Effects of exercise-based cardiac rehabilitation on heart rate variability and turbulence in patients with ST elevation myocardial infarction

Year 2020, Volume: 6 Issue: 1, 26 - 35, 04.01.2020

İsmet Zengin , Selma Arı , Hasan Arı , Mehmet Melek

https://doi.org/10.18621/eurj.447020

Abstract

Objectives: The
objective of this study was to evaluate the effect of the exercise-based cardiac
rehabilitation (CR) on the heart rate variability (HRV) and turbulence (HRT) in
patients with ST elevation myocardial infarction (STEMI) treated with the
primary percutaneous coronary intervention (PCI).

Methods: One hundred
one patients with STEMI, who underwent primary PCI were included in our study. Sixty-eight
of these patients were randomized to the CR group and the remaining 33 patients
to the control group. One month after the primary PCI, cardiac rehabilitation
was performed in CR group with a cycle ergometer for 8 weeks (30 sessions). One
month after STEMI, rhythm Holter monitorization was carried out in both groups
for 48 hours. The rhythm Holter monitorization was repeated in cardiac
rehabilitation group (CR group) after the cardiac rehabilitation again for 48
hours. HRV was evaluated according to time and frequency domains; HRT was
evaluated with the turbulence onset and turbulence slope parameters obtained
from the Holter recordings.

Results: Baseline
characteristics and baseline HRV and HRT parameters were comparable between CR
group and control group. In CR group, there was no statistically significant
difference between the HRV and HRT parameters, which were obtained before and
after the cardiac rehabilitation. The subgroup analyses (left ventricular
ejection fraction lower or higher than 40%) showed that turbulence onset
improved with the cardiac rehabilitation in the group with an ejection fraction
lower than 40%.

Conclusions: Our
results showed that exercise-based cardiac rehabilitation did not affect HRV
and HRT in patients whose left ventricular ejection fraction was mildly
affected (> 40%) after the treatment with primary PCI. However, the cardiac
rehabilitation provided an improvement of turbulence onset in patients with the
low left ventricular ejection fraction.

Keywords

Cardiac rehabilitation, ST elevation myocardial infarction, heart rate variability, heart rate turbulence

References

• 1. Goble AJ, Worcester MUC. Best practice guidelines for cardiac rehabilitation and secondary prevention. Heart Research Center. Melbourne, on behalf of Department of Human Services Victoria; Australia, 1999. www.health.vic.gov.au.
• 2. Arat N. Akut Koroner Sendrom ve Perkütan Koroner Girişim Uygulanan Hastalarda Kardiyak Rehabilitasyon. In: Uzun M. (Eds). Kardiyak ve Pulmoner Rehabilitasyon. İstanbul, İstanbul Tıp Kitabevi. 2014; 365-90.
• 3. Malik M, Wichterle D, Schmidt G. Heart rate turbulence. G Ital Cardiol 1999;29:65-9.
• 4. Schwartz PJ, La Rovere MT, Vanoli E. Autonomic nervous system mechanisms and sudden cardiac death: Experimental basis and clinical observations for post-myocardial infarction risk stratification. Circulation 1992;85(1 Suppl): I77-91.
• 5. La Rovere MT, Bigger JT Jr, Marcus FI, Mortara A, Schwartz PJ. Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (The Autonomic Tone and Reflexes After Myocardial Infarction) Investigators. Lancet 1998;351:478-84.
• 6. Lin LY, Lai LP, Lin JL, Du CC, Shau WY, Chan HL, et al. Tight mechanism correlation between heart rate turbulence and baroreflex sensitivity: sequential autonomic blockade analysis. J Cardiovasc Electrophysiol 2002;13:427-31.
• 7. Priori SG, Aliot E, Blomstrom-Lundqvist C, Bossaert L, Breithardt G, Brugada P, et al. Task Force on Sudden Cardiac Death of the European Society of Cardiology. Eur Heart J 2001;22:1374-450.
• 8. Watanabe MA, Schmidt G. Heart rate turbulence: a 5-year review. Heart Rhythm 2004;1:732-8.
• 9. Goel K, Lennon RJ, Tilbury TR, Squires RW, Thomas RJ. Impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the community. Circulation 2011;123:2344-52.
• 10. Kleiger RE, Miller JP, Bigger JT Jr, Moss AJ. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol 1987;59:256-62.
• 11. Oliveira NL, Ribeiro F, Teixeira M, Campos L, Alves AJ, Silva G, et al. Effect of 8-week exercise-based cardiac rehabilitation on cardiac autonomic function: A randomized controlled trial in myocardial infarction patients. Am Heart J 2014;167:753-61.
• 12. Lampert R, Ickovics JR, Viscoli CJ, Horwitz RI, Lee FA. Effects of propranolol on recovery of heart rate variability following acute myocardial infarction and relation to outcome in Beta-Blocker Heart Attack Trial. Am J Cardiol 2003;91:137-42.
• 13. Binkley PF, Haas GJ, Starling RC, Nunziata E, Hatton PA, Leier CV, et al. Sustained augmentation of parasympathetic tone with angiotensin-converting enzyme inhibition in patients with congestive heart failure. J Am Coll Cardiol 1993;21:655-61.
• 14. Mortara A, Specchia G, La Rovere MT, Bigger JT Jr, Marcus FI, Camm JA, et al. Patency of infarct-related artery: effects of restoration of anterograde flow on vagal reflexes. ATRAMI (Automatic Tone and Reflexes After Myocardial Infarction) Investigators. Circulation 1996;93:111-22.
• 15. Bonnemeier H, Wiegand UKH, Friedlbinder J, Schulenburg S, Hartmann F, Bode F, et al. Reflex cardiac activity in ischemia and reperfusion heart rate turbulence in patients undergoing direct percutaneous coronary intervention for acute myocardial infarction. Circulation 2003;108:958-64.
• 16. Trzos E, Krzemińska-Pakuła M, Rechciński T, Drozdz J, Kurpesa M. Heart rate turbulence in patients with chronic heart failure. Kardiol Pol 2008;66:1183-90.