Arrhythmias and heart rate variability during and after therapeutic hypothermia for cardiac arrest

Objective: To evaluate the effects of therapeutic hypothermia (HT) of 33 degrees C after cardiac arrest (CA) on cardiac arrhythmias, heart rate variability (HRV), and their prognostic value. Design: Prospective, comparative substudy of a randomized controlled trial of mild HT after out-of-hospital CA, the European Hypothermia After Cardiac Arrest study. Setting: Intensive care unit of a tertiary referral hospital (Helsinki University Hospital). Patients: Seventy consecutive adult patients resuscitated from out-of-hospital ventricular fibrillation were randomly assigned either to therapeutic HT of 33 degrees C or normothermia. Interventions: Patients randomized to HT were cooled with an external cooling device for 24 hours and then allowed to rewarm slowly during 12 hours. In the normothermia group, the core temperature was kept <38 degrees C by antipyretics and physical means. All patients received standard intensive care for at least 2 days. Measurements and Main Results: Twenty-four hour ambulatory electrocardiography recordings were performed at 0-24 hours, at 24-48 hours, and at 14 days. The clinical outcome was assessed at 6 months after CA. The occurrence of premature ventricular beats was increased in the HT-treated group during the first two recordings, with no difference in the number of ventricular tachycardia or ventricular fibrillation episodes. All HRV values were significantly higher during the HT (p < 0.01), but no differences were observed 2 weeks later. In multivariate analysis, only shorter delay to restoration of spontaneous circulation (p = 0.009) and the SD of individual normal-to-normal intervals >100 msec of the 24-48-hour recording in the HT group (p = 0.018) predicted good outcome. Conclusions: The use of therapeutic HT of 33 degrees C for 24 hours after CA was not associated with an increase in clinically significant arrhythmias. Preserved 24 to 48-hour HRV may be a predictor of favorable outcome in patients with CA treated with HT. (Grit Care Med 2009; 37:403-409)