Skip to main content
PMC home page
Heart logoLink to Heart
. 1999 Dec;82(6):704–707. doi: 10.1136/hrt.82.6.704

Total cavopulmonary and atriopulmonary connections are associated with reduced heart rate variability

G Butera 1, D Bonnet 1, L Iserin 1, D Sidi 1, J Kachaner 1, E Villain 1
PMCID: PMC1729209  PMID: 10573498

Abstract

AIM—To determine whether cavopulmonary connections are associated with abnormalities of heart rate variability.
METHODS—Heart rate variability was studied by 24 hour Holter monitoring in 39 patients (mean (SD) age 12.2 (4.1) years) who underwent cavopulmonary connection operations (partial in 12, total in 13, and atriopulmonary in 14). Two control groups were used: 18 healthy children (11.1 (2.5) years) and 16 patients (11.7 (4.3) years) undergoing cardiovascular surgery for biventricular repair of congenital heart disease. All patients were in sinus rhythm and had normal left ventricular function. Four time domain indices were calculated: mean duration of RR intervals (RR), standard deviation of all RR intervals (SD), square root of the mean squared differences of successive RR intervals (r-MSSD), and percentage differences of successive RR intervals of > 50 ms duration (pNN50). Four frequency domain indices were calculated: total power (TP), low frequency (LF), high frequency (HF), and the LF:HF ratio.
RESULTS—Heart rate variability indices were identical in the two control groups. Significantly reduced heart rate variability was found in patients with total cavopulmonary connections and atriopulmonary connections compared with the two control groups. In patients with partial cavopulmonary connections, heart rate variability was reduced compared with healthy controls. No differences in heart rate variability could be related to clinical status (New York Heart Association functional class), number of surgical interventions, or presence of right atrial enlargement.
CONCLUSIONS—Patients with cavopulmonary connections have significantly reduced heart rate variability and a particularly low vagal drive.


Keywords: heart rate variability; cavopulmonary connections; autonomic nervous system; paediatric cardiology

Full Text

The Full Text of this article is available as a PDF (72.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bernardi L., Valenti C., Wdowczyck-Szulc J., Frey A. W., Rinaldi M., Spadacini G., Passino C., Martinelli L., Viganò M., Finardi G. Influence of type of surgery on the occurrence of parasympathetic reinnervation after cardiac transplantation. Circulation. 1998 Apr 14;97(14):1368–1374. doi: 10.1161/01.cir.97.14.1368. [DOI] [PubMed] [Google Scholar]
  2. Bigger J. T., Jr, Fleiss J. L., Steinman R. C., Rolnitzky L. M., Kleiger R. E., Rottman J. N. Frequency domain measures of heart period variability and mortality after myocardial infarction. Circulation. 1992 Jan;85(1):164–171. doi: 10.1161/01.cir.85.1.164. [DOI] [PubMed] [Google Scholar]
  3. Brembilla-Perrot B., Jacquemin L., Danchin N., Mathieu P., Villemot J. P., Haouzi A., Schwalm F. Altération de la variabilité sinusale après chirurgie cardiaque. Ann Cardiol Angeiol (Paris) 1998 Mar;47(3):149–154. [PubMed] [Google Scholar]
  4. Finley J. P., Nugent S. T., Hellenbrand W., Craig M., Gillis D. A. Sinus arrhythmia in children with atrial septal defect: an analysis of heart rate variability before and after surgical repair. Br Heart J. 1989 Mar;61(3):280–284. doi: 10.1136/hrt.61.3.280. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Fishberger S. B., Wernovsky G., Gentles T. L., Gauvreau K., Burnett J., Mayer J. E., Jr, Walsh E. P. Factors that influence the development of atrial flutter after the Fontan operation. J Thorac Cardiovasc Surg. 1997 Jan;113(1):80–86. doi: 10.1016/s0022-5223(97)70402-1. [DOI] [PubMed] [Google Scholar]
  6. Gelatt M., Hamilton R. M., McCrindle B. W., Gow R. M., Williams W. G., Trusler G. A., Freedom R. M. Risk factors for atrial tachyarrhythmias after the Fontan operation. J Am Coll Cardiol. 1994 Dec;24(7):1735–1741. doi: 10.1016/0735-1097(94)90181-3. [DOI] [PubMed] [Google Scholar]
  7. Gewillig M., Wyse R. K., de Leval M. R., Deanfield J. E. Early and late arrhythmias after the Fontan operation: predisposing factors and clinical consequences. Br Heart J. 1992 Jan;67(1):72–79. doi: 10.1136/hrt.67.1.72. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Horackova M., Armour J. A. Role of peripheral autonomic neurones in maintaining adequate cardiac function. Cardiovasc Res. 1995 Sep;30(3):326–335. doi: 10.1016/0008-6363(95)00105-0. [DOI] [PubMed] [Google Scholar]
  9. Kao J. M., Alejos J. C., Grant P. W., Williams R. G., Shannon K. M., Laks H. Conversion of atriopulmonary to cavopulmonary anastomosis in management of late arrhythmias and atrial thrombosis. Ann Thorac Surg. 1994 Nov;58(5):1510–1514. doi: 10.1016/0003-4975(94)91945-3. [DOI] [PubMed] [Google Scholar]
  10. Kleiger R. E., Miller J. P., Bigger J. T., Jr, Moss A. J. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol. 1987 Feb 1;59(4):256–262. doi: 10.1016/0002-9149(87)90795-8. [DOI] [PubMed] [Google Scholar]
  11. Kocovic D. Z., Harada T., Shea J. B., Soroff D., Friedman P. L. Alterations of heart rate and of heart rate variability after radiofrequency catheter ablation of supraventricular tachycardia. Delineation of parasympathetic pathways in the human heart. Circulation. 1993 Oct;88(4 Pt 1):1671–1681. doi: 10.1161/01.cir.88.4.1671. [DOI] [PubMed] [Google Scholar]
  12. Komatsu T., Kimura T., Nishiwaki K., Fujiwara Y., Sawada K., Shimada Y. Recovery of heart rate variability profile in patients after coronary artery surgery. Anesth Analg. 1997 Oct;85(4):713–718. doi: 10.1097/00000539-199710000-00001. [DOI] [PubMed] [Google Scholar]
  13. Manning P. B., Mayer J. E., Jr, Wernovsky G., Fishberger S. B., Walsh E. P. Staged operation to Fontan increases the incidence of sinoatrial node dysfunction. J Thorac Cardiovasc Surg. 1996 Apr;111(4):833–840. doi: 10.1016/s0022-5223(96)70344-6. [DOI] [PubMed] [Google Scholar]
  14. Odemuyiwa O., Malik M., Farrell T., Bashir Y., Poloniecki J., Camm J. Comparison of the predictive characteristics of heart rate variability index and left ventricular ejection fraction for all-cause mortality, arrhythmic events and sudden death after acute myocardial infarction. Am J Cardiol. 1991 Aug 15;68(5):434–439. doi: 10.1016/0002-9149(91)90774-f. [DOI] [PubMed] [Google Scholar]
  15. Randall W. C., Wurster R. D., Duff M., O'Toole M. F., Wehrmacher W. Surgical interruption of postganglionic innervation of the sinoatrial nodal region. J Thorac Cardiovasc Surg. 1991 Jan;101(1):66–74. [PubMed] [Google Scholar]
  16. Singh S., Johnson P. I., Lee R. E., Orfei E., Lonchyna V. A., Sullivan H. J., Montoya A., Tran H., Wehrmacher W. H., Wurster R. D. Topography of cardiac ganglia in the adult human heart. J Thorac Cardiovasc Surg. 1996 Oct;112(4):943–953. doi: 10.1016/S0022-5223(96)70094-6. [DOI] [PubMed] [Google Scholar]
  17. Stavri G. T., Zachary I. C., Baskerville P. A., Martin J. F., Erusalimsky J. D. Basic fibroblast growth factor upregulates the expression of vascular endothelial growth factor in vascular smooth muscle cells. Synergistic interaction with hypoxia. Circulation. 1995 Jul 1;92(1):11–14. doi: 10.1161/01.cir.92.1.11. [DOI] [PubMed] [Google Scholar]
  18. Weber H. S., Hellenbrand W. E., Kleinman C. S., Perlmutter R. A., Rosenfeld L. E. Predictors of rhythm disturbances and subsequent morbidity after the Fontan operation. Am J Cardiol. 1989 Oct 1;64(12):762–767. doi: 10.1016/0002-9149(89)90761-3. [DOI] [PubMed] [Google Scholar]
  19. el Gamel A., Yonan N. A., Rahman A. N., Deiraníya A. K., Campbell C. S., Sarsam M. A. The clinical benefit of the bicaval technique for cardiac transplantation. J Thorac Cardiovasc Surg. 1995 Jun;109(6):1257–1259. doi: 10.1016/s0022-5223(95)70218-0. [DOI] [PubMed] [Google Scholar]

Articles from Heart are provided here courtesy of BMJ Publishing Group

RESOURCES