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Preserved heart rate variability identifies low-risk patients with nonischemic dilated cardiomyopathy: results from

Eric J Rashba1, N A Mark Estes, Paul Wang

  • 1Division of Cardiology, Department of Medicine, University of Maryland at Baltimore, 22 South Greene Street, Room N3W77, Baltimore, MD 21201, USA. erashba@medicine.umaryland.edu

Heart Rhythm
|February 28, 2006
PubMed

Insights

Patients with nonischemic dilated cardiomyopathy and preserved heart rate variability (HRV) have a good prognosis and may not need an implantable cardioverter-defibrillator (ICD). Those with low HRV face higher mortality risks.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Preventive Medicine

Background:

  • Expanding indications for prophylactic implantable cardioverter-defibrillators (ICDs) in nonischemic dilated cardiomyopathy raise cost-effectiveness questions.
  • Identifying low-risk patient subgroups is crucial for optimizing prophylactic ICD therapy.

Purpose of the Study:

  • To identify patients with nonischemic dilated cardiomyopathy at low risk for adverse events who may not benefit from prophylactic ICD placement.
  • To evaluate the prognostic value of heart rate variability (HRV) in this patient population.

Main Methods:

  • Prospective analysis of 274 patients from the DEFINITE trial (Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation).
  • 24-hour Holter monitoring for heart rate variability (HRV) analysis, focusing on the standard deviation of normal R-R intervals (SDNN).
  • Kaplan-Meier survival analysis comparing mortality rates across SDNN tertiles and excluded patient groups.

Main Results:

  • A 3-year follow-up revealed significantly different mortality rates based on SDNN levels (P = .03).
  • Patients with preserved HRV (SDNN >113 ms) had 0% mortality, irrespective of ICD treatment.
  • Mortality increased with decreasing SDNN levels (<81 ms: 10%) and in patients excluded from HRV analysis (17%).

Conclusions:

  • Nonischemic dilated cardiomyopathy patients with preserved HRV demonstrate an excellent prognosis, potentially not requiring prophylactic ICDs.
  • Severely depressed HRV and exclusion from HRV analysis due to arrhythmias indicate a high-risk group with elevated mortality.
Abstract

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