Abstract
Background: Autonomic heart rate control is impaired after CABG. The aim of this study was to establish the temporal pattern of change in the decrease of HRV observed after CABG.
Methods and Results: Twelve patients with coronary artery disease were assessed with 24‐hour Holter recordings 2 days before CABG and 1 week, 3 months, 6 months, 1 year, and 3 years after CABG. All the time‐domain and frequency‐domain HRV parameters decreased precipitately after CABG and were mostly recovered 3 months after CABG except mean NN, rMSSD, and pNN50. The ratio of LF to HF showed a slight decrease after surgery, recovered to preoperative values after 3 months, surpassed, and continued to increase 6 months after surgery. At 3 years of follow‐up the recovery was complete. The rate of change of time‐domain and frequency‐domain parameters were calculated and their correlation with aortic cross‐clamping time, number of vessels bypassed, the amount of cardioplegic used were sought and no statistically significant correlation was found.
Conclusion: The recovery of HRV regardless to the preoperative state of the patients and their postoperative course implies that the early drop of HRV after CABG was related to the acute effects of surgery. Late complete recovery of HRV may be due to resolution of ischemia or use of angiotensin‐converting enzyme inhibitor. A.N.E. 2002;7(3):247–250
Keywords: coronary artery bypass surgery, heart rate variability, autonomic nervous system
REFERENCES
- 1. Hogue CW Jr, Stein PK, Apostolidou I, et al. Alterations in temporal patterns of heart rate variability after coronary artery bypass graft surgery. Anesthesiology 1994;81:1356–1364. [DOI] [PubMed] [Google Scholar]
- 2. Kim YD, Jones M, Hanowell ST, et al. Changes in peripheral vascular and cardiac sympathetic activity before and after coronary artery bypass surgery: Interrelationships with hemodynamic alterations. Am Heart J 1981;102:972–979. [DOI] [PubMed] [Google Scholar]
- 3. Komatsu T, Kimura T, Sakakibara Y, et al. Depression of heart rate variability after cardiac surgery in patients, (abstract) Anesthesiology 1992;77:A94. [Google Scholar]
- 4. Niemela MJ, Airaksinen KEJ, Tahvanainen KUO, et al. Effect of coronary artery bypass grafting on cardiac para‐sympathetic nervous function. Eur Heart J 1992; 13;932–935. [DOI] [PubMed] [Google Scholar]
- 5. Kuo CD, Chen GY, Lai ST, et al. Sequential changes in heart rate variability after coronary artery bypass grafting. Am J Cardiol 1999;83:776–779. [DOI] [PubMed] [Google Scholar]
- 6. Demirel S, Tukek T, Akkaya V, et al. Heart rate variability after coronary artery bypass grafting, (letter) Am J Cardiol 1999;84: 496–497. [DOI] [PubMed] [Google Scholar]
- 7. Bosner MS, Kleiger RE. Heart rate variability and risk stratification after myocardial infarction In Malik M, Camm AJ. (eds.): Heart Rate Variability. Armonk , NY , Futura Publishing Company, 1995, p. 331. [Google Scholar]
- 8. Fei L, Malik M. Short term and long term assessment of heart rate variability for post infarction risk stratification In Malik M, Camm AJ. (eds.): Heart Rate Variability. Annonk , NY , Futura Publishing Company, 1995, p. 341. [Google Scholar]
- 9. Odemuyiwa O. Heart rate variability and risk stratification after acute myocardial infarction: Change in heart rate variability after acute myocardial infarction In Malik M, Camm AJ. (eds.): Heart Rate Variability. Armonk , NY , Futura Publishing Company, 1995, p. 363. [Google Scholar]
- 10. Vanoli E, Adamson PB, Cerati D, et al. Heart rate variability and risk stratification post myocardial infarction In Malik M, Camm AJ. (eds.): Heart Rate Variability. Armonk , NY , Futura Publishing Company, 1995, p. 347. [Google Scholar]
- 11. Singer DH, On Z. Changes in heart rate variability associated with sudden cardiac death In Malik M, Camm AJ. (eds.): Heart Rate Variability. Armonk , NY , Futura Publishing Company, 1995, p. 429. [Google Scholar]
- 12. Declaration of Helsinki. Recommendations Guiding Physicians in Biomedical Research Involving Human Subjects. 41st World Medical Assembly, Hong Kong, September, 1989.
- 13. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology: Heart rate variability: Standards of measurement, physiological interpretation, and clinical use. Circulation 1996;93: 1043–1065. [PubMed] [Google Scholar]
- 14. Rich MW, Saini JS, Kleiger RE, et al. Correlation of heart rate variability with clinical and angiographic variables and late mortality after coronary angiography. Am J Cardiol 1988;62:714–717. [DOI] [PubMed] [Google Scholar]
- 15. Holmes DR Jr, Davis KB, Mock MB, et al. The effect of medical and surgical treatment on subsequent sudden cardiac death in patients with coronary artery disease: A report from the coronary artery surgery study. Circulation 1986; 73;1254–1263. [DOI] [PubMed] [Google Scholar]
- 16. Smith PL, Treasure T, Newman SP, et al. Cerebral consequences of cardiopulmonary bypass. Lancet 1986;1:823–825. [DOI] [PubMed] [Google Scholar]
- 17. Bigger JT Jr, Fleiss JL, Rolnitzky LM, et al. Time course of recovery of heart period variability after myocardial infarction. J Am Coll Cardiol 1991;18:1643–1649. [DOI] [PubMed] [Google Scholar]
- 18. Mazzuero G, Lanfranchi P, Colombo R, et al. A long term adaptability of 24 hour heart rate variability after myocardial infarction. Chest 1992;101:3048–3085. [PubMed] [Google Scholar]