Heart rate variability (HRV) is strongly correlated with fatal arrhythmias and sudden cardiac death. Therefore, it has been used to screen candidates for implantable cardioverter-defibrillators (ICDs). Although HRV measurements are non-invasive and may provide useful prognostic information, it may not be safe to select patients for therapy based on HRV measurements alone.
In the Defibrillator in Acute Myocardial Infarction Trial (DINAMIT), altered HRV was used to select candidates for ICD placement in survivors of acute myocardial infarction (MI or heart attack). Although there were fewer deaths among ICD patients than in non-ICD patients, this decreased death was offset by more deaths from nonarrhythmic causes. In the AzimiLide post Infarct surVival Evaluation (ALIVE) trial, stratifying (ranking) patients according to HRV also did not affect death rates in patients treated with azimilide (an antiarrhythmic drug). This may be because HRV has not yet been optimized for predicting death from non-arrhythmic effects of drugs.
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