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      ACC/AHA guidelines for ambulatory electrocardiography

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          Most cited references 241

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          Frequency domain measures of heart period variability and mortality after myocardial infarction

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            The relationships among ventricular arrhythmias, left ventricular dysfunction, and mortality in the 2 years after myocardial infarction.

            We examined the relationships among ventricular arrhythmias, left ventricular dysfunction, and mortality after the occurrence of myocardial infarction in 766 patients who enrolled in a nine-hospital study and underwent two special tests. Frequency and repetitiveness of ventricular premature depolarizations (VPDs) were determined by computer analysis of predischarge 24 hr electrocardiographic recordings. The left ventricular ejection fraction (LVEF) was determined by radionuclide ventriculography and dichotomized at its optimal value of 30%. Frequency of VPDs was divided into three categories: (1) less than one per hour, (2) one to 2.9 per hour, and (3) three or more per hour. Repetitiveness of VPDs was also divided into three categories: (1) no repetitive VPDs, (2) paired VPDs, and (3) VPD runs. These variables were related, one at a time and jointly, to total mortality and to deaths caused by arrhythmias. The hazard ratios for dying in the higher or highest risk stratum vs the lower or lowest stratum for each variable (adjusted for the effects of the others) were: LVEF below 30%, 3.5; VPD runs, 1.9; and VPD frequency of three or more per hour, 2.0. There were no significant interactions among the three variables with respect to effects on the risk of mortality. There was a suggestion of an interaction between each risk variable and time after infarction. LVEF below 30% was a better predictor of early mortality (less than 6 months) and the presence of ventricular arrhythmias was a better predictor of late mortality (after 6 months).(ABSTRACT TRUNCATED AT 250 WORDS)
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              Heart rate variability: a measure of cardiac autonomic tone.

              Analysis of HRV based on routine 24-hour Holter recordings provides a sensitive, noninvasive measurement of autonomic input to the heart. HRV can be measured in the time or frequency domain. Each frequency domain variable correlates at least r = 0.85 with a time domain variable. Thus time domain measures can be used as surrogates for frequency domain measures which may simplify future studies. Abnormalities of autonomic input to the heart, which are indicated by decreased indices of HRV, are associated with increased susceptibility to ventricular arrhythmias. Decreased indices of HRV are also associated with CHF, diabetes, and alcoholic cardiomyopathy. Decreased indices of HRV are an independent risk factor for mortality post MI and in patients with advanced CHF. Medications can also affect HRV, and that effect may become an important clinical consideration, especially in high-risk patients.
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                Author and article information

                Journal
                Journal of the American College of Cardiology
                Journal of the American College of Cardiology
                Elsevier BV
                07351097
                September 1999
                September 1999
                : 34
                : 3
                : 912-948
                Article
                10.1016/S0735-1097(99)00354-X
                © 1999

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