Heart Rate Variability in a Progressive Heart Failure Model with Rapid Ventricular Pacing
DOI:
https://doi.org/10.1532/HSF98.20081058Abstract
Background: Heart rate variability (HRV) is an indicator of autonomic nervous system functionality and a recognized predictor of cardiac death; however, the changes in HRV occurring in progressive heart failure are not fully understood. The purpose of this study was to evaluate the progressive changes of autonomic system activity in progressive heart failure by rapid ventricular pacing in an animal model.
Methods: Heart failure was induced in 13 mongrel dogs (27.8 ± 3.7 kg) by rapid ventricular pacing (230 beats/min) for 4 weeks and maintenance of pacing at a reduced rate (190 beats/min) for 2 weeks. Time domain analysis and spectral analysis of HRV were performed with the MemCalc system after 30 minutes of pacing cessation every week. Hemodynamic and echocardiographic data were obtained before and after induction of heart failure.
Results: Cardiac output decreased significantly (3.6 L/min versus 1.6 L/min, P < .001) after 6 weeks of ventricular pacing. Significantly increased were the heart rate (126 beats/min versus 138 beats/min, P < .05), left ventricular end-diastolic pressure (9.1 mm Hg versus 30.9 mm Hg, P < .001), and pulmonary capillary wedge pressure (8.0 mm Hg versus 18.7 mm Hg, P < .001). High-frequency components progressively decreased. Low-frequency components progressively decreased except at 5 weeks after the pacing. A ratio of low- to high-frequency components increased in moderate heart failure and decreased in severe heart failure.
Conclusions: Changes in the high-frequency component and low-frequency component are important for assessing heart failure in progressive heart failure. Serial follow-up measurements of HRV might be helpful for patients with such disease.
References
Galinier M, Pathak A, Fourcade J, et al. 2000. Depressed low frequency power of heart rate variability as an independent predictor of sudden death in chronic heart failure. Eur Heart J21:475-82.nHoffmann J, Grimm W, Menz V, Müller HH, Maisch B. 2000. Heart rate variability and baroreflex sensitivity in idiopathic dilated cardiomyopathy. Heart83:531-8.nLampert R, Ickovics JR, Viscoli CJ, Horwitz RI, Lee FA. 2003. Effects of propranolol on recovery of heart rate variability following acute myocardial infarction and relation to outcome in the Beta-Blocker Heart Attack Trial. Am J Cardiol91:137-42.nLucreziotti S, Gavazzi A, Scelsi L, et al. 2000. Five-minute recording of heart rate variability in severe chronic heart failure: correlates with right ventricular function and prognostic implications. Am Heart J139:1088-95.nMotte S, Mathieu M, Brimioulle S, et al. 2005. Respiratory-related heart rate variability in progressive experimental heart failure. Am J Physiol Heart Circ Physiol289:H1729-35.nArmstrong PW, Stopps TP, Ford SE, de Bold AJ. 1986. Rapid ventricular pacing in the dog: pathophysiologic studies of heart failure. Circulation74:1075-84.nAronson D, Burger AJ. 2001. Effect of beta-blockade on heart rate variability in decompensated heart failure. Int J Cardiol79:31-9.nBinkley PF, Nunziata E, Haas GJ, Nelson SD, Cody RJ. 1991. Parasympathetic withdrawal is an integral component of autonomic imbalance in congestive heart failure: demonstration in human subjects and verification in a paced canine model of ventricular failure. J Am Coll Cardiol18:464-72.nBullinga JR, Alharethi R, Schram MS, Birstow MR, Gilbert EM. 2005. Changes in heart rate variability are correlated to hemodynamic improvement with chronic CARVEDILOL therapy in heart failure. J Card Fail11:693-9.nCasolo GC, Stroder P, Sulla A, Chelucci A, Freni A, Zerauschek M. 1995. Heart rate variability and functional severity of congestive heart failure secondary to coronary artery disease. Eur Heart J16:360-7.nCoumel P, Leenhardt A. 1991. Mental activity, adrenergic modulation, and cardiac arrhythmias in patients with heart disease. Circulation83 (4 Suppl):II58-70.nEaton GM, Cody RJ, Nunziata E, Binkley PF. 1995. Early left ventricular dysfunction elicits activation of sympathetic drive and attenuation of parasympathetic tone in the paced canine model of congestive heart failure. Circulation92:555-61.nIshise H, Asanoi H, Ishizaka S, et al. 1998. Time course of sympathovagal imbalance and left ventricular dysfunction in conscious dogs with heart failure. J Appl Physiol84:1234-41.nKanaya N, Hirata N, Kurosawa S, Nakayama M, Namiki A. 2003. Differential effects of propofol and sevoflurane on heart rate variability. Anesthesiology98:34-40.nKawasaki T, Azuma A, Sakatani T, et al. 2003. Prognostic value of heart rate variability in patients with hypertrophic cardiomyopathy. J Electrocardiol36:333-8.nNolan J, Batin PD, Andrews R, et al. 1998. Prospective study of heart rate variability and mortality in chronic heart failure: results of the United Kingdom Heart Failure Evaluation and Assessment of Risk Trial (UK-HEART). Circulation98:1510-6.nPetretta M, Spinelli L, Marciano F, et al. 2000. Effects of losartan treatment on cardiac autonomic control during volume loading in patients with DCM. Am J Physiol Heart Circ Physiol279:H86-92.nPonikowski P, Anker SD, Amadi A, et al. 1996. Heart rhythms, ventricular arrhythmias, and death in chronic heart failure. J Card Fail2:177-83.nPonikowski P, Anker SD, Chua TP, et al. 1997. Depressed heart rate variability as an independent predictor of death in chronic congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol79:1645-50.nScalvini S, Volterrani M, Zanelli E, et al. 1998. Is heart rate variability a reliable method to assess autonomic modulation in left ventricular dysfunction and heart failure? Assessment of autonomic modulation with heart rate variability. Int J Cardiol67:9-17.nSchwartz PJ, La Rovere MT, Vanoli E. 1992. Autonomic nervous system and sudden cardiac death: experimental basis and clinical observations for postmyocardial infarction risk stratification. Circulation85 (1 Suppl):I77-91.nTakagaki M, McCarthy PM, Tabata T, et al. 2002. Induction and maintenance of an experimental model of severe cardiomyopathy with a novel protocol of rapid ventricular pacing. J Thorac Cardiovasc Surg123:544-9.nTakusagawa M, Komori S, Umetani K, et al. 1999. Alterations of autonomic nervous activity in recurrence of variant angina. Heart82:75-81.n
