Heart rate dynamics at the onset of ventricular tachyarrhythmias as retrieved from implantable cardioverter-defibrillators in patients with coronary artery disease

• Published in: Circulation (New York, N.Y.) N.Y.), 2000-05, Vol.101 (20), p.2398-2404
• Main Authors: Pruvot, E, Thonet, G, Vesin, J M, van-Melle, G, Seidl, K, Schmidinger, H, Brachmann, J, Jung, W, Hoffmann, E, Tavernier, R, Block, M, Podczeck, A, Fromer, M
• Format: Article
• Language: English
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Aged; Anti-Arrhythmia Agents - therapeutic use; Coronary Disease - complications; Defibrillators, Implantable; Heart Rate - drug effects; Humans; Middle Aged; Sotalol - therapeutic use; Tachycardia, Ventricular - drug therapy; Tachycardia, Ventricular - etiology; Tachycardia, Ventricular - physiopathology; Tachycardia, Ventricular - therapy
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.101.20.2398

The recent availability of implantable cardioverter-defibrillators (ICDs) that record 1024 R-R intervals preceding a ventricular tachyarrhythmia (VTA) provides a unique opportunity to analyze heart rate variability (HRV) before the onset of VTA. Fifty-eight post-myocardial infarction patients with an implanted ICD for recurrent VTA provided 2 sets of 98 heart rate recordings in sinus rhythm: (1) before a VTA and (2) during control conditions. Three subgroups were considered according to the antiarrhythmic (AA) drug regimen. A state of sympathoexcitation was suggested by the significant reduction in HRV before VTA onset compared with control conditions. beta-Blockers and dl-sotalol enhanced HRV in control recordings; nevertheless, HRV declined before VTA independent of AA drugs. A gradual increase in heart rate and decrease in sinus arrhythmia at VTA onset were specific findings of patients who received dl-sotalol. The peculiar heart rate dynamics observed before VTA onset are suggestive of a state of sympathoexcitation that is independent of AA drugs.