Heart rate dynamics during and after exercise in postoperative congenital heart disease patients. Their relation to cardiac autonomic nervous activity and intrinsic sinus node dysfunction

Background: The association between physical activity (PA) and arterial stiffness is particularly important in children with congenital heart disease (CHD) who are at risk for arterial stiffening. The aim of this study was to examine the association between objectively measured PA and arterial stiffness in children and adolescents with CHD. Methods: In 387 children and adolescents with various CHD (12.2 ± 3.3 years; 162 girls) moderate-to-vigorous PA (MVPA) was assessed with the “Garmin vivofit jr.” for 7 consecutive days. Arterial stiffness parameters including pulse wave velocity (PWV) and central systolic blood pressure (cSBP) were non-invasively assessed by oscillometric measurement via Mobil-O-Graph®. Results: MVPA was not associated with PWV (ß = −0.025, p = 0.446) and cSBP (ß = −0.020, p = 0.552) in children with CHD after adjusting for age, sex, BMI z-score, peripheral systolic blood pressure, heart rate and hypertensive agents. Children with CHD were remarkably active with 80% of the study population reaching the WHO recommendation of average 60 min of MVPA per day. Arterial stiffness did not differ between low-active and high-active CHD group after adjusting for age, sex, BMI z-score, peripheral systolic blood pressure, heart rate and hypertensive agents (PWV: F = 0.530, p = 0.467; cSBP: F = 0.843, p = 0.359). Conclusion: In this active cohort, no association between PA and arterial stiffness was found. Longer exposure to the respective risk factors of physical inactivity might be necessary to determine an impact of PA on the vascular system.

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Heart Rate Recovery Following Exercise Testing in Pediatric Patients with Acyanotic Repaired Congenital Heart Disease

Pediatric Cardiology ◽

10.1007/s00246-021-02788-7 ◽

2022 ◽

Author(s):

Natalie S. Shwaish ◽

Lindsey Malloy-Walton ◽

Keith Feldman ◽

Kelli M. Teson ◽

Jessica S. Watson ◽

...

Keyword(s):

Heart Rate ◽

Congenital Heart Disease ◽

Heart Disease ◽

Exercise Testing ◽

Congenital Heart ◽

Pediatric Patients ◽

Heart Rate Recovery

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Abstract 2971: Managed Ventricular Pacing In Pediatric Patients And Patients With Congenital Heart Disease

Circulation ◽

10.1161/circ.116.suppl_16.ii_663-d ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Jonathan R Kaltman ◽

Pamela Ro ◽

Frank Zimmerman ◽

Jeffrey P Moak ◽

Michael Epstein ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Subgroup Analysis ◽

Congenital Heart ◽

Sinus Node ◽

Rank Test ◽

Atrial Pacing ◽

Av Block ◽

Ventricular Pacing ◽

Low Rate

Introduction: Ventricular dyssynchrony induced by ventricular pacing (VP) may predispose patients (pts) to congestive heart failure. The detrimental effects of VP are directly related to the cumulative percentage of VP (Cum%VP). Managed ventricular pacing (MVP, Medtronic) is a novel pacing algorithm developed to minimize unnecessary VP by uncoupling atrial pacing from VP. The use, efficacy, and safety of MVP in pediatrics pts and pts with congenital heart disease (CHD) have not been described. Methods: A multicenter review evaluated all pediatric pts < 22 years old and older pts with CHD that had an implanted device using an MVP algorithm. Primary outcome variables were Cum%VP and adverse events. A subgroup analysis evaluated pts that had a DDD/R pacemaker prior to MVP device with similar low pacing rate and compared Cum%VP before and after initiation of MVP, using Wilcoxon signed-rank test. Results: 62 patients from 6 centers were included for the review (see table ). Mean age at MVP device implant was 21.5 ± 9.6 years (range 7–51). 63% of pts had CHD. With MVP device, mean Cum%VP was 4.3 ± 14.6% (range 0 – 83.7). By pacing indication, Cum%VP was 2.9 ± 6.5% in pts with sinus node dysfunction (n = 24), 34.8 ± 41.3% in pts with atrioventricular (AV) block (n = 5), and 0.6 ± 1.0% in pts with an ICD (n = 33). 11 patients were eligible for subgroup analysis. With DDD/R pacing, mean low rate was 64 ppm and mean paced/sensed AV intervals were 251 and 241 ms. With MVP, mean low rate was 63 ppm and mean paced/sensed AV intervals were 193 and 166 ms. Compared to DDD/R, Cum%VP significantly decreased with MVP (67.1 ± 29.4 vs. 9.2 ± 24.8%; p < 0.005). One MVP-related adverse event occurred: a pt with intermittent AV block had symptoms with nonconducted atrial beats and was reprogrammed to DDD. Conclusions: MVP can be used safely and can significantly reduce unnecessary ventricular pacing in pediatric pts and pts with CHD. MVP should be considered when choosing a pacing mode for this pt population.

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Hypoxic Challenge Testing (Fitness to Fly) in children with complex congenital heart disease

Heart ◽

10.1136/heartjnl-2017-312753 ◽

2018 ◽

Vol 104 (16) ◽

pp. 1333-1338 ◽

Cited By ~ 4

Author(s):

Nitha Naqvi ◽

Victoria L Doughty ◽

Luke Starling ◽

Rodney C Franklin ◽

Simon Ward ◽

...

Keyword(s):

Heart Rate ◽

Congenital Heart Disease ◽

Heart Disease ◽

Qt Interval ◽

Congenital Heart ◽

Supplemental Oxygen ◽

Complex Congenital Heart Disease ◽

Challenge Testing ◽

Significant Difference ◽

Fraction Of Inspired Oxygen

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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