BAROREFLEX SENSITIVITY AS A CARDIAC AND ARRHYTHMIA MORTALITY RISK STRATIFIER

The last two decades have provided clear evidence for the tight and ca sual relation existing between arrhythmic mortality and the autonomic nervous system, particularly with imbalances characterized by decrease s in vagal and/or increases in sympathetic activity. A series of compe lling experimental results has represented the driving force for the c linical evaluation of the potential prognostic value of baroreflex sen sitivity (BRS), a measure that can provide information on the capabili ty to augment vagal activity. This article reviews the methodology mor e commonly used to quantify the clinical evaluation of this parameter, and then focuses on the key clinical studies highlighting those perfo rmed in postmyocardial infarction patients. Among them the most inform ative is ATRAMI, a multicenter prospective study involving almost 1300 patients. The main conclusion is that both heart rate variability and BRS are strong and independent risk factors for post-infarction morta lity, thus demonstrating the clinical usefulness of autonomic markers.