Heart rate variability is markedly abnormal following surgical repair of atrial and ventricular septal defects in pediatric patients
Background: Abnormalities in heart rate variability (HRV) have been associated with increased morbidity and mortality. Adults with a history of successful correction of atrial septal defects (ASDs) and ventricular septal defects (VSDs) have clinically relevant abnormalities in HRV. The etiology of t...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-03-01
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| Series: | International Journal of Cardiology Congenital Heart Disease |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666668522000167 |
| _version_ | 1818047850868637696 |
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| author | Zarmiga Karunanithi Anusha Jegatheeswaran Sebastian D. Goodfellow Will Dixon Vibeke Elisabeth Hjortdal Danny Eytan Mjaye L. Mazwi |
| author_facet | Zarmiga Karunanithi Anusha Jegatheeswaran Sebastian D. Goodfellow Will Dixon Vibeke Elisabeth Hjortdal Danny Eytan Mjaye L. Mazwi |
| author_sort | Zarmiga Karunanithi |
| collection | DOAJ |
| description | Background: Abnormalities in heart rate variability (HRV) have been associated with increased morbidity and mortality. Adults with a history of successful correction of atrial septal defects (ASDs) and ventricular septal defects (VSDs) have clinically relevant abnormalities in HRV. The etiology of these abnormalities is unknown as is when they occur in the natural history of these lesions. We sought to determine whether the abnormalities described in adult patients are identifiable in pediatric patients. Materials and methods: Eighty-five ASD patients, 105 VSD patients, and 142 non-cardiac surgical comparison patients aged 0–18 years were studied during post-operative admission to the critical care unit using continuously monitored bedside electrocardiographic (ECG) data. Results: ASD and VSD patients had statistically significantly lower time-domain heart rate variability parameters, i.e., standard deviation of NN interval duration, and lower frequency-domain heart rate variability parameters, i.e., power in the high frequency band and power in the low frequency band, compared to the comparison cohort. The lower frequency band to high frequency band power ratio was lower in ASD patients and higher in VSD patients compared to the comparison cohort. The abnormalities identified correlate well with patterns described in adult patients. Conclusion: Post-surgical ASD and VSD patients have markedly abnormal heart rate variability patterns indicative of reduced parasympathetic activity and predominance of sympathetic activity. The HRV abnormalities described in adult patients are identifiable as early as the postoperative period in childhood. This finding warrants prospective study to identify drivers of this phenomenon. |
| first_indexed | 2024-12-10T10:12:21Z |
| format | Article |
| id | doaj.art-2712e0734be44b619ba4466bede65b9d |
| institution | Directory Open Access Journal |
| issn | 2666-6685 |
| language | English |
| last_indexed | 2024-12-10T10:12:21Z |
| publishDate | 2022-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology Congenital Heart Disease |
| spelling | doaj.art-2712e0734be44b619ba4466bede65b9d2022-12-22T01:53:05ZengElsevierInternational Journal of Cardiology Congenital Heart Disease2666-66852022-03-017100333Heart rate variability is markedly abnormal following surgical repair of atrial and ventricular septal defects in pediatric patientsZarmiga Karunanithi0Anusha Jegatheeswaran1Sebastian D. Goodfellow2Will Dixon3Vibeke Elisabeth Hjortdal4Danny Eytan5Mjaye L. Mazwi6Division of Cardiology, The Hospital for Sick Children, Toronto, Canada; Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Canada; Corresponding author. Division of Cardiology & Department of Critical Care Medicine, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.Division of Cardiac Surgery, The Hospital for Sick Children, Toronto, CanadaDepartment of Critical Care Medicine, The Hospital for Sick Children, Toronto, Canada; Faculty of Applied Science and Engineering, University of Toronto, Toronto, CanadaDepartment of Critical Care Medicine, The Hospital for Sick Children, Toronto, CanadaDepartment of Cardiothoracic Surgery, Rigshospitalet, University of Copenhagen, DenmarkDepartment of Critical Care Medicine, The Hospital for Sick Children, Toronto, Canada; Department of Medicine, Technion, Haifa, IsraelDivision of Cardiology, The Hospital for Sick Children, Toronto, Canada; Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, CanadaBackground: Abnormalities in heart rate variability (HRV) have been associated with increased morbidity and mortality. Adults with a history of successful correction of atrial septal defects (ASDs) and ventricular septal defects (VSDs) have clinically relevant abnormalities in HRV. The etiology of these abnormalities is unknown as is when they occur in the natural history of these lesions. We sought to determine whether the abnormalities described in adult patients are identifiable in pediatric patients. Materials and methods: Eighty-five ASD patients, 105 VSD patients, and 142 non-cardiac surgical comparison patients aged 0–18 years were studied during post-operative admission to the critical care unit using continuously monitored bedside electrocardiographic (ECG) data. Results: ASD and VSD patients had statistically significantly lower time-domain heart rate variability parameters, i.e., standard deviation of NN interval duration, and lower frequency-domain heart rate variability parameters, i.e., power in the high frequency band and power in the low frequency band, compared to the comparison cohort. The lower frequency band to high frequency band power ratio was lower in ASD patients and higher in VSD patients compared to the comparison cohort. The abnormalities identified correlate well with patterns described in adult patients. Conclusion: Post-surgical ASD and VSD patients have markedly abnormal heart rate variability patterns indicative of reduced parasympathetic activity and predominance of sympathetic activity. The HRV abnormalities described in adult patients are identifiable as early as the postoperative period in childhood. This finding warrants prospective study to identify drivers of this phenomenon.http://www.sciencedirect.com/science/article/pii/S2666668522000167Congenital heart diseaseAtrial septal defectVentricular septal defectHeart rate variabilityAutonomic imbalance |
| spellingShingle | Zarmiga Karunanithi Anusha Jegatheeswaran Sebastian D. Goodfellow Will Dixon Vibeke Elisabeth Hjortdal Danny Eytan Mjaye L. Mazwi Heart rate variability is markedly abnormal following surgical repair of atrial and ventricular septal defects in pediatric patients International Journal of Cardiology Congenital Heart Disease Congenital heart disease Atrial septal defect Ventricular septal defect Heart rate variability Autonomic imbalance |
| title | Heart rate variability is markedly abnormal following surgical repair of atrial and ventricular septal defects in pediatric patients |
| title_full | Heart rate variability is markedly abnormal following surgical repair of atrial and ventricular septal defects in pediatric patients |
| title_fullStr | Heart rate variability is markedly abnormal following surgical repair of atrial and ventricular septal defects in pediatric patients |
| title_full_unstemmed | Heart rate variability is markedly abnormal following surgical repair of atrial and ventricular septal defects in pediatric patients |
| title_short | Heart rate variability is markedly abnormal following surgical repair of atrial and ventricular septal defects in pediatric patients |
| title_sort | heart rate variability is markedly abnormal following surgical repair of atrial and ventricular septal defects in pediatric patients |
| topic | Congenital heart disease Atrial septal defect Ventricular septal defect Heart rate variability Autonomic imbalance |
| url | http://www.sciencedirect.com/science/article/pii/S2666668522000167 |
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