Sunkak Suleyman, Pamukcu Ozge, Baykan Ali, Tasci Onur, Vural Cagdas, Uzum Kazim, Narin Nazmi
Kayseri City Education and Research Hospital, Division of Pediatric Cardiology, Kayseri, Turkey.
Erciyes University, School of Medicine, Division of Pediatric Cardiology, Kayseri, Turkey.
Rev Port Cardiol. 2023 Jan;42(1):41-47. doi: 10.1016/j.repc.2021.11.012. Epub 2022 Oct 12.
Heart rate variability (HRV) is a sign of the cardiac autonomic nervous system. Its evaluation in pediatric ventricular septal defect (VSD) cases before and after transcatheter closure contributes to an understanding of cardiac autonomic control.
Nineteen children with VSDs treated with transcatheter closure and 18 healthy children were enrolled in this study. A 24-h Holter rhythm monitor was applied to all patients before VSD closure and to those in the control group. Holter rhythm monitoring was repeated at three months in the patient group. HRV parameters were measured using the Cardio Scan Premier 12® program. Frequency-domain (total power; very-low-frequency, low-frequency (LF), and high-frequency (HF) indices; and the LF/HF ratio) and time-domain (standard deviation of all RR intervals (SDNN), standard deviation of 5-min averages of RR intervals (SDANN), the SDNN index, percentage of the difference between adjacent RR intervals, and the square root of the mean of the sum of square differences between adjacent filtered RR intervals) parameters were assessed.
Before the procedure, SDNN, SDANN, and total power values were lower in the patient group than in the control group; other parameters were similar in the two groups. No significant difference in the SDNN, SDANN, or total power was detected between the patient and control groups in the third month, indicating that autonomic control of patients' hearts became normal during the third postoperative month. No correlation was detected between any hemodynamic parameters and any time-domain or frequency-domain parameters before closure.
This study showed that transcatheter closure of VSDs changed HRV parameters in pediatric patients.
心率变异性（HRV）是心脏自主神经系统的一个标志。在小儿室间隔缺损（VSD）患者经导管封堵术前和术后对其进行评估，有助于了解心脏自主神经控制情况。
本研究纳入了19例接受经导管封堵治疗的VSD患儿和18例健康儿童。所有患者在VSD封堵术前以及对照组均应用24小时动态心电图监测。患者组在术后3个月重复进行动态心电图监测。使用Cardio Scan Premier 12®程序测量HRV参数。评估频域参数（总功率；极低频、低频（LF）和高频（HF）指数；以及LF/HF比值）和时域参数（所有RR间期的标准差（SDNN）、RR间期5分钟平均值的标准差（SDANN）、SDNN指数、相邻RR间期差值的百分比，以及相邻滤波后RR间期平方差之和的平均值的平方根）。
术前，患者组的SDNN、SDANN和总功率值低于对照组；两组的其他参数相似。在术后第3个月，患者组和对照组的SDNN、SDANN或总功率均未检测到显著差异，表明术后第3个月患者心脏的自主神经控制恢复正常。封堵术前，未检测到任何血流动力学参数与任何时域或频域参数之间存在相关性。
本研究表明，经导管封堵VSD可改变小儿患者的HRV参数。
