Heart rate variability is depressed in the early transitional period for newborns with complex congenital heart disease

ObjectiveCommercial airplanes fly with an equivalent cabin fraction of inspired oxygen of 0.15, leading to reduced oxygen saturation (SpO2) in passengers. How this affects children with complex congenital heart disease (CHD) is unknown. We conducted Hypoxic Challenge Testing (HCT) to assess need for inflight supplemental oxygen.MethodsChildren aged <16 years had a standard HCT. They were grouped as (A) normal versus abnormal baseline SpO2 (≥95% vs <95%) and (B) absence versus presence of an actual/potential right-to-left (R–L) shunt. We measured SpO2, heart rate, QT interval corrected for heart rate and partial pressure of carbon dioxide measured transcutaneously (PtcCO2). A test failed when children with (1) normal baseline SpO2 desaturated to 85%, (2) baseline SpO285%–94% desaturated by 15% of baseline; and (3) baseline SpO275%–84% desaturated to 70%.ResultsThere were 68 children, mean age 3.3 years (range 10 weeks–14.5 years). Children with normal (n=36) baseline SpO2 desaturated from median 99% to 91%, P<0.0001, and 3/36 (8%) failed the test. Those with abnormal baseline SpO2 (n=32) desaturated from median 84% to 76%, P<0.0001, and 5/32 (16%) failed (no significant difference between groups). Children with no R–L shunt (n=25) desaturated from median 99% to 93%, P<0.0001, but 0/25 failed. Those with an actual/potential R–L shunt (n=43) desaturated from median 87% to 78%, P<0.0001, and 8/43 (19%) failed (difference between groups P<0.02). PtcCO2, heart rate and QT interval corrected for heart rate were unaffected by the hypoxic state.ConclusionsThis is the first evidence to help guide which children with CHD need a preflight HCT. We suggest all children with an actual or potential R–L shunt should be tested.

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Heart rate variability in children with cyanotic and acyanotic congenital heart disease: Analysis by spectral and non linear indices

2012 Annual International Conference of the IEEE Engineering in Medicine and Biology Society ◽

10.1109/embc.2012.6346890 ◽

2012 ◽

Cited By ~ 8

Author(s):

F. Aletti ◽

M. Ferrario ◽

Taiana Bertacini Almas de Jesus ◽

R. Stirbulov ◽

Audrey Borghi Silva ◽

...

Keyword(s):

Heart Rate ◽

Congenital Heart Disease ◽

Heart Rate Variability ◽

Heart Disease ◽

Congenital Heart ◽

Non Linear ◽

Acyanotic Congenital Heart Disease ◽

Disease Analysis

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Heart rate variability in healthy children and in those with congenital heart disease both before and after operation

The American Journal of Cardiology ◽

10.1016/s0002-9149(99)00173-3 ◽

1999 ◽

Vol 83 (12) ◽

pp. 1654-1657 ◽

Cited By ~ 37

Author(s):

Narakesari P Heragu ◽

William A Scott

Keyword(s):

Heart Rate ◽

Congenital Heart Disease ◽

Heart Rate Variability ◽

Heart Disease ◽

Congenital Heart ◽

Healthy Children ◽

Before And After

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Depression Associated with Reduced Heart Rate Variability Predicts Outcome in Adult Congenital Heart Disease

Journal of Clinical Medicine ◽

10.3390/jcm10081554 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1554

Author(s):

Mechthild Westhoff-Bleck ◽

Lars H. Lemke ◽

Jan-Marc S. Bleck ◽

Anja C. Bleck ◽

Johann Bauersachs ◽

...

Keyword(s):

Heart Rate ◽

Congenital Heart Disease ◽

Heart Rate Variability ◽

Regression Analysis ◽

Heart Disease ◽

Congenital Heart ◽

Cox Regression ◽

Adult Congenital Heart Disease ◽

Cox Regression Analysis ◽

Adult Congenital

In adult congenital heart disease (ACHD), major depressive disorder (MDD) represents a frequent comorbidity. In non-CHD, adverse outcome is predicted by MDD and heart rate variability (HRV), whereas in ACHD their prognostic relevance is unknown. We prospectively evaluated 171 patients (age 35.6 ± 11.4 years; male 42.7%, mean observation time 54.7 ± 14.9 months). Binary regression analysis calculated the association between MDD and HRV. Cox proportional survival analysis estimated their impact on decompensated heart failure and all-cause mortality (HF/death), supraventricular and ventricular tachycardia (SVT/VT), and hospitalization due to unexpected cardiac causes. Exclusively MDD with moderate/severe symptoms showed significantly lower HRV as derived from frequency-domain analysis (Symindex) (p = 0.013). In multivariate Cox regression analysis, patients stratified according to the lower quartile of the Symindex comorbid with MDD (n = 16) exhibited poorer prognosis regarding HF/death (Hazard Ratio (HR): 7.04 (95%CI:(1.87–26.5)), SVT/VT (HR: 4.90 (95%CI:1.74–9.25)) and hospitalization (HR: 3.80 (95%CI:1.36–10.6)). An additional independent predictor was N-terminal pro-B-type natriuretic peptide elevation (p < 0.001), indicating advanced HF and heart disease complexity (p < 0.001). Autonomic nervous system dysfunction measured by altered HRV is considered to be one of the pathways linking MDD and adverse outcomes in cardiac diseases. Our results exceed the existing literature by demonstrating that MDD with decreased HRV is associated with poorer prognosis in ACHD.

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An Algorithm to Predict Life-Threatening Complications using Heart Rate Variability and the Circadian Heart Rate Difference with a Special Interest on Covid-19, Sudep Children with Congenital Heart Disease and Obesity

Journal of Biomedical Engineering and Medical Imaging ◽

10.14738/jbemi.74.8589 ◽

2020 ◽

Vol 7 (4) ◽

pp. 01-10

Author(s):

Reiner Buchhorn

Keyword(s):

Heart Rate ◽

Congenital Heart Disease ◽

Heart Rate Variability ◽

Heart Disease ◽

Respiratory Failure ◽

Congenital Heart ◽

Fatal Outcome ◽

Healthy Children ◽

Rate Difference ◽

Life Threatening

Corona virus disease (COVID-19) has been declared as a pandemic by the WHO with a global mortality rate of about 3.4%. More recently the neuroinvasive potential of SARS-CoV2 was emphasized as a potential cause for respiratory failure. Such pathophysiology has been investigated in sudden unexplained death in epilepsy (SUDEP) including functional neuroimaging that demonstrates alterations to networks involved in central autonomic and respiratory control located in the brainstem. For risk stratification in these patients, one method may be heart rate and heart rate variability (HRV) monitoring. Method: For a better understanding, we compare HRV monitoring in two cases; 1.) Twenty Holter ECGs of a boy with generalized tonic-clonic seizures up to his dead at the age of 10.5 years with special interest on an acute respiratory failure at the age of 5.4 years. 2.) Thirty one Holter ECGs of a 58-year old pediatric cardiologist who survived an infection with COVID-19. During his disease 24-hour Holter electrocardiography (ECG) was performed continuously over 10 days. Moreover, 24-hour Holter ECGs from the last 10 years were available. The derived algorithm that depends on the global heart rate variability and circadian heart rate difference was proofed in 151 healthy children, 26 children with a fatal outcome or transplantation, 151 patients with operated congenital heart disease, 130 obese children and healthy adult data from literature. Results: In both cases we observe a decline of the global heart rate variability SDNN together with a loss of the circadian heart rate difference. The derived algorithm differentiate healthy children from children with a fatal outcome. The algorithm identify 7.3% of 151 patients with operated congenital heart disease and 5.4% of children with obesity as candidates for COVID-19 complications. Conclusions: A sudden decline of HRV together with a loss of the circadian heart rate difference may indicate a life-threatening complication in critical illness.

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