise, H. Le Marec, and F. Charpentier Electropharmacological characterization of cardiac repolarization in German shepherd dogs with an inherited syndrome of sudden death: abnormal response to potassium channel blockers J. Am. Coll. Cardiol., September 1, 2000; 36(3): 939 - 947. [Abstract] [Full Text] [PDF]

				J Hoffmann, W Grimm, V Menz, H-H Müller, and B Maisch Heart rate variability and baroreflex sensitivity in idiopathic dilated cardiomyopathy Heart, May 1, 2000; 83(5): 531 - 538. [Abstract] [Full Text]

				X. Zhou, F. L. Vance IV, A. L. Sims, C. M. Sreenan, and R. E. Ideker Prevention of High Incidence of Neurally Mediated Ventricular Arrhythmias by Afferent Nerve Stimulation in Dogs Circulation, February 22, 2000; 101(7): 819 - 824. [Abstract] [Full Text] [PDF]

				K. S. Leong, P. Mann, M. Wallymahmed, I. A. MacFarlane, and J. P. H. Wilding Abnormal Heart Rate Variability in Adults with Growth Hormone Deficiency J. Clin. Endocrinol. Metab., February 1, 2000; 85(2): 628 - 633. [Abstract] [Full Text]

				R. Wolk Arrhythmogenic mechanisms in left ventricular hypertrophy Europace, January 1, 2000; 2(3): 216 - 223. [Abstract] [PDF]

				M. Pasic, M. Musci, H. Siniawski, O. Grauhan, B. Edelmann, T. Tedoriya, Y. Weng, and R. Hetzer THE COX MAZE III PROCEDURE: PARALLEL NORMALIZATION OF SINUS NODE DYSFUNCTION, IMPROVEMENT OF ATRIAL FUNCTION, AND RECOVERY OF THE CARDIAC AUTONOMIC NERVOUS SYSTEM J. Thorac. Cardiovasc. Surg., August 1, 1999; 118(2): 287 - 296. [Abstract] [Full Text] [PDF]

				B M Pluim, C A Swenne, A H Zwinderman, A C Maan, A van der Laarse, J Doornbos, and E E Van der Wall Correlation of heart rate variability with cardiac functional and metabolic variables in cyclists with training induced left ventricular hypertrophy Heart, June 1, 1999; 81(6): 612 - 617. [Abstract] [Full Text]

				T. M. Saleh, B. J. Connell, and G. V. Allen Visceral afferent activation-induced changes in sympathetic nerve activity and baroreflex sensitivity Am J Physiol Regulatory Integrative Comp Physiol, June 1, 1999; 276(6): R1780 - R1791. [Abstract] [Full Text] [PDF]

				M. S. Lauer, G. S. Francis, P. M. Okin, F. J. Pashkow, C. E. Snader, and T. H. Marwick Impaired Chronotropic Response to Exercise Stress Testing as a Predictor of Mortality JAMA, February 10, 1999; 281(6): 524 - 529. [Abstract] [Full Text] [PDF]

				T. M. Saleh and B. J. Connell Centrally mediated effect of 17beta -estradiol on parasympathetic tone in male rats Am J Physiol Regulatory Integrative Comp Physiol, February 1, 1999; 276(2): R474 - R481. [Abstract] [Full Text] [PDF]

				T. M. Saleh and B. J. Connell Role of 17beta -estradiol in the modulation of baroreflex sensitivity in male rats Am J Physiol Regulatory Integrative Comp Physiol, September 1, 1998; 275(3): R770 - R778. [Abstract] [Full Text] [PDF]

				O. Fruchter, F.A.E. Suliman, J. T. Bigger, J. P. DiMarco, and J. N. Rottman Prophylactic Use of Implanted Cardiac Defibrillators in Patients at High Risk for Ventricular Arrhythmias after Coronary-Artery Bypass Graft Surgery N. Engl. J. Med., April 23, 1998; 338(17): 1227 - 1228. [Full Text]

				G. J. Ter Horst and F. Postema Forebrain parasympathetic control of heart activity: retrograde transneuronal viral labeling in rats Am J Physiol Heart Circ Physiol, December 1, 1997; 273(6): H2926 - H2930. [Abstract] [Full Text] [PDF]

				E. Drouin, V. Gournay, J. Calamel, A. Mouzard, and J.-C. Rozé Assessment of spontaneous baroreflex sensitivity in neonates Arch. Dis. Child. Fetal Neonatal Ed., March 1, 1997; 76(2): 108F - 112. [Abstract] [Full Text]

				R. B. Silver, C. J. Mackins, N. C. E. Smith, I. L. Koritchneva, K. Lefkowitz, T. W. Lovenberg, and R. Levi Coupling of histamine H3 receptors to neuronal Na+/H+ exchange: A novel protective mechanism in myocardial ischemia PNAS, February 27, 2001; 98(5): 2855 - 2859. [Abstract] [Full Text] [PDF]