Rozen Guy, Kobo Roi, Beinart Roy, Feldman Shlomo, Sapunar Michal, Luria David, Eldar Michael, Levitan Jacob, Glikson Michael
Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Pacing Clin Electrophysiol. 2013 Nov;36(11):1342-7. doi: 10.1111/pace.12180. Epub 2013 May 28.
Contemporary implantable cardiac defibrillators (ICD) enable storage of multiple, preepisode R-R recordings in patients who suffered from ventricular tachyarrhythmia (VTA). Timely prediction of VTA, using heart rate variability (HRV) analysis techniques, may facilitate the implementation of preventive and therapeutic strategies.
To evaluate the novel multipole method of the HRV analysis in prediction of imminent VTAs in ICD patients.
We screened patients from the Biotronik HAWAI Registry (Heart Rate Analysis with Automated ICDs). A total of 28 patients from the HAWAI registries (phase I and II), having medical records, who had experienced documented, verified VTA during the 2-year follow-up, were included in our analysis. HRV during preepisode recordings of 4,500 R-R intervals were analyzed using the Dyx parameter and compared to HRV of similar length recordings from the same patients that were not followed by arrhythmia.
Our study population consisted mainly of men 25 of 28 (89%), average age of 64.8 ± 9.4 years, 92% with coronary artery disease. HRV during 64 preevent recordings (2.3 events per patient on average) was analyzed and compared with 60 control recordings. The multipole method of HRV analysis showed 50% sensitivity and 91.6% specificity for prediction of ventricular tachycardia/ventricular fibrillation in the study population, with 84.5% positive predictive value. No statistically significant correlation was found between various clinical parameters and the sensitivity of imminent VTA predetection in our patients.
The multipole method of HRV analysis emerges as a highly specific, possible predictor of imminent VTA, providing an early warning allowing to prepare for an arrhythmic episode.
当代植入式心脏除颤器（ICD）能够存储室性快速心律失常（VTA）患者发作前的多个R-R记录。使用心率变异性（HRV）分析技术对VTA进行及时预测，可能有助于实施预防和治疗策略。
评估HRV分析的新型多极方法在预测ICD患者即将发生的VTA中的作用。
我们从百多力HAWAI注册研究（使用自动ICD进行心率分析）中筛选患者。共有28名来自HAWAI注册研究（I期和II期）且有病历记录、在2年随访期间经历过记录在案且经证实的VTA的患者纳入我们的分析。使用Dyx参数分析4500个R-R间期发作前记录期间的HRV，并与同一患者未发生心律失常的相似长度记录的HRV进行比较。
我们的研究人群主要为男性，28名中有25名（89%），平均年龄64.8±9.4岁，92%患有冠状动脉疾病。分析了64次事件前记录期间的HRV（平均每位患者2.3次事件），并与60次对照记录进行比较。HRV分析的多极方法在研究人群中对室性心动过速/心室颤动预测的敏感性为50%，特异性为91.6%，阳性预测值为84.5%。在我们的患者中，未发现各种临床参数与即将发生的VTA预检测敏感性之间存在统计学显著相关性。
HRV分析中的多极方法是即将发生的VTA的一种高度特异性的可能预测指标，可提供早期预警，以便为心律失常发作做好准备。
