title: Impaired cardiac autonomic nervous activity predicts sudden cardiac death in patients with operated and unoperated congenital cardiac disease.
abstract: OBJECTIVE
  Sudden cardiac death is a leading cause of mortality in patients with congenital cardiac disease after surgical correction and is potentially preventable. The identification of patients at risk is therefore of major interest. We sought to assess the prognostic value of impaired cardiac autonomic nervous activity in patients with congenital cardiac disease.
  
  
  METHODS
  Forty-three consecutive patients with congenital cardiac disease were included in this prospective study. Parameters of heart rate turbulence and heart rate variability were calculated from Holter electrocardiograms. In addition, serum brain natriuretic peptide levels were measured. A combined end point of sudden cardiac death or nearly missed sudden cardiac death was used.
  
  
  RESULTS
  During a mean follow up of 27 +/- 12.7 months, 5 patients died, and another 2 were successfully resuscitated. On univariate analysis, both brain natriuretic peptide levels and parameters of heart rate variability and heart rate turbulence were associated with impaired prognosis. On multivariate analysis, pathologic heart rate turbulence was found to be the strongest independent risk stratifier (hazard ratio, 61.5; P < .001).
  
  
  CONCLUSIONS
  Impaired cardiac autonomic nervous activity is associated with an increased risk of sudden cardiac death in congenital cardiac disease. Our results suggest that heart rate turbulence might be superior to established markers of cardiac autonomic dysfunction, such as heart rate variability. The combined use of heart rate turbulence, heart rate variability, and markers of neurohormonal activation, such as brain natriuretic peptide, might further improve the prognostic value.
authors.affiliation: Klinik für Kinderkardiologie und angeborene Herzfehler, Deutsches Herzzentrum München, Klinik an der Technischen Universität München, Germany.
authors.forename: Astrid
authors.initials: A
authors.lastname: Lammers
authors.forename: Harald
authors.initials: H
authors.lastname: Kaemmerer
authors.forename: Regina
authors.initials: R
authors.lastname: Hollweck
authors.forename: Raphael
authors.initials: R
authors.lastname: Schneider
authors.forename: Petra
authors.initials: P
authors.lastname: Barthel
authors.forename: Siegmund
authors.initials: S
authors.lastname: Braun
authors.forename: Annette
authors.initials: A
authors.lastname: Wacker
authors.forename: Silke
authors.initials: S
authors.lastname: Brodherr-Heberlein
authors.forename: Michael
authors.initials: M
authors.lastname: Hauser
authors.forename: Andreas
authors.initials: A
authors.lastname: Eicken
authors.forename: Georg
authors.initials: G
authors.lastname: Schmidt
authors.forename: John
authors.initials: J
authors.lastname: Hess
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000503:physiopathology*; D016757:Death, Sudden, Cardiac / Q000209:etiology; D005260:Female; D006321:Heart / Q000294:innervation* / Q000503:physiopathology*; D006331:Heart Diseases / Q000150:complications / Q000151:congenital* / Q000601:surgery*; D006339:Heart Rate; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies