The role of variability in night-time mean heart rate on the prediction of ventricular arrhythmias and all-cause mortality in implantable cardioverter defibrillator patients

Abstract

Aims: This study was to use implantable cardioverter defibrillator (ICD) home monitoring (HM) feature to evaluate the role of mean night-time heart rate (MNHR) in the occurrence of ventricular arrhythmias (VAs) and mortality.

Methods and results: This study retrospectively analysed clinical and ICD device data in 318 ICD patients. Data of the first 30-day MNHR (recorded 02:00-06:00 am) by HM were collected. The average and standard deviation of 30-day MNHR (AVHR and SDHR, respectively) were then determined in each patient. The primary endpoint was appropriate ICD treatment of VAs. The secondary endpoint was all-cause mortality. During a mean follow-up period of 32 ± 10 months, 179 of the 318 patients (56.3%) experienced VAs, 123 patients (38.7%) were treated by ICD shocks, and 37 patients (11.6%) died. The overall SDHR in this study cohort was 4.5 ± 3.0 bpm. Based on the receiver operating characteristic curve, the cut-off value of SDHR = 3.685 bpm was identified to predict VAs. In the Kaplan-Meier survival, SDHR ≥ 3.685 bpm was associated with increased VAs [hazard ratio (HR) = 1.885; 95% confidence interval (CI) = 1.362-2.609; P < 0.001], shock events (HR = 1.637; 95% CI = 1.11-2.414; P = 0.013), all-cause mortality (HR = 2.42; 95% CI = 1.266-4.627; P = 0.008), and the combined endpoints (HR = 1.872; 95% CI = 1.365-2.567; P < 0.001). In univariate and multivariate Cox models (adjusting for clinical factors), SDHR ≥ 3.685 bpm was still an independent predictor for all endpoints.

Conclusion: In ICD population, SDHR ≥ 3.685 bpm was an independent predictor for VAs and all-cause mortality.

Keywords: Heart rate variability; Home monitoring; Implantable cardioverter defibrillator; Night-time heart rate; Ventricular arrhythmias.