Heart Rate Variability Following Neonatal Heart Surgery for Complex Congenital Heart Disease
- 5 May 2006
- journal article
- clinical trial
- Published by Wiley in Pacing and Clinical Electrophysiology
- Vol. 29 (5), 471-478
- https://doi.org/10.1111/j.1540-8159.2006.00378.x
Abstract
Altered cardiac autonomic control may play a role in the morbidity and mortality suffered by neonates who undergo surgery for complex congenital heart disease (CHD). The purpose of this study was to evaluate cardiac autonomic activity, as measured by spectral indices of heart rate variability (HRV), prior to and early after infant surgery for CHD and attempt to correlate HRV indices with clinical outcome. In addition, we assessed the hypothesis that single-ventricle physiology and surgical interruption of the great arteries negatively affects HRV. Sixty neonates prospectively wore 24-hour Holter monitors at three time points: before and early after CHD surgery, and at 3- to 6-month follow-up. Standard spectral indices of HRV were measured. In the early postoperative time point, patients with single-ventricle physiology had lower low-frequency power (LF) compared to patients with two ventricles (P=0.040). Surgical interruption of the great arteries did not affect HRV in this cohort. For the entire cohort, LF (P=0.004) and high-frequency power (HF) (P<0.001) increased over the three time points, while LF/HF (P=0.119) did not significantly change. In the multivariable linear regression model, significant predictors of longer postoperative hospital stay included longer total support time (P=or<0.001), longer duration of inotrope support (P=0.012), elevated mean heart rate at postoperative time point (P=0.002), and lower LF/HF ratio at the postoperative time point (P=0.014). Patients with single-ventricle physiology have a significant physiologic reduction in LF in the early postoperative period compared to patients with two ventricles. Diminished cardiac autonomic control is associated with longer hospitalization following neonatal cardiac surgery.This publication has 22 references indexed in Scilit:
- Global Impairment of Cardiac Autonomic Nervous Activity Late After the Fontan OperationCirculation, 2003
- Interim mortality in infants with systemic-to–pulmonary artery shuntsThe Annals of Thoracic Surgery, 2003
- Evolving strategies and improving outcomes of the modified Norwood procedure: a 10-year single-institution experienceThe Annals of Thoracic Surgery, 2001
- Depressed low frequency power of heart rate variability as an independent predictor of sudden death in chronic heart failureEuropean Heart Journal, 2000
- Heart rate variability in the neonate and infant: analytical methods, physiological and clinical observationsActa Paediatrica, 1999
- Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarctionThe Lancet, 1998
- Normal Ranges of Heart Rate Variability During Infancy and ChildhoodPediatric Cardiology, 1997
- Absence of Low-Frequency Variability of Sympathetic Nerve Activity in Severe Heart FailureCirculation, 1997
- Heart Rate VariabilityCirculation, 1996
- Heart-rate spectral analysis: A noninvasive probe of cardiovascular regulation in critically ill children with heart diseasePediatric Cardiology, 1988