Changes in Heart Rate and Heart Rate Variability During Surgical Stages to Completed Fontan Circulation
(2021) In Pediatric Cardiology 42(5). p.1162-1169- Abstract
Arrhythmia is related to heart rate variability (HRV), which reflects the autonomic nervous regulation of the heart. We hypothesized that autonomic nervous ganglia, located at the junction of the superior vena cava’s entrance to the heart, may be affected during the bidirectional Glenn procedure (BDG), resulting in reduced HRV. We aimed to investigate changes in heart rate and HRV in a cohort of children with univentricular heart defects, undergoing stepwise surgery towards total cavopulmonary connection (TCPC), and compare these results with healthy controls. Twenty four hours Holter-ECG recordings were obtained before BDG (n = 47), after BDG (n = 47), and after total cavopulmonary connection (TCPC) (n = 45) in patients and in 38... (More)
Arrhythmia is related to heart rate variability (HRV), which reflects the autonomic nervous regulation of the heart. We hypothesized that autonomic nervous ganglia, located at the junction of the superior vena cava’s entrance to the heart, may be affected during the bidirectional Glenn procedure (BDG), resulting in reduced HRV. We aimed to investigate changes in heart rate and HRV in a cohort of children with univentricular heart defects, undergoing stepwise surgery towards total cavopulmonary connection (TCPC), and compare these results with healthy controls. Twenty four hours Holter-ECG recordings were obtained before BDG (n = 47), after BDG (n = 47), and after total cavopulmonary connection (TCPC) (n = 45) in patients and in 38 healthy controls. HRV was analyzed by spectral and Poincaré methods. Age-related z scores were calculated and compared using linear mixed effects modeling. Total HRV was significantly lower in patients before BDG when compared to healthy controls. The mean heart rate was significantly reduced in patients after BDG compared to before BDG. Compared to healthy controls, patients operated with BDG had significantly reduced heart rate and reduced total HRV. Patients with TCPC showed reduced heart rate and HRV compared with healthy controls. In patients after TCPC, total HRV was decreased compared to before TCPC. Heart rate was reduced after BDG procedure, and further reductions of HRV were seen post-TCPC. Our results indicate that autonomic regulation of cardiac rhythm is affected both after BDG and again after TCPC. This may be reflected as, and contribute to, postoperative arrhythmic events.
(Less)
- author
- Dahlqvist, Jenny Alenius ; Wiklund, Urban ; Karlsson, Marcus ; Hanséus, Katarina LU ; Strömvall Larsson, Eva ; Johansson Ramgren, Jens LU ; Berggren, Håkan and Rydberg, Annika
- publishing date
- 2021
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Arrhythmia, Bidirectional Glenn procedure, Fontan circulation, Heart rate variability, Total cavopulmonary connection, Univentricular heart defect
- in
- Pediatric Cardiology
- volume
- 42
- issue
- 5
- pages
- 1162 - 1169
- publisher
- Springer
- external identifiers
-
- scopus:85104152599
- pmid:33837840
- ISSN
- 0172-0643
- DOI
- 10.1007/s00246-021-02595-0
- language
- English
- LU publication?
- no
- id
- f8db1b51-9b6c-49c3-90d7-6bd2164c8ad8
- date added to LUP
- 2021-04-27 08:50:29
- date last changed
- 2024-06-01 09:54:25
@article{f8db1b51-9b6c-49c3-90d7-6bd2164c8ad8,
abstract = {{<p>Arrhythmia is related to heart rate variability (HRV), which reflects the autonomic nervous regulation of the heart. We hypothesized that autonomic nervous ganglia, located at the junction of the superior vena cava’s entrance to the heart, may be affected during the bidirectional Glenn procedure (BDG), resulting in reduced HRV. We aimed to investigate changes in heart rate and HRV in a cohort of children with univentricular heart defects, undergoing stepwise surgery towards total cavopulmonary connection (TCPC), and compare these results with healthy controls. Twenty four hours Holter-ECG recordings were obtained before BDG (n = 47), after BDG (n = 47), and after total cavopulmonary connection (TCPC) (n = 45) in patients and in 38 healthy controls. HRV was analyzed by spectral and Poincaré methods. Age-related z scores were calculated and compared using linear mixed effects modeling. Total HRV was significantly lower in patients before BDG when compared to healthy controls. The mean heart rate was significantly reduced in patients after BDG compared to before BDG. Compared to healthy controls, patients operated with BDG had significantly reduced heart rate and reduced total HRV. Patients with TCPC showed reduced heart rate and HRV compared with healthy controls. In patients after TCPC, total HRV was decreased compared to before TCPC. Heart rate was reduced after BDG procedure, and further reductions of HRV were seen post-TCPC. Our results indicate that autonomic regulation of cardiac rhythm is affected both after BDG and again after TCPC. This may be reflected as, and contribute to, postoperative arrhythmic events.</p>}},
author = {{Dahlqvist, Jenny Alenius and Wiklund, Urban and Karlsson, Marcus and Hanséus, Katarina and Strömvall Larsson, Eva and Johansson Ramgren, Jens and Berggren, Håkan and Rydberg, Annika}},
issn = {{0172-0643}},
keywords = {{Arrhythmia; Bidirectional Glenn procedure; Fontan circulation; Heart rate variability; Total cavopulmonary connection; Univentricular heart defect}},
language = {{eng}},
number = {{5}},
pages = {{1162--1169}},
publisher = {{Springer}},
series = {{Pediatric Cardiology}},
title = {{Changes in Heart Rate and Heart Rate Variability During Surgical Stages to Completed Fontan Circulation}},
url = {{http://dx.doi.org/10.1007/s00246-021-02595-0}},
doi = {{10.1007/s00246-021-02595-0}},
volume = {{42}},
year = {{2021}},
}