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Chemoreflex sensitivity as a predictor of arrhythmia relapse in ICD recipients
Marcus G Hennersdorf1, Verena Niebch, Christian Perings
1Department of Cardiology, Pneumology and Angiology, Medical Clinic and Policlinic B, Heinrich-Heine-University, Moorenstr. 5, D-40225 Dusseldorf, Germany. hennersdorf@med.uni-duesseldorf.de
Background:
The chemoreflex sensitivity as a marker of a disturbed vagal reflex activity has proved to be a parameter of increased risk for ventricular tachyarrhythmias or sudden cardiac death. The sensitivity of patients with prior myocardial infarction concerning ventricular tachyarrhythmias amounted to about 70%. This prospective study should evaluate the positive predictive accuracy of this new method in patients at risk for ventricular arrhythmias.
Methods:
42 patients were enrolled into this study. All had a prior myocardial infarction at least 6 months previously; 35 patients were resuscitated from sudden cardiac death, and seven patients had documented monomorphic ventricular tachycardias. All patients were recipients of an ICD. The chemoreflex sensitivity was measured by determination of the venous partial pressure of oxygen and the heart rate before and after inhalation of pure oxygen. The difference in the RR-intervals before and after inhalation divided by the difference in the oxygen pressures were calculated as the chemoreflex sensitivity [ms/mmHg]. Furthermore, in all patients additional risk stratifiers used in this study were the presence of ventricular late potentials (LP), the short-term heart rate variability (HRV), the baroreflex sensitivity (BRS) and a decreased left ventricular function (ejection fraction<40%, EF).
Results:
The chemoreflex sensitivity in the patient group as a whole amounted to 2.59+/-2.06 ms/mmHg. During follow-up, out of the 42 patients enrolled, 20 had a documented arrhythmic event (AE: sustained ventricular tachycardia or ventricular fibrillation). Patients with and without AE showed significantly different values of chemoreflex sensitivity (1.58+/-1.09 vs. 3.51+/-2.31 ms/mmHg, P<0.01) and EF (33.3+/-15.6 vs. 47.9+/-17.9%, P<0.05), but not of LP, HRV or BRS. The relative risk of reduced chemoreflex sensitivity concerning an AE amounted to 2.83 (95% CI 0.99-8.01).
Conclusions:
The chemoreflex sensitivity as a marker of increased risk for ventricular tachyarrhythmias shows a high positive predictive power in patients with prior myocardial infarction and who previously survived ventricular tachyarrhythmias. These results should be confirmed by studies in broad populations and without survived arrhythmic event.