Diurnal variation of ventricular response to atrial fibrillation in patients with advanced heart failure.
Variability of ventricular rate was quantified by two measures of heart rate variability: the SD of the mean R-R interval (SDNN) and the SD of the 5-minute mean R-R interval (SDANN). In 35 patients with atrial fibrillation and advanced heart failure (left ventricular ejection fraction 20% +/- 9%, cardiac index 2.4 +/- 0.7 L/min/m2), SDNN and SDANN were compared to 13 preselected clinical and hemodynamic variables for prediction of outcome. During a 12-month follow-up period, 8 (23%) patients deteriorated clinically; 3 (9%) died, and 5 (14%) underwent heart transplantation. SDNN and SDANN correlated to the difference of the mean R-R interval between night (2 AM to 3 PM) and day (11 AM to noon) with r values of 0.62 and 0.77, respectively. From 15 preselected variables, only SDANN (chi 2 = 6.7, p = 0.01) was independently associated with survival on multivariate analysis. Dichotomized SDANN at 100 msec accurately predicted 12-month survival in 28 (80%) patients (relative risk = 9.77, p = 0.001). In conclusion, analysis of heart rate variability is useful in quantifying diurnal variation of ventricular rate in atrial fibrillation and might be useful in predicting survival in patients with advanced heart failure.
Frey
B
B
Department of Internal Medicine II, University of Vienna, Austria.
Heinz
G
G
Binder
T
T
Wutte
M
M
Schneider
B
B
Schmidinger
H
H
Weber
H
H
Pacher
R
R
D000368:Aged; D001281:Atrial Fibrillation / Q000401:mortality / Q000503:physiopathology*; D006328:Cardiac Catheterization; D002908:Chronic Disease; D002940:Circadian Rhythm / Q000502:physiology*; D015716:Electrocardiography, Ambulatory; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013223:Statistics as Topic; D016276:Ventricular Function / Q000502:physiology*