Predicting Arrhythmias in Anorexic Patients

Cardiac arrhythmias are the most common cause of death in patients with anorexia nervosa (AN), but there is still no way to predict the frequency of or risk factors for arrhythmias. In a pilot study at St. Paul’s Hospital Eating Disorders Program at the University of British Columbia, Vancouver, Dr. Laird Birmingham and Jane Harbottle recently designed a study of arrhythmias among patients with AN who were admitted for refeeding. At St. Paul’s Hospital, the “King of Hearts Express+” arrhythmic monitor is used for continuous inpatient monitoring during the 21 days of refeeding treatment. The monitor enables patients experiencing fleeting symptoms, including angina, palpitations or unexplained dizziness, to correlate these symptoms with their EKGs at the time they occur, then to transmit their EKG to certified cardiac technicians. As they reported at the Eating Disorders Research Society last fall, the researchers found that independent variables of risk for arrhythmias were: instability of weight, mineral deficiency, medications that provoke arrhythmias, prolonged QT interval, change in QT dispersion, and change in heart rate variability. They also reported that arrhythmias occur during early refeeding, which corresponds with the time of change in heart rate variability. Thus, increased heart rate variability before refeeding may predict the likelihood of arrhythmias .