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CLINICAL STUDIES

Autonomic nervous system activity and the spontaneous initiation of ventricular tachycardia

^a Cardiac Electrophysiology Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

Manuscript received January 27, 1998; revised manuscript received July 30, 1998, accepted August 6, 1998.

Address for correspondence: Kelley P. Anderson, MD, Cardiac Electrophysiology Program, University of Pittsburgh, Presbyterian University Hospital Room B535, Pittsburgh, Pennsylvania 15213-2582
anders{at}ep1.bwing.upmc.edu

Objectives. We hypothesized that neurohormonal activity contributes to the initiation of sustained ventricular tachycardia (VT) as reflected in indices of heart rate variability (HRV).

Background. Autonomic nervous system activity participates in experimental arrhythmias but clinical studies have been inconsistent.

Methods. Holter electrocardiograms from 53 patients with VT were analyzed. Heart rate variability indices were determined over 5 and 15 min and 24 h and examined for changes before the onset of VT. Heart rate variability indices in the frequency domain included ultra low frequency power (FP) (ULFP): 0–0.0033 Hz; very low FP (VLFP): 0.0033–0.04 Hz; low FP (LFP): 0.04–0.15 Hz; high FP (HFP): 0.15–0.4 Hz; total power (TP); normalized LFP (LFP_n); normalized HFP (HFP_n), and the ratio: LFP/HFP.

Results. Heart rate variability indices were severely diminished: TP: 12,009 ± 11,076 ms²; ULFP: 10,087 ± 9,565 ms²; VLFP: 1,416 ± 1,571 ms²; LFP: 544 ± 620 ms²; HFP: 161 ± 176 ms², and LFP/HFP: 3.68 ± 2.83. Heart rate increased before VT (80.4 ± 17.3 to 85.3 ± 17.4 bpm, p < 0.001). Several HRV variables declined 30 min before VT compared to 24-h values (VLFP: –5.89 ± 17.81%, p = 0.031; LFP: –5.23 ± 14.3%, p = 0.003; HFP: –4.35 ± 13.7%, p = 0.04). LFP_n and the LFP/HFP ratio decreased significantly before the onset of VT (–17.7 ± 46.9%, p = 0.035 and –8.24 ± 38.8%, p = 0.037, respectively), whereas HFP_n increased slightly (4.29 ± 29.9%, p = 0.097).

Conclusions. Heart rate rose, whereas LFP, LFP_n and LFP/HFP fell before the onset of VT. This pattern of changes could be explained by a rise in sympathetic activity and saturation of the HRV signal resulting in dissociation of the average and rhythmical effects of sympathetic activity. These findings suggest that alterations in autonomic activity contributed to arrhythmogenesis in this group of patients.

Abbreviations and Acronyms   ANOVA = analysis of variance   ESVEM = Electrophysiologic Study Versus Electrocardiographic Monitoring   HFP = high frequency power   HFPn = normalized high frequency power   HR = heart rate   HRV = heart rate variability   LFP = low frequency power   LFPn = normalized low frequency power   pNN50 = percentage of differences between adjacent normal RR intervals that are >50 ms   r-MSSD = square root of the mean of the squared differences between adjacent normal RR intervals   SDANN = standard deviation index of the average normal RR-intervals for all 5-minute segments   SDANN index = SD of the average normal RR intervals for all 5 minute segments   SDNN = standard deviation (SD) of normal RR-intervals in the entire 24-hour ECG recording   SDNN index = mean of the SDs of normal RR-intervals for all 5-minute segments   TP = total power   ULFP = ultra low frequency power   VLFP = very low frequency power   VT = Sustained monomorphic ventricular tachycardia

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