Sudden cardiac death: role of heart rate variability to identify patients at risk

Lombardi, Federico

doi:10.1016/s0008-6363(01)00221-8

Cited by 112 publications

(74 citation statements)

References 45 publications

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“…Finally, recent findings have shown a positive correlation between reduced heart rate variability caused by autonomic impairment and poor prognosis represented by increased morbidity and mortality in coronary disease, diabetes mellitus, heart failure and non-coronary sudden death; that is, the more heart rate variability is depressed, the worse the outcome [48][49][50][51][52]69,84 . In this context, it is likewise possible that the loss of homeostatic adaptive capacity dependent on changes in heart rate consequent to permanently impaired cardiac autonomic modulation capacity in Chagas disease may contribute to its progression and to increase of the cardiovascular and overall mortality and morbidity of affected subjects.…”

Section: Disturbed Cardiovascular Homeostatic Neural Regulationmentioning

confidence: 99%

“…Also, several recent observations have emerged linking unfavourable cardiovascular outcomes to cardiac dysautonomia in various pathological conditions that affect the autonomic nervous system [47][48][49][50][51][52][53] . …”

Section: Cardiac Autonomic Nervous System In Chagas Diseasementioning

confidence: 99%

“…Moreover, several studies based on heart rate variability analysis in patients with coronary disease have showed that altered autonomic influence on the heart has a key role in the vulnerability, development and maintenance of life-threatening arrhythmias, which may result in sudden death 49,50,69 . A shift of the sympatho-vagal balance toward sympathetic dominance has been demonstrated before the beginning of arrhythmic events such as ventricular tachycardia and fibrillation 50,62 . Reduced complexity of heart rate variability as assessed by nonlinear dynamic analysis has also been noted before the initiation of ventricular tachyarrhythmias in patients with Chagas heart disease, suggesting impaired cardiac autonomic control as the underlying mechanism 46 .…”

Section: Dysautonomic Arrhythmogenesis -A Working Hypothesismentioning

confidence: 99%

“…However, this was the sole index evaluated in this study and was derived from series of ECG R-R intervals employing the 24h Holter monitoring, which methodologically show some restrictions limiting the heart rate variability analysis and interpretation. To this regard, it should be reinforced that there are abundant data supporting the prognostic significance and the role as risk marker of some classical linear and newer non-linear measures of heart variability in different clinical conditions other than Chagas disease [48][49][50][51][52]69,71 . But, several factors influence the prognostic value of heart rate variability measurements when they are used in risk stratification, which among the more important are: a) the type and combination of indexes, b) the nature of the autonomic modulation that the indexes reflect, if overall or parasympathetic or sympathetic exclusive or balanced one, c) the circadian rhythm of heart rate variability, d) the epoch of evaluation during the development of the clinical, functional or pathological condition analysed, e) the severity of left ventricular dysfunction, f) the method employed to achieve, process and editing the ECG R-R intervals series, if derived from 5min short-term recording in controlled experimental setting, or long-term ambulatory 24h Holter recording under uncontrolled interfering factors and non-stationary data series, g) the nature of the selected adverse outcome 50,51,69,71 .…”

Section: Dysautonomic Arrhythmogenesis -A Working Hypothesismentioning

confidence: 99%

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Insights into the clinical and functional significance of cardiac autonomic dysfunction in Chagas disease

Junqueira Junior

2012

Rev. Soc. Bras. Med. Trop.

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INTRODUCTION: Exclusive or associated lesions in various structures of the autonomic nervous system occur in the chronic forms of Chagas disease. In the indeterminate form, the lesions are absent or mild, whereas in the exclusive or combined heart and digestive disease forms, they are often more pronounced. Depending on their severity these lesions can result mainly in cardiac parasympathetic dysfunction but also in sympathetic dysfunction of variable degrees. Despite the key autonomic effect on cardiovascular functioning, the pathophysiological and clinical significance of the cardiac autonomic dysfunction in Chagas disease remains unknown. METHODS: Review of data on the cardiac autonomic dysfunction in Chagas disease and their potential consequences, and considerations supporting the possible relationship between this disturbance and general or cardiovascular clinical and functional adverse outcomes. RESULTS: We hypothesise that possible consequences that cardiac dysautonomia might variably occasion or predispose in Chagas disease include: transient or sustained arrhythmias, sudden cardiac death, adverse overall and cardiovascular prognosis with enhanced morbidity and mortality, an inability of the cardiovascular system to adjust to functional demands and/or respond to internal or external stimuli by adjusting heart rate and other hemodynamic variables, and immunomodulatory and cognitive disturbances. CONCLUSIONS: Impaired cardiac autonomic modulation in Chagas disease might not be a mere epiphenomenon without significance. Indirect evidences point for a likely important role of this alteration as a primary predisposing or triggering cause or mediator favouring the development of subtle or evident secondary cardiovascular functional disturbances and clinical consequences, and influencing adverse outcomes.

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Section: Disturbed Cardiovascular Homeostatic Neural Regulationmentioning

confidence: 99%

Section: Cardiac Autonomic Nervous System In Chagas Diseasementioning

confidence: 99%

Section: Dysautonomic Arrhythmogenesis -A Working Hypothesismentioning

confidence: 99%

Section: Dysautonomic Arrhythmogenesis -A Working Hypothesismentioning

confidence: 99%

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Insights into the clinical and functional significance of cardiac autonomic dysfunction in Chagas disease

Junqueira Junior

2012

Rev. Soc. Bras. Med. Trop.

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“…Previous models of cardiac electrical and mechanical activities [8,9,21,23] will be used as reference to create the new coupled multi-resolution model.…”

Section: Renal Modulementioning

confidence: 99%

SAPHIR - a multi-scale, multi-resolution modeling environment targeting blood pressure regulation and fluid homeostasis

Thomas

Abdulhay

Baconnier

et al. 2007

2007 29th Annual International Conference of the IEEE Engineering in Medicine and Biology Society

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Abstract-We present progress on a comprehensive, modular, interactive modeling environment centered on overall regulation of blood pressure and body fluid homeostasis. We call the project SAPHIR, for "a Systems Approach for PHysiological Integration of Renal, cardiac, and respiratory functions". The project uses state-of-the-art multi-scale simulation methods. The basic core model will give succinct input-output (reduced-dimension) descriptions of all relevant organ systems and regulatory processes, and it will be modular, multi-resolution, and extensible, in the sense that detailed submodules of any process(es) can be "plugged-in" to the basic model in order to explore, eg. system-level implications of local perturbations. The goal is to keep the basic core model compact enough to insure fast execution time (in view of eventual use in the clinic) and yet to allow elaborate detailed modules of target tissues or organs in order to focus on the problem area while maintaining the system-level regulatory compensations.

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Physiological Understanding of HRV Components

Lombardi

2004

Dynamic Electrocardiography

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Sudden cardiac death: role of heart rate variability to identify patients at risk

Cited by 112 publications

References 45 publications

Insights into the clinical and functional significance of cardiac autonomic dysfunction in Chagas disease

Insights into the clinical and functional significance of cardiac autonomic dysfunction in Chagas disease

SAPHIR - a multi-scale, multi-resolution modeling environment targeting blood pressure regulation and fluid homeostasis

Physiological Understanding of HRV Components

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