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Can chronotropic incompetence predict life-threatening ventricular arrhythmias in patients with stable ischemic heart

Yelena Rib1, Gulnar Zhussupova2, Gaukhar Igimbayeva3

  • 1Astana Medical University, Astana, Kazakhstan.

Caspian Journal of Internal Medicine
|May 8, 2018
PubMed

Insights

A low chronotropic index, a measure of heart rate response during exercise, significantly increases the risk of dangerous ventricular arrhythmias in patients with stable ischemic heart disease. This finding holds true even with severe left ventricle systolic dysfunction.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Internal Medicine

Background:

  • Chronotropic incompetence is a known prognostic indicator for mortality in ischemic heart disease (IHD).
  • The relationship between chronotropic response and ventricular arrhythmias in IHD patients requires further investigation.

Purpose of the Study:

  • To examine the association between chronotropic response during exercise testing and the incidence of ventricular arrhythmias in stable ischemic heart disease patients.

Main Methods:

  • 153 stable ischemic heart disease patients were monitored for 24 months.
  • Assessments included ECG, 24-hour Holter monitoring, echocardiography, and exercise stress tests to calculate the chronotropic index.
  • Holter monitoring was repeated to detect ventricular arrhythmias.

Main Results:

  • Patients with a low chronotropic index exhibited a higher frequency of ventricular extrasystoles.
  • A low chronotropic index was associated with a >2-fold increased risk of high-grade ventricular extrasystoles (P=0.015).
  • Significantly higher risks were observed for non-sustained VT (>3 times, p<0.001) and sustained VT (>9 times, p<0.001).

Conclusions:

  • A chronotropic index below 35.6 is linked to an elevated risk of life-threatening ventricular arrhythmias.
  • This risk is present in patients with stable chronic ischemic heart disease, irrespective of left ventricle systolic dysfunction severity.
Abstract

Keywords:
Chronotropic incompetenceRisk factorStable ischemic heart diseaseVentricular arrhythmias

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