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Arrhythmia Watch Editorial Staff

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Excessive Heart Rates May Signal Sudden Death Risk

Data from the Paris Prospective Study (1) shows a higher risk for sudden death for those apparently healthy individuals whose heart rate responses are exaggerated under mild mental stress and below normal during peak exercise. Heart rate changes before an exercise test may therefore provide a simple tool for risk stratification.

The early identification, within the general and apparently healthy population, of the subjects at high risk of sudden death during acute myocardial ischaemia remains a major challenge for contemporary cardiology.

These French workers have previously tested the association between sudden death risk and heart rate increase during physical stress and have shown that an insufficient increase in heart rate during strenuous exercise is predictive of sudden death in a healthy population. Compared with heart rate recorded at rest, heart rate increases usually by a few beats per min just before the exercise test, while the subjects are preparing themselves mentally for exercise. This was considered this as a ‘mild mental stress’ in preparation for exercise. Whereas numerous studies have focused on the well-documented relationship between a major stress (e.g. earthquakes, strenuous exercise) and sudden death, the potential of a mild mental stress has not been investigated in the general population. The potential destabilizing effects of mild mental stress on ventricular arrhythmias has been only described in very high-risk patients with implanted cardioverter-defibrillators (ICDs).

The aim of this study involves the early identification, among apparently healthy individuals, of those at high risk for sudden cardiac death. They tested the hypothesis that individuals who respond to mild mental stress in preparation for exercise test with the largest heart rate increases might be at highest risk.

Data from 7746 civil servants participating in the Paris Prospective Study I, followed-up for 23 years, allowed to compare heart rate changes between rest and mild mental stress (preparation prior to an exercise test) between subjects who suffered sudden cardiac death (n = 81), non-sudden (n = 129) coronary death, or death from any cause (n = 1306). The mean heart rate increase during mild mental stress was 8.9 + 10.8 b.p.m. Risk of sudden cardiac death increased progressively with heart rate increase during mental stress and the relative risk of the third vs. the first tertile was 2.09 after adjustment for confounders. This relationship was not observed for non-sudden coronary death.

The highest proportion of sudden deaths was found among the subjects who increased their heart rates the most during mental stress and the least during exercise.

The present findings carry important implications. Heart rate is an easy and inexpensive measurement. An important heart rate increase produced by a mild mental stress predicts long-term risk for sudden cardiac death. Heart rate changes before an exercise test may provide a simple tool for risk stratification.

Reference:

Excessive heart rate increase during mild mental stress in preparation for exercise predicts sudden death in the general population. Jouven X, Schwartz J, Escoland S, et al. European Heart Journal (2009) 30, 1703 – 1710.

Published on: August 19, 2009

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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