Multipole Analysis of Heart Rate Variability as a Predictor of Imminent Ventricular Arrhythmias in ICD Patients

Authors

  • GUY ROZEN M.D., M.H.A.,

    Corresponding author
    1. Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel
    2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
    • Address for reprints: Guy Rozen, M.D., M.H.A., Davidai Arrhythmia Center, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel. Fax: 972-77-3210038; e-mail: guyrozen@gmail.com

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  • ROI KOBO Ph.D.,

    1. Department of Physics, Ariel University Center of Samaria, Ariel, Israel
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  • ROY BEINART M.D.,

    1. Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel
    2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • SHLOMO FELDMAN M.D.,

    1. Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel
    2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • MICHAL SAPUNAR M.Sc.,

    1. Medlab LTD, Biotronik, Kochav Yair, Israel
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  • DAVID LURIA M.D.,

    1. Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel
    2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • MICHAEL ELDAR M.D.,

    1. Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel
    2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • JACOB LEVITAN Ph.D.,

    1. Department of Physics, Ariel University Center of Samaria, Ariel, Israel
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  • MICHAEL GLIKSON M.D.

    1. Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel
    2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract

Background

Contemporary implantable cardiac defibrillators (ICD) enable storage of multiple, preepisode R-R recordings in patients who suffered from ventricular tachyarrhythmia (VTA). Timely prediction of VTA, using heart rate variability (HRV) analysis techniques, may facilitate the implementation of preventive and therapeutic strategies.

Aim

To evaluate the novel multipole method of the HRV analysis in prediction of imminent VTAs in ICD patients.

Methods

We screened patients from the Biotronik HAWAI Registry (Heart Rate Analysis with Automated ICDs). A total of 28 patients from the HAWAI registries (phase I and II), having medical records, who had experienced documented, verified VTA during the 2-year follow-up, were included in our analysis. HRV during preepisode recordings of 4,500 R-R intervals were analyzed using the Dyx parameter and compared to HRV of similar length recordings from the same patients that were not followed by arrhythmia.

Results

Our study population consisted mainly of men 25 of 28 (89%), average age of 64.8 ± 9.4 years, 92% with coronary artery disease. HRV during 64 preevent recordings (2.3 events per patient on average) was analyzed and compared with 60 control recordings. The multipole method of HRV analysis showed 50% sensitivity and 91.6% specificity for prediction of ventricular tachycardia/ventricular fibrillation in the study population, with 84.5% positive predictive value. No statistically significant correlation was found between various clinical parameters and the sensitivity of imminent VTA predetection in our patients.

Conclusion

The multipole method of HRV analysis emerges as a highly specific, possible predictor of imminent VTA, providing an early warning allowing to prepare for an arrhythmic episode.

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