Document Detail


A phenomenon of heart-rate turbulence, its evaluation, and prognostic value.
MedLine Citation:
PMID:  12114848     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Identification of high-risk cardiac patients is crucial for stratification strategies and prevention of cardiovascular events, including death. Single ventricular premature beat triggers some oscillations in cardiac cycle duration (the shortening followed by the lengthening of the cycle intervals) in healthy subjects and low-risk patients with ischaemic heart disease and/or heart failure. This phenomenon is called heart-rate turbulence (HRT). It was shown in retrospective and prospective studies that the absence of HRT is associated with increased risk of subsequent mortality in cardiac patients. HRT can be quantified by two variables: turbulence onset (TO), describing an early acceleration phase, and turbulence slope (TS), describing a late deceleration phase of heart rate after ventricular premature beat. Both TO and TS are independent one from another and from other conventional risk predictors. The combination of TO and TS seems to be the strongest Holter-based risk predictor and has some addictive predictive value to left ventricular ejection fraction, heart rate variability, and the averaged diurnal heart rate and baroreflex sensitivity. In addition, HRT has a predictive value in patients treated with beta-blockers and amiodarone. Moreover, it is thought that HRT is mediated by baroreflex and therefore can be used as a non-invasive measure of its sensitivity and autonomic nervous system function. Blunted HRT can be observed in diabetic patients with autonomic dysfunction and in patients with atropine-blocked vagal nerve activity. Moreover, it seems that a diurnal variation of HRT exists because it is better expressed during sleep. However, the use of HRT is limited to patients with dominant sinus rhythm and the presence of single ventricular beat. Nevertheless, the assessment of HRT is an inexpensive and simple method and can be performed with a routine ambulatory 24-hour ECG recording.
Authors:
Przemysław Guzik; Georg Schmidt
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Cardiac electrophysiology review     Volume:  6     ISSN:  1385-2264     ISO Abbreviation:  Card Electrophysiol Rev     Publication Date:  2002 Sep 
Date Detail:
Created Date:  2002-07-12     Completed Date:  2003-04-15     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9708907     Medline TA:  Card Electrophysiol Rev     Country:  United States    
Other Details:
Languages:  eng     Pagination:  256-61     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Intensive Therapy, K. Marcinkowski's University School of Medical Sciences in Poznań, Poland. pguzik@ptkardio.pl
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MeSH Terms
Descriptor/Qualifier:
Arrhythmias, Cardiac / physiopathology*
Autonomic Nervous System / physiology
Baroreflex / physiology
Electrocardiography, Ambulatory / methods*
Heart Conduction System / physiopathology*
Heart Rate / physiology*
Humans
Predictive Value of Tests
Prognosis

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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