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. 1999 Jun;81(6):656–660. doi: 10.1136/hrt.81.6.656

Reduced heart rate variability following repair of tetralogy of Fallot

K McLeod 1, W Hillis 1, A Houston 1, N Wilson 1, A Trainer 1, J Neilson 1, W Doig 1
PMCID: PMC1729075  PMID: 10336928

Abstract

OBJECTIVE—To examine autonomic function as assessed by heart rate variability in patients 10 or more years after repair of tetralogy of Fallot, and to relate this to cardiac structure, function, and electrocardiographic indices.
METHODS—Heart rate variability was measured by standard time domain techniques on a 24 hour Holter ECG in 28 patients, aged 12 to 34 years (mean 19.5), who had undergone repair of tetralogy of Fallot at least 10 years previously. Echocardiography was performed to assess left ventricular size and function, right ventricular size and pressure, and any proximal pulmonary arterial stenosis. Right ventricular function was evaluated by radionuclide scan. QRS duration, QT interval, and QT dispersion were measured on a standard 12 lead ECG. Measurements of heart rate variability were compared with values from 28 age matched healthy controls (mean age 19.9 years). Interrelations between variables were assessed using Pearson correlation coefficients and stepwise regression analysis.
RESULTS—Heart rate variability was reduced, compared with values for age matched normal controls, in 12 of the 28 patients. Reduced heart rate variability was associated with increased age, increased right ventricular size and pressure, and widening of the QRS complex.
CONCLUSIONS—Reduced heart rate variability is a feature following repair of tetralogy of Fallot. It is associated with increasing age, impaired right ventricular haemodynamics, and widening of the QRS complex. Under these circumstances, reduced heart rate variability may be a marker for deteriorating right ventricular function. Increased QRS duration has been identified as a risk factor for sudden death following repair of tetralogy of Fallot, and impaired cardiac autonomic control may be one of the mechanisms involved.


Keywords: tetralogy of Fallot; heart rate variability; right ventricular function; congenital heart disease

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Figure 1  .

Figure 1  

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Heart rate variability following repair of tetralogy of Fallot plotted on a logarithmic scale against the range of values for normal controls aged 12-34 years. Mean sNN50 in patients with tetralogy of Fallot was significantly reduced compared with the age matched normal controls (p < 0.05). Heart rate variability was below the normal range in 12 of the patients with repair of tetralogy of Fallot.

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