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J Am Coll Cardiol, 1999; 33:1203-1207
© 1999 by the American College of Cardiology Foundation
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CLINICAL STUDIES

Prognostic value of heart rate variability for sudden death and major arrhythmic events in patients with idiopathic dilated cardiomyopathy

Laurent Fauchier, MDa, Dominique Babuty, MDa, Pierre Cosnay, MDa and Jean Paul Fauchier, MD, FACCa

a Service de Cardiologie B et Laboratoire d’électrophysiologie cardiaque, Centre Hospitalier Universitaire Trousseau, Tours, France

Manuscript received March 27, 1998; revised manuscript received November 25, 1998, accepted January 5, 1999.

Reprint requests and correspondence: Laurent Fauchier, MD, Service de Cardiologie B., Centre Hospitalier Universitaire Trousseau, 37044 Tours, France
lfau{at}med.univ-tours.fr

OBJECTIVE

This study was designed to evaluate the prognostic value of heart rate variability for sudden death, resuscitated ventricular fibrillation or sustained ventricular tachycardia in patients with idiopathic dilated cardiomyopathy.

BACKGROUND

Previous studies have shown that heart rate variability could predict arrhythmic events and sudden death in postinfarction patients, but the prognostic value of heart rate variability for arrhythmic events or sudden death in patients with idiopathic dilated cardiomyopathy has not been established.

METHODS

Time and frequency domain analysis of heart rate variability on 24-h electrocardiographic (ECG) recording was assessed in 116 patients with idiopathic dilated cardiomyopathy (91 men, aged 51 ± 12 years, left ventricular ejection fraction 34 ± 12%).

RESULTS

Mean follow-up (± SD) was 53 ± 39 months. Sixteen patients reached one of the defined study end-points (sudden death, resuscitated ventricular fibrillation or sustained ventricular tachycardia) during follow-up. Using multivariate analysis, only reduced standard deviation of all normal-to-normal intervals (SDNN) (p = 0.02) and ventricular tachycardia during 24-h ECG recording (p = 0.02) predicted sudden death and/or arrhythmic events. For SDNN, a cutoff level of 100 ms seemed the best for the risk stratification.

CONCLUSIONS

Decrease in heart rate variability is an independent predictor of arrhythmic events and sudden death in idiopathic dilated cardiomyopathy, whether the mechanism of sudden death is ventricular tachyarrhythmia or not.

Abbreviations and Acronyms
  CHF = congestive heart failure
  ECG = electrocardiogram
  HF = high frequency power
  HRV = heart rate variability
  IDC = idiopathic dilated cardiomyopathy
  LF = low frequency power
  LV = left ventricle
  Mean RR = mean duration of all normal-to-normal
  NN = normal-to-normal intervals
  NYHA class = New York Heart Association function class
  pNN50 = number of NN intervals differing by more than 50 ms from adjacent interval divided by the total number of all NN intervals
  rmsSD = square root of the sum of the squares of differences between adjacent NN intervals
  SDANN = standard deviation of the averages of NN intervals in all 5-min segments
  SDNN = standard deviation of all NN intervals
  Tot P = total frequency power
  VLF = very low frequency power
  VF = ventricular fibrillation
  VT = ventricular tachycardia




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