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CLINICAL RESEARCH: HEART FAILURE

Cardiac Resynchronization Therapy Improves Heart Rate Profile and Heart Rate Variability of Patients With Moderate to Severe Heart Failure

Cecilia Fantoni, MD^_*,, Santi Raffa, MD^_*, Francois Regoli, MD^_*, Francesco Giraldi, MD, Maria Teresa La Rovere, MD, John Prentice, PhD^||, Francesca Pastori, MD^_*, Simona Fratini, MD, PhD^_*, Jorge A. Salerno-Uriarte, MD, Helmut U. Klein, MD^_* and Angelo Auricchio, MD, PhD^_*,_*

^_* Division of Cardiology, University Hospital, Magdeburg, Germany
Department of Cardiovascular Sciences, University of Insubria, Varese, Italy
Centro Cardiologico Monzino, Milan, Italy
Department of Cardiology, Centro Medico di Montescano, S. Maugeri Foundation, IRCSS, Pavia, Italy
^|| Wild Rose Biophysics, Boulder, Colorado.

Manuscript received March 1, 2005; revised manuscript received May 8, 2005, accepted June 6, 2005.

^_* Reprint requests and correspondence: Dr. Angelo Auricchio, Division of Cardiology, University Hospital, Leipzigerstr. 44, D-39120 Magdeburg, Germany. (Email: angelo.auricchio{at}medizin.uni-magdeburg.de).

OBJECTIVES: This study sought to report long-term changes of cardiac autonomic control by continuous, device-based monitoring of the standard deviation of the averages of intrinsic intervals in the 288 five-min segments of a day (SDANN) and of heart rate (HR) profile in heart failure (HF) patients treated with cardiac resynchronization therapy (CRT).

BACKGROUND: Data on long-term changes of time-domain parameters of heart rate variability (HRV) and of HR in highly symptomatic HF patients treated with CRT are lacking.

METHODS: Stored data were retrieved for 113 HF patients (New York Heart Association functional class III to IV, left ventricular ejection fraction 35%, QRS >120 ms) receiving a CRT device capable of continuous assessment of HRV and HR profile.

RESULTS: The CRT induced a reduction of minimum HR (from 63 ± 9 beats/min to 58 ± 7 beats/min, p < 0.001) and mean HR (from 76 ± 10 beats/min to 72 ± 8 beats/min, p < 0.01) and an increase of SDANN (from 69 ± 23 ms to 93 ± 27 ms, p < 0.001) at three-month follow-up, which were consistent with improvement of functional capacity and structural changes. Different kinetics were observed among these parameters. The SDANN reached the plateau before minimum HR, and mean HR was the slowest parameter to change. Suboptimal left ventricular lead position was associated with no significant functional and structural improvement as well as no change or even worsening of HRV. The two-year event-free survival rate was significantly lower (62% vs. 94%, p < 0.005) in patients without any SDANN change ( change 0%) compared with patients who showed an increase in SDANN ( change >0%) four weeks after CRT initiation.

CONCLUSIONS: Cardiac resynchronization therapy is able to significantly modify the sympathetic-parasympathetic interaction to the heart, as defined by HR profile and HRV. Lack of HRV improvement four weeks after CRT identifies patients at higher risk for major cardiovascular events.

Abbreviations and Acronyms   CRT = cardiac resynchronization therapy   CRT-D = cardiac resynchronization therapy device with defibrillator back-up   HF = heart failure   HR = heart rate   HRV = heart rate variability   SDANN = standard deviation of the averages of intrinsic intervals in the 288 five-min segments of a day   SDNN = standard deviation of RR intervals

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