Heart Rate Turbulence

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Georg Schmidt - One of the best experts on this subject based on the ideXlab platform.

  • Heart Rate Turbulence in Chagas disease.
    Pacing and clinical electrophysiology : PACE, 2020
    Co-Authors: Antonio Luiz P Ribeiro, Georg Schmidt, Marcos Roberto De Sousa, Federico Lombardi, Murilo E D Gomes, Amanda Arantes Perez, Marcio Vinicius Lins Barros, Fernando Santana Machado, Manoel Otávio Costa Rocha
    Abstract:

    Heart Rate Turbulence (HRT) quantifies the biphasic response of the sinus node to ventricular premature complexes (VPCs) and is a powerful electrocardiogram related risk predictor. VPCs are frequent in Chagas disease, a potentially lethal illness, and can hamper the analysis by conventional methods of autonomic Heart control. The aim of the study was to examine HRT in patients with Chagas disease. Chagas disease patients and healthy controls (group 0, n = 11) without other diseases were submitted to a standardized protocol, including electrocardiogram, echocardiography, and 24-hour Holter monitoring. Chagas disease patients were divided according to their left ventricular systolic function: normal (group 1, n = 103) and reduced ejection fraction (group 2, n = 23). Two HRT indices, Turbulence onset (TO) and Turbulence slope (TS), were calculated and compared among groups after adjustment for covariates like the prevalence of VPCs and the mean Heart Rate. Chagas disease patients had significantly altered TO (group 1: -0.0186, group 2: -0.0126) and TS (group 1: 10.844, group 2: 7.870) values in comparison with controls (TO -0.0256, TS 19.829); P < 0.001 for both comparisons. In conclusion, HRT data may be useful in the electrocardiographic analysis of autonomic Heart control in Chagas disease. Its prognostic value remains to be determined.

  • Heart Rate Turbulence to guide treatment for prevention of sudden death
    Journal of Cardiovascular Pharmacology, 2010
    Co-Authors: Axel Bauer, Christine Zurn, Georg Schmidt
    Abstract:

    Heart Rate Turbulence (HRT) denotes the baroreflex-mediated short-term oscillation of cardiac cycle lengths after spontaneous ventricular premature complexes. The physiological pattern of HRT consists of brief Heart Rate acceleration followed by more gradual Heart Rate deceleration before the Heart Rate returns to baseline. Physiological mechanisms of HRT are complex and require an intact interplay between both sympathetic and parasympathetic nervous systems. The strong and independent prognostic value of HRT in identifying postinfarction patients at high risk for death has been validated in six retrospective and three prospective studies together enrolling more than 8000 patients. This evidence qualifies HRT as a promising tool for selection of patients who might benefit from implantation of a cardioverter-defibrillator. Moreover, HRT predicts poor outcome in patients with Heart failure. It is not only correlated with a patient's clinical status, but also recovers when Heart failure treatment, including beta-blockers, angiotensin-converting enzyme inhibitors, or cardiac resynchronization therapy, is effective. Therefore, HRT might also be used as a treatment target to guide pharmacotherapy of Heart failure.

  • risk prediction by Heart Rate Turbulence and deceleration capacity in postinfarction patients with preserved left ventricular function retrospective analysis of 4 independent trials
    Journal of Electrocardiology, 2009
    Co-Authors: Axel Bauer, Marek Malik, Petra Barthel, Alexander Muller, Heikki V Huikuri, Georg Schmidt
    Abstract:

    BACKGROUND AND AIM: In the Improved Stratification of Autonomic Regulation-Risk trial, postinfarction patients with severe autonomic failure (SAF)-defined as abnormal Heart Rate Turbulence in the presence of abnormal deceleration capacity (DC)-were at high risk of subsequent death, even if left ventricular function was not particularly compromised. The aim of this study was to investigate SAF as a risk predictor in independent postinfarction cohorts. METHODS AND RESULTS: The data of 3 postinfarction trials (ie, St George's Hospital Medical School Postinfarction Survey, Holter substudy of the European Myocardial Infarction Amiodarone Trial with both the placebo and the amiodarone arms, and Multiple Risk Factor Analysis Trial) were reanalyzed in a blinded fashion. The populations included a total of 2534 postinfarction patients. Heart Rate Turbulence and DC were obtained from 24-hour Holter recordings. Patients with both abnormal Heart Rate Turbulence (slope or =0%) and abnormal DC ( 30%). The mortality risk of these patients was not statistically different from that of patients with impaired LVEF (< or =30%). The combined use of the criteria, LVEF of 30% or less and LVEF of more than 30% as well as SAF lead to a significant increase of sensitivity in all populations, whereas the positive predictive accuracies were preserved. CONCLUSION: In postinfarction patients with preserved left ventricular function, SAF identifies a subgroup with increased mortality risk equivalent to patients with LVEF of 30% or less.

  • Heart Rate Turbulence a 5 year review
    Heart Rhythm, 2004
    Co-Authors: Mari A Watanabe, Georg Schmidt
    Abstract:

    April 2004 marks the fifth anniversary of the first Heart Rate Turbulence (HRT) publication, which demonstRated the usefulness of HRT in predicting cardiac death in postmyocardial infarction patients. Since then, HRT has been shown to predict prognosis of patients with dilated cardiomyopathy and of patients with Heart failure of mixed etiology. HRT also has been shown to be predictive even in the current lower-mortality era of acute revascularization therapy for myocardial infarction. We discuss the latest criteria for obtaining reliable measurements of HRT, review factors that influence HRT values, and consider recent clinical studies.

  • Heart Rate Turbulence
    Journal of Electrocardiology, 2003
    Co-Authors: Axel Bauer, Georg Schmidt
    Abstract:

    Survivors of acute myocardial infarction are at increased risk of sudden cardiac death. Recent trials have demonstRated that in selected high risk post-myocardial infarction patients mortality can be significantly reduced by implantation of an autonomic cardioverter defibrillator. Therefore, risk stratification stRategies have gained increasing importance. Recently, a new method for risk stratification, coined Heart Rate Turbulence, has been published. The method quantifies the physiological short term fluctuation of sinus rhythm cycle lengths following singular ventricular premature complexes. Heart Rate Turbulence is a consistent phenomenon in low risk patients with ischemic Heart disease. The absence of this phenomenon indicates a signifi- cantly increased risk of subsequent mortality. The measures for quantifying Heart Rate Turbulence, Turbulence onset, and Turbulence slope are strong risk predictors, even when adjusted for other established mortality predictors, such as left ventricular ejection fraction, arrhythmia count, Heart Rate variability, mean Heart Rate and history of previous myocardial infarction. Heart Rate Turbulence may be useful not only for risk prediction in post-myocardial infarction patients but also for risk prediction in other patients such as in patients with dilated cardiomyopathy and Chagas disease. Key words: Auto- nomic function, sudden cardiac death, baroreflex sensitivity, myocardial infarction. Survivors of acute myocardial infarction (MI) are at an increased risk of sudden cardiac death, with the incidence highest in the first year after infarc- tion. The major causes of sudden death are ventric- ular tachycardia and ventricular fibrillation. Recent multicenter randomized clinical trials have demon- stRated that in selected high risk post-MI patients mortality can be significantly reduced by implanta- tion of an autonomic cardioverter defibrillator

J O Schwab - One of the best experts on this subject based on the ideXlab platform.

  • induced and spontaneous Heart Rate Turbulence in mice influence of coupling interval
    Europace, 2014
    Co-Authors: Florian Stockigt, J O Schwab, Sonja Pohlmann, Georg Nickenig, Jan W Schrickel
    Abstract:

    Aims Heart Rate Turbulence (HRT) is a prognostic parameter for risk stratification in patients suffering from coronary artery disease. The aims of this study were to demonstRate the feasibility of quantifying HRT in mice, both in long-term electrocardiograms (ECGs) as well as after extrastimulus pacing, and to analyse its characteristics. Methods and results We performed long-term ECG recordings using implanted telemetric chips and electrophysiological (EP) investigations, using transvenously inserted EP catheters, in healthy mice. Heart Rate Turbulence was calculated using the established Turbulence onset (TO) and slope (TS) algorithm. After spontaneous ventricular premature complexes (VPCs), we found a negative TO (−2.2 ± 7.5%) and positive TS (15.5 ± 18.3 ms/RR interval). Electrophysiological investigations revealed positive values for TO (0.6 ± 1.1%) and TS (6.5 ± 2.9 ms/RR interval) after extrastimulus pacing maneuvers. The shortening of the extrastimuli coupling intervals delivered during EP investigations significantly influenced TO ( r = 0.57; P = 0.01): shorter coupling intervals provoked more positive TO values. Conclusion Mice display both spontaneous and induced HRT. In terms of TO, VPCs geneRated by extrastimulus pacing are significantly dependent on the coupling interval. Determining HRT in mice is feasible and provides insight into basic mechanisms of blood pressure regulation, which is realized by the baroreflex.

  • Influence of obstructive sleep apnea on Heart Rate Turbulence
    Basic Research in Cardiology, 2005
    Co-Authors: Alexander Yang, H Schafer, R Manka, Rene Andrie, J O Schwab, Thorsten Lewalter, Berndt Luderitz, S Tasci
    Abstract:

    Background Patients with obstructive sleep apnea (OSA) are at increased risk for cardiovascular disease. Increased sympathetic drive is considered as one of the underlying mechanisms. Both Heart Rate Turbulence (HRT) and Heart Rate variability (HRV) are parameters to describe autonomic regulation. We investigated the influence of sleep–disordered breathing (SDB) on HRT and HRV in patients with OSA. Methods Sixty–five patients underwent overnight polysomnography for clinically suspected SDB and simultaneous Holter monitoring (11 p.m.–6 a.m.). Patients with diabetes mellitus, a history of cardiac disease, left ventricular dysfunction, periodic breathing pattern, and those on beta–blockers or theophylline were excluded. According to the apnea–hypopnea index (AHI), the patients were assigned to group A (AHI

  • influence of obstructive sleep apnea on Heart Rate Turbulence
    Basic Research in Cardiology, 2005
    Co-Authors: Alexander Yang, H Schafer, R Manka, Rene Andrie, J O Schwab, Thorsten Lewalter, Berndt Luderitz, S Tasci
    Abstract:

    Background Patients with obstructive sleep apnea (OSA) are at increased risk for cardiovascular disease. Increased sympathetic drive is considered as one of the underlying mechanisms. Both Heart Rate Turbulence (HRT) and Heart Rate variability (HRV) are parameters to describe autonomic regulation. We investigated the influence of sleep–disordered breathing (SDB) on HRT and HRV in patients with OSA.

  • influence of basic Heart Rate and sex on Heart Rate Turbulence in healthy subjects
    Pacing and Clinical Electrophysiology, 2004
    Co-Authors: J O Schwab, Thorsten Lewalter, Gerrit Eichner, Gudrun Veit, H. Schmitt, Berndt Luderitz
    Abstract:

    Acceleration and deceleration of the Heart Rate after the occurrence of a ventricular premature complex is characterized as Heart Rate Turbulence (HRT). Two parameters quantify Heart Rate Turbulence: onset and slope. The physiological properties have not been clarified in a large cohort of persons yet. This study evaluated properties of HRT, and focused on the influence of basic Heart Rate and sex on HRT. Using a special protocol, 95 persons were studied prospectively. HRT and its physiological properties were determined in 95 persons using Holter ECGs. The authors found 24% with a Turbulence onset 0% and 5% with a Turbulence slope <2.5 ms/RRI. Mean Heart Rate during Holter differed significantly between women and men (745 vs 817 ms, P < 0.0001). A linear, weighted regression model revealed that an increased Heart Rate before a ventricular premature complex is associated with a decreased Turbulence onset (P < 0.0001). Turbulence slope was attenuated by basic Heart Rate only in men (P = 0.0022). On the contrary, the study detected no influence of the basic Heart Rate on Turbulence slope in women (P = 0.0015 for the comparison between women and men). Basic Heart Rate and sex show an influence on HRT and should be considered when using HRT for noninvasive risk stratification.

  • influence of the point of origin on Heart Rate Turbulence after stimulated ventricular and atrial premature beats
    Basic Research in Cardiology, 2004
    Co-Authors: J O Schwab, Alexander Yang, Thorsten Lewalter, Jan W Schrickel, Nikolay Shlevkov, Katrin Grunwald, Lars Lickfett, Berndt Luderitz
    Abstract:

    BACKGROUND: Heart Rate Turbulence (HRT) is a new and auspicious parameter for risk stratification in patients suffering from structural Heart disease. The HRT parameters onset (TO) and slope (TS) are derived from Holter ECGs. Only a few studies have evaluated physiologic properties like age or prematurity of the ventricular beat on HRT. Until now, to our knowledge, little is known about the influence of the point of origin of the premature beat on HRT. Therefore, we conducted a study consisting of 25 patients (pts) with premature beats generating from 2 different sites in the atrium and ventricle. METHODS: During an electrophysiologic study, premature extra beats were induced. The high right atrium (HRA) and the lateral part of the coronary sinus (CS) represented the atrial pacing sites, while the right ventricular apex (RVAP) and right ventricular out flow tract (RVOT) represented the ventricular pacing sites. Prematurity started at 450 ms and was decreased to the refractoriness of each site. TO and TS were computed and correlated to the site of origin and the coupling interval (CI). RESULTS: Atrial TO was positive in 9 pts (HRA) and 7 (CS) as well as ventricular TO in 2 pts, respectively. TO induced in CS correlated with the CI (r = -0.50, p < 0.05). TS was negative, independent of the site of origin. Atrial TS showed no correlation with the CI. TO geneRated from both ventricular sites was positive in 2 pts. TO from RVAP correlated with the CI (r = -0.81, p < 0.005), but not with RVOT. TS from both ventricular sites exhibited no correlation with the pacing site, but correlated with themselves (r = -0.69, p < 0.03). CONCLUSION: The site of origin of the premature beat exhibits no influence on Heart Rate Turbulence slope. The prematurity of the extra beat correlates with Turbulence onset, but not with slope. Finally, the site of origin revealed no influence on HRT slope. Therefore, the calculation of Heart Rate Turbulence derived from extra beats extracted from Holter ECG is reliable.

Berndt Luderitz - One of the best experts on this subject based on the ideXlab platform.

  • Influence of obstructive sleep apnea on Heart Rate Turbulence
    Basic Research in Cardiology, 2005
    Co-Authors: Alexander Yang, H Schafer, R Manka, Rene Andrie, J O Schwab, Thorsten Lewalter, Berndt Luderitz, S Tasci
    Abstract:

    Background Patients with obstructive sleep apnea (OSA) are at increased risk for cardiovascular disease. Increased sympathetic drive is considered as one of the underlying mechanisms. Both Heart Rate Turbulence (HRT) and Heart Rate variability (HRV) are parameters to describe autonomic regulation. We investigated the influence of sleep–disordered breathing (SDB) on HRT and HRV in patients with OSA. Methods Sixty–five patients underwent overnight polysomnography for clinically suspected SDB and simultaneous Holter monitoring (11 p.m.–6 a.m.). Patients with diabetes mellitus, a history of cardiac disease, left ventricular dysfunction, periodic breathing pattern, and those on beta–blockers or theophylline were excluded. According to the apnea–hypopnea index (AHI), the patients were assigned to group A (AHI

  • influence of obstructive sleep apnea on Heart Rate Turbulence
    Basic Research in Cardiology, 2005
    Co-Authors: Alexander Yang, H Schafer, R Manka, Rene Andrie, J O Schwab, Thorsten Lewalter, Berndt Luderitz, S Tasci
    Abstract:

    Background Patients with obstructive sleep apnea (OSA) are at increased risk for cardiovascular disease. Increased sympathetic drive is considered as one of the underlying mechanisms. Both Heart Rate Turbulence (HRT) and Heart Rate variability (HRV) are parameters to describe autonomic regulation. We investigated the influence of sleep–disordered breathing (SDB) on HRT and HRV in patients with OSA.

  • Influence of basic Heart Rate and sex on Heart Rate Turbulence in healthy subjects.
    Pacing and Clinical Electrophysiology, 2004
    Co-Authors: Jörg O. Schwab, Thorsten Lewalter, Gerrit Eichner, Gudrun Veit, H. Schmitt, Berndt Luderitz
    Abstract:

    Acceleration and deceleration of the Heart Rate after the occurrence of a ventricular premature complex is characterized as Heart Rate Turbulence (HRT). Two parameters quantify Heart Rate Turbulence: onset and slope. The physiological properties have not been clarified in a large cohort of persons yet. This study evaluated properties of HRT, and focused on the influence of basic Heart Rate and sex on HRT. Using a special protocol, 95 persons were studied prospectively. HRT and its physiological properties were determined in 95 persons using Holter ECGs. The authors found 24% with a Turbulence onset 0% and 5% with a Turbulence slope

  • influence of basic Heart Rate and sex on Heart Rate Turbulence in healthy subjects
    Pacing and Clinical Electrophysiology, 2004
    Co-Authors: J O Schwab, Thorsten Lewalter, Gerrit Eichner, Gudrun Veit, H. Schmitt, Berndt Luderitz
    Abstract:

    Acceleration and deceleration of the Heart Rate after the occurrence of a ventricular premature complex is characterized as Heart Rate Turbulence (HRT). Two parameters quantify Heart Rate Turbulence: onset and slope. The physiological properties have not been clarified in a large cohort of persons yet. This study evaluated properties of HRT, and focused on the influence of basic Heart Rate and sex on HRT. Using a special protocol, 95 persons were studied prospectively. HRT and its physiological properties were determined in 95 persons using Holter ECGs. The authors found 24% with a Turbulence onset 0% and 5% with a Turbulence slope <2.5 ms/RRI. Mean Heart Rate during Holter differed significantly between women and men (745 vs 817 ms, P < 0.0001). A linear, weighted regression model revealed that an increased Heart Rate before a ventricular premature complex is associated with a decreased Turbulence onset (P < 0.0001). Turbulence slope was attenuated by basic Heart Rate only in men (P = 0.0022). On the contrary, the study detected no influence of the basic Heart Rate on Turbulence slope in women (P = 0.0015 for the comparison between women and men). Basic Heart Rate and sex show an influence on HRT and should be considered when using HRT for noninvasive risk stratification.

  • Influence of the point of origin on Heart Rate Turbulence after stimulated ventricular and atrial premature beats
    Basic Research in Cardiology, 2004
    Co-Authors: Jörg O. Schwab, Alexander Yang, Thorsten Lewalter, Nikolay Shlevkov, Katrin Grunwald, Jan Wilko Schrickel, Lars Lickfett, Berndt Luderitz
    Abstract:

    Background: Heart Rate Turbulence (HRT) is a new and auspicious parameter for risk stratification in patients suffering from structural Heart disease. The HRT parameters onset (TO) and slope (TS) are derived from Holter ECGs. Only a few studies have evaluated physiologic properties like age or prematurity of the ventricular beat on HRT. Until now, to our knowledge, little is known about the influence of the point of origin of the premature beat on HRT. Therefore, we conducted a study consisting of 25 patients (pts) with premature beats generating from 2 different sites in the atrium and ventricle. Methods: During an electrophysiologic study, premature extra beats were induced. The high right atrium (HRA) and the lateral part of the coronary sinus (CS) represented the atrial pacing sites, while the right ventricular apex (RVAP) and right ventricular outflow tract (RVOT) represented the ventricular pacing sites. Prematurity started at 450 ms and was decreased to the refractoriness of each site. TO and TS were computed and correlated to the site of origin and the coupling interval (CI). Results: Atrial TO was positive in 9 pts (HRA) and 7 (CS) as well as ventricular TO in 2 pts, respectively. TO induced in CS correlated with the CI (r = –0.50, p < 0.05). TS was negative, independent of the site of origin. Atrial TS showed no correlation with the CI. TO geneRated from both ventricular sites was positive in 2 pts. TO from RVAP correlated with the CI (r = –0.81, p < 0.005), but not with RVOT. TS from both ventricular sites exhibited no correlation with the pacing site, but correlated with themselves (r = –0.69, p < 0.03). Conclusion: The site of origin of the premature beat exhibits no influence on Heart Rate Turbulence slope. The prematurity of the extra beat correlates with Turbulence onset, but not with slope. Finally, the site of origin revealed no influence on HRT slope. Therefore, the calculation of Heart Rate Turbulence derived from extra beats extracted from Holter ECG is reliable.

Mari A Watanabe - One of the best experts on this subject based on the ideXlab platform.

  • Heart Rate Turbulence slope reduction in imminent ventricular tachyarrhythmia and its implications
    Journal of Cardiovascular Electrophysiology, 2006
    Co-Authors: Mari A Watanabe
    Abstract:

    Heart Rate Turbulence in Imminent VT/VF. introduction: The aim of this study was to see whether Heart Rate Turbulence (HRT) parameters change preceding imminent ventricular tachyarrhythmias (VT/VF). Methods and Results: The Spontaneous Ventricular Tachyarrhythmia Database (Medtronic Version 1.0) consisting of 83 paired (control and pre-VT/VF) sets of 1,000 RR intervals recorded by the Medtronic Jewel Plus ICD was used. Sixty-one control records and 69 pre-VT/VF records had two or more ectopic beats, allowing calculation of six HRT indices: means and standard deviations (SD) of Turbulence slope (TS), Turbulence onset (TO), and Turbulence timing (TT). The only index found to be different between control and pre-VT/VF records was SD of TS (4.2 ± 3.0 control vs 3.1 ± 1.9 pre-VT/VF, P < 0.05). Thirty-one datasets classified as having normal HRT in control demonstRated a decrease of both TS mean (P < 0.01) and SD (P < 0.01), and loss of correlation between TS mean and left ventricular ejection fraction (LVEF) preceding VT/VF (P < 0.0001 control, P = 0.8 pre-VT/VF). Conclusion: Both mean and SD of TS are reduced before VT/VF, but only in patients who have normal baseline HRT, and are capable of manifesting reduction. This may be why previous studies could not agree on pre-arrhythmia characteristics.

  • Heart Rate Turbulence a 5 year review
    Heart Rhythm, 2004
    Co-Authors: Mari A Watanabe, Georg Schmidt
    Abstract:

    April 2004 marks the fifth anniversary of the first Heart Rate Turbulence (HRT) publication, which demonstRated the usefulness of HRT in predicting cardiac death in postmyocardial infarction patients. Since then, HRT has been shown to predict prognosis of patients with dilated cardiomyopathy and of patients with Heart failure of mixed etiology. HRT also has been shown to be predictive even in the current lower-mortality era of acute revascularization therapy for myocardial infarction. We discuss the latest criteria for obtaining reliable measurements of HRT, review factors that influence HRT values, and consider recent clinical studies.

  • Heart Rate Turbulence a review
    Indian pacing and electrophysiology journal, 2003
    Co-Authors: Mari A Watanabe
    Abstract:

    Heart Rate Turbulence (HRT) is a recently coined phrase that describes the short term fluctuation in sinus cycle length that follows a ventricular premature complex (VPC). Its proven clinical significance lies in its ability to predict mortality and sudden cardiac death following myocardial infarction, although small studies suggest that it is also applicable to many other cardiac diseases. This review will attempt to summarize the literature to date, and to speculate on possible mechanisms. Because HRT is a new field, there are only a handful of full length papers on it. In order to present the full breadth of the research being carried out, the information provided here is based on conference abstracts as well as peer reviewed articles, and readers should keep this in mind. Most of the literature cited here, and downloadable HRT calculation programs (in C++) are available on the website www.h-r-t.org.

Axel Bauer - One of the best experts on this subject based on the ideXlab platform.

  • Heart Rate Turbulence as risk predictor after myocardial infarction
    Frontiers in Physiology, 2011
    Co-Authors: Christine S Zuern, Petra Barthel, Axel Bauer
    Abstract:

    Heart Rate Turbulence (HRT) is the baroreflex-mediated short-term oscillation of cardiac cycle lengths after spontaneous ventricular premature complexes. HRT is composed of a brief Heart Rate acceleration followed by a gradual Heart Rate deceleration. In high risk patients after myocardial infarction (MI) HRT is blunted or diminished. Since its first description in 1999 HRT emerged as one of the most potent risk factors after MI. Predictive power of HRT has been studied in more than 10,000 post-infarction patients. This review is intended to provide an overview of HRT as risk-predictor after MI.

  • Heart Rate Turbulence to guide treatment for prevention of sudden death
    Journal of Cardiovascular Pharmacology, 2010
    Co-Authors: Axel Bauer, Christine Zurn, Georg Schmidt
    Abstract:

    Heart Rate Turbulence (HRT) denotes the baroreflex-mediated short-term oscillation of cardiac cycle lengths after spontaneous ventricular premature complexes. The physiological pattern of HRT consists of brief Heart Rate acceleration followed by more gradual Heart Rate deceleration before the Heart Rate returns to baseline. Physiological mechanisms of HRT are complex and require an intact interplay between both sympathetic and parasympathetic nervous systems. The strong and independent prognostic value of HRT in identifying postinfarction patients at high risk for death has been validated in six retrospective and three prospective studies together enrolling more than 8000 patients. This evidence qualifies HRT as a promising tool for selection of patients who might benefit from implantation of a cardioverter-defibrillator. Moreover, HRT predicts poor outcome in patients with Heart failure. It is not only correlated with a patient's clinical status, but also recovers when Heart failure treatment, including beta-blockers, angiotensin-converting enzyme inhibitors, or cardiac resynchronization therapy, is effective. Therefore, HRT might also be used as a treatment target to guide pharmacotherapy of Heart failure.

  • risk prediction by Heart Rate Turbulence and deceleration capacity in postinfarction patients with preserved left ventricular function retrospective analysis of 4 independent trials
    Journal of Electrocardiology, 2009
    Co-Authors: Axel Bauer, Marek Malik, Petra Barthel, Alexander Muller, Heikki V Huikuri, Georg Schmidt
    Abstract:

    BACKGROUND AND AIM: In the Improved Stratification of Autonomic Regulation-Risk trial, postinfarction patients with severe autonomic failure (SAF)-defined as abnormal Heart Rate Turbulence in the presence of abnormal deceleration capacity (DC)-were at high risk of subsequent death, even if left ventricular function was not particularly compromised. The aim of this study was to investigate SAF as a risk predictor in independent postinfarction cohorts. METHODS AND RESULTS: The data of 3 postinfarction trials (ie, St George's Hospital Medical School Postinfarction Survey, Holter substudy of the European Myocardial Infarction Amiodarone Trial with both the placebo and the amiodarone arms, and Multiple Risk Factor Analysis Trial) were reanalyzed in a blinded fashion. The populations included a total of 2534 postinfarction patients. Heart Rate Turbulence and DC were obtained from 24-hour Holter recordings. Patients with both abnormal Heart Rate Turbulence (slope or =0%) and abnormal DC ( 30%). The mortality risk of these patients was not statistically different from that of patients with impaired LVEF (< or =30%). The combined use of the criteria, LVEF of 30% or less and LVEF of more than 30% as well as SAF lead to a significant increase of sensitivity in all populations, whereas the positive predictive accuracies were preserved. CONCLUSION: In postinfarction patients with preserved left ventricular function, SAF identifies a subgroup with increased mortality risk equivalent to patients with LVEF of 30% or less.

  • Heart Rate Turbulence
    Journal of Electrocardiology, 2003
    Co-Authors: Axel Bauer, Georg Schmidt
    Abstract:

    Survivors of acute myocardial infarction are at increased risk of sudden cardiac death. Recent trials have demonstRated that in selected high risk post-myocardial infarction patients mortality can be significantly reduced by implantation of an autonomic cardioverter defibrillator. Therefore, risk stratification stRategies have gained increasing importance. Recently, a new method for risk stratification, coined Heart Rate Turbulence, has been published. The method quantifies the physiological short term fluctuation of sinus rhythm cycle lengths following singular ventricular premature complexes. Heart Rate Turbulence is a consistent phenomenon in low risk patients with ischemic Heart disease. The absence of this phenomenon indicates a signifi- cantly increased risk of subsequent mortality. The measures for quantifying Heart Rate Turbulence, Turbulence onset, and Turbulence slope are strong risk predictors, even when adjusted for other established mortality predictors, such as left ventricular ejection fraction, arrhythmia count, Heart Rate variability, mean Heart Rate and history of previous myocardial infarction. Heart Rate Turbulence may be useful not only for risk prediction in post-myocardial infarction patients but also for risk prediction in other patients such as in patients with dilated cardiomyopathy and Chagas disease. Key words: Auto- nomic function, sudden cardiac death, baroreflex sensitivity, myocardial infarction. Survivors of acute myocardial infarction (MI) are at an increased risk of sudden cardiac death, with the incidence highest in the first year after infarc- tion. The major causes of sudden death are ventric- ular tachycardia and ventricular fibrillation. Recent multicenter randomized clinical trials have demon- stRated that in selected high risk post-MI patients mortality can be significantly reduced by implanta- tion of an autonomic cardioverter defibrillator

  • risk stratification after acute myocardial infarction by Heart Rate Turbulence
    Circulation, 2003
    Co-Authors: Petra Barthel, Axel Bauer, Raphael Schneider, Claus Schmitt, Albert Schomig, Georg Schmidt
    Abstract:

    Background— Retrospective postinfarction studies revealed that decreased Heart Rate Turbulence (HRT) indicates increased risk for subsequent death. This is the first prospective study to validate HRT in a large cohort of the reperfusion era. Methods and Results— One thousand four hundred fifty-five survivors of an acute myocardial infarction (age <76 years) in sinus rhythm were enrolled. HRT onset (TO) and slope (TS) were calculated from Holter records. Patients were classified into the following HRT categories: category 0 if both TO and TS were normal, category 1 if either TO or TS was abnormal, or category 2 if both TO and TS were abnormal. The primary end point was all-cause mortality. During a follow-up of 22 months, 70 patients died. Multivariately, HRT category 2 was the strongest predictor of death (hazard ratio, 5.9; 95% CI, 2.9 to 12.2), followed by left ventricular ejection fraction (LVEF) ≤30% (4.5; 2.6 to 7.8), diabetes mellitus (2.5; 1.6 to 4.1), age ≥65 years (2.4; 1.5 to 3.9), and HRT categ...

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