Complex Heart Rate Control in Patients with Acute Coronary Syndrome

Abstract Background Previous studies highlighted the importance of adequate heart rate control in heart failure patients, and suggested under-treatment with beta-blockers especially in women. However, data on women achieving effective heart rate control during beta-blocker therapy optimization are lacking. Methods The wearable cardioverter defibrillator (WCD) allows continuous monitoring of heart rate (HR) trends during WCD use. In the current study, we assessed resting HR trends (nighttime: midnight-7am) in women, both at the beginning of WCD use and at the end of WCD use to assess the adequacy of beta-blockade following a typical 3 months of therapy optimization with beta-blockers. An adequate heart rate control was defined as having a nighttime HR <70 bpm at the end of the 3 months. Results There were a total of 21,453 women with at least 30 days of WCD use (>140 hours WCD use on the first and last week). The mean age was 67 years (IQR 58–75). The mean nighttime heart rate was 72 bpm (IQR 65–81) at the beginning of WCD use, that decreased to 68 bpm (IQR 61–76) at the end of WCD use with therapy optimization. Women had an insufficient heart rate control with resting heart rate ≥70 bpm in 59% at the beginning of WCD use that decreased to 44% at the end of WCD use, but still remained surprisingly high. Interestingly, there were 21% of the women starting with HR ≥70 bpm at the beginning of use (BOU) who achieved adequate heart rate control by the end of use (EOU). Interestingly, 6% of women with adequate heart rate control at the start of therapy optimization ended up having higher heart rates >70 bpm at the end of the therapy optimization time period (Figure). Figure 1 Conclusions A significant proportion of women with heart failure and low ejection fraction do not reach an adequate heart rate control during the time of beta blocker initiation/titration. The wearble cardioverter defibrillator is a monitoring device that has been demonstrated in this study to appropriately identify patients with inadequate heart rate control at the end of the therapy optimization period. The WCD could be utilized to improve management of beta-blocker therapy in women and improve the achievement of adequate heart rate control in women.

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Heart rate control with oral metoprolol in a patient with Short Bowel Syndrome

Scandinavian Journal of Gastroenterology ◽

10.1080/00365521.2016.1230780 ◽

2016 ◽

Vol 52 (1) ◽

pp. 92-92

Author(s):

Espen Skarstein Kolberg ◽

Monica Sue-Chu ◽

Astrid Rydning

Keyword(s):

Heart Rate ◽

Short Bowel Syndrome ◽

Rate Control ◽

Heart Rate Control ◽

Short Bowel

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PROGNOSTIC ROLE OF ATRIAL FIBRILLATION AND HEART RATE CONTROL IN CHRONIC HEART FAILURE PATIENTS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(13)60735-4 ◽

2013 ◽

Vol 61 (10) ◽

pp. E735

Author(s):

Savina Nodari ◽

Marco Triggiani ◽

Laura Lupi ◽

Alessandra Manerba ◽

Giuseppe Milesi ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Heart Rate ◽

Chronic Heart Failure ◽

Rate Control ◽

Heart Rate Control ◽

Prognostic Role ◽

Heart Failure Patients

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Altered Dynamic Heart Rate Control in M2-Muscarinic Acetylcholine Receptor Knockout Mice

Medicine & Science in Sports & Exercise ◽

10.1249/00005768-200611001-00137 ◽

2006 ◽

Vol 38 (Suppl 1) ◽

pp. S35

Author(s):

Hirotsugu Tsuchimochi ◽

James T. Pearson ◽

Minoru Matsui ◽

Daryl O. Schwenke ◽

Hidezo Mori ◽

...

Keyword(s):

Heart Rate ◽

Acetylcholine Receptor ◽

Knockout Mice ◽

Rate Control ◽

Muscarinic Acetylcholine Receptor ◽

Heart Rate Control ◽

Muscarinic Acetylcholine

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Characteristics of heart rate variability in patients with acute coronary syndrome without ST segment elevation in comparison with clinical and biochemical parameters

I P Pavlov Russian Medical Biological Herald ◽

10.17816/pavlovj35173 ◽

2021 ◽

Vol 29 (3) ◽

pp. 369-378

Author(s):

Aleksej A. Nizov ◽

Aleksej I. Girivenko ◽

Mihail M. Lapkin ◽

Aleksej V. Borozdin ◽

Yana A. Belenikina ◽

...

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Acute Coronary Syndrome ◽

Creatine Phosphokinase ◽

Spectral Power ◽

Low Frequency ◽

Heart Rhythm ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment

BACKGROUND: The search for rational methods of primary, secondary, and tertiary prevention of coronary heart disease. To date, there are several publications on heart rate variability in ischemic heart disease. AIM: To study the state of the regulatory systems in the organism of patients with acute coronary syndrome without ST segment elevation based on the heart rhythm, and their relationship with the clinical, biochemical and instrumental parameters of the disease. MATERIALS AND METHODS: The open comparative study included 76 patients (62 men, 14 women) of mean age, 61.0 0.9 years, who were admitted to the Emergency Cardiology Department diagnosed of acute coronary syndrome without ST segment elevation. On admission, cardiointervalometry was performed using Varicard 2.51 apparatus, and a number of clinical and biochemical parameters were evaluated RESULTS: Multiple correlations of parameters of heart rate variability and clinical, biochemical and instrumental parameters were observed. From this, a cluster analysis of cardiointervalometry was performed, thereby stratifying patients into five clusters. Two extreme variants of dysregulation of the heart rhythm correlated with instrumental and laboratory parameters. A marked increase in the activity of the subcortical nerve centers (maximal increase of the spectral power in the very low frequency range with the underlying reduction of SDNN) in cluster 1 was associated with reduction of the left ventricular ejection fraction: cluster 147.0 [40.0; 49.0], cluster 260.0 [58.0; 64.0], cluster 360.0 [52.5; 64.5] % (the data are presented in the form of median and interquartile range; Me [Q25; Q75], p 0,05). Cluster 5 showed significant reduction in SDNN (monotonous rhythm), combined with increased level of creatine phosphokinase (CPC): cluster 5446,0 [186.0; 782.0], cluster 4141.0 [98.0; 204.0] IU/l; Me [Q25; Q75], p 0.05) and MВ-fraction of creatine phosphokinase; cluster 532.0 [15.0; 45.0], 4 cluster 412.0 [9.0; 18.0] IU/l; Me [Q25; Q75], p 0.05). CONCLUSIONS: In patients with acute coronary syndrome without ST segment elevation, cluster analysis of parameters of heart rate variability identified different peculiarities of regulation of the heart rhythm. Pronounced strain of the regulatory systems of the body was found to be associated with signs of severe pathology: the predominance of VLF (spectral power of the curve enveloping a dynamic range of cardiointervals in the very low frequency range) in spectral analysis with an underlying reduced SDNN is characteristic of patients with a reduced ejection fraction, and a monotonous rhythm is characteristic of patients with an increased level of creatine phosphokinase and MB-fraction of creatine phosphokinase.

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