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

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

Clinical Autonomic Research ◽

10.1007/s10286-019-00616-w ◽

2019 ◽

Vol 30 (2) ◽

pp. 165-172 ◽

Cited By ~ 2

Author(s):

Sarah B. Mulkey ◽

Rathinaswamy Govindan ◽

Marina Metzler ◽

Christopher B. Swisher ◽

Laura Hitchings ◽

...

Keyword(s):

Heart Rate ◽

Congenital Heart Disease ◽

Heart Rate Variability ◽

Heart Disease ◽

Congenital Heart ◽

Transitional Period ◽

Complex Congenital Heart Disease

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Heart Rate Variability Following Neonatal Heart Surgery for Complex Congenital Heart Disease

Pacing and Clinical Electrophysiology ◽

10.1111/j.1540-8159.2006.00378.x ◽

2006 ◽

Vol 29 (5) ◽

pp. 471-478 ◽

Cited By ~ 12

Author(s):

JONATHAN R. KALTMAN ◽

BRIAN D. HANNA ◽

PAUL R. GALLAGHER ◽

J. WILLIAM GAYNOR ◽

RODOLFO I. GODINEZ ◽

...

Keyword(s):

Heart Rate ◽

Congenital Heart Disease ◽

Heart Rate Variability ◽

Heart Disease ◽

Congenital Heart ◽

Heart Surgery ◽

Complex Congenital Heart Disease ◽

Neonatal Heart

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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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