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Abstract
In the United States, sudden cardiac death is a major public health problem, accounting
for approximately 300,000 deaths annually. Accurate identification of those patients
at highest risk for this event has been problematic. The use of signal-averaged electrocardiography,
Holter monitoring and assessment of left ventricular function have been shown to be
predictive of future arrhythmic events in patients after a myocardial infarction.
However, the clinical utility of these tests has been limited by their low sensitivity
and positive predictive value. It has become increasingly clear that the autonomic
nervous system is extremely important in the pathogenesis of ventricular arrhythmias
and sudden cardiac death. The two most important techniques used to study the autonomic
nervous system--heart rate variability and baroreflex sensitivity--are reviewed, and
the clinical and experimental data suggesting that these techniques are powerful predictors
of future arrhythmic events are discussed in depth.