Baroreflex sensitivity assessed with the sequence method is associated with ventricular arrhythmias in patients implanted with a defibrillator for the primary prevention of sudden cardiac death.
BACKGROUND
Left ventricular ejection fraction lacks accuracy in predicting sudden cardiac death, resulting in unnecessary implantation of cardioverter defibrillators for the primary prevention of sudden cardiac death. Baroreflex sensitivity could help to stratify patients at risk of ventricular arrhythmia.


AIM
To assess the association between cardiac baroreflex sensitivity and ventricular arrhythmias in patients implanted with an implantable cardioverter defibrillator for the primary prevention of sudden cardiac death after myocardial infarction.


METHODS
This case-control single-centre study took place between 2015 and 2016. Cases (n=10) had experienced ventricular arrhythmias treated by the implantable cardioverter defibrillator in the previous 3 years; controls (n=22) had no arrhythmia during the same period. Baroreflex sensitivity was assessed using the temporal sequence method (mean slope) and cross-spectral analysis (low-frequency gain and high-frequency gain).


RESULTS
The mean age was 65 years; 94% of the patients were men. 24-hour Holter electrocardiogram autonomous nervous system variables, left ventricular ejection fraction and N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) concentration did not differ between cases and controls. The mean slope was lower in cases than in controls (8 vs. 15ms/mmHg [P=0.009] in the supine position; 7 vs. 12ms/mmHg [P=0.038] in the standing position). The mean slope in the supine position was still significantly different between groups after adjustment for age, left ventricular ejection fraction and NT-proBNP (P=0.03). By comparison, low-frequency gain and high-frequency gain did not differ between groups in either the supine or the standing position.


CONCLUSION
Patients with ventricular arrhythmias had a lower mean slope compared with those who were free of arrhythmia. A prospective study is needed to confirm this association.
['Garcia|Rodrigue|R|', 'Degand|Bruno|B|', 'Fraty|Mathilde|M|', 'Le Marcis|Véronique|V|', 'Bidegain|Nicolas|N|', 'Laude|Dominique|D|', 'Tavernier|Marine|M|', 'Le Gal|François|F|', 'Hadjadj|Samy|S|', 'Saulnier|Pierre-Jean|PJ|', 'Ragot|Stéphanie|S|']
D000368:Aged D001145:Arrhythmias, Cardiac D017704:Baroreflex D015415:Biomarkers D000066491:Clinical Decision-Making D003430:Cross-Sectional Studies D003645:Death, Sudden D017147:Defibrillators, Implantable D004554:Electric Countershock D004562:Electrocardiography D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D009203:Myocardial Infarction D020097:Natriuretic Peptide, Brain D018579:Patient Selection D010446:Peptide Fragments D010865:Pilot Projects D010991:Plethysmography D011237:Predictive Value of Tests D011322:Primary Prevention D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D013318:Stroke Volume D013997:Time Factors D016896:Treatment Outcome D016277:Ventricular Function, Left
Baroreflex Ventricular arrhythmia Primary prevention Sudden cardiac death Myocardial infarction Arythmies ventriculaires Baroréflexe Infarctus du myocarde Mort subite Prévention primaire