Pediatric Cardiology

, Volume 27, Issue 6, pp 670–678 | Cite as

Spectral and Time-Domain Analyses of Heart-Rate Variability During Head-Upright Tilt-Table Testing in Children with Neurally Mediated Syncope

  • Harun Evrengul
  • Vedide Tavlı
  • Havva Evrengul
  • Talat Tavlı
  • Dursun Dursunoglu
ORIGINAL ARTICLE
First Online:
Received:
Accepted:

Abstract

Neurocardiac syncope (NS) is a common cause of syncope in children. The mechanism, though related to abnormalities in autonomic function, has not been fully elucidated, particularly in pediatric patients. This study assessed the heart-rate variability (HRV) response to head-upright tilt-table test (HUT) in children with NS and normal volunteers. Spectral and time-domain analysis of HRV was used to assess changes in autonomic function in 27 children (9 male, mean age 12.3 ± 1.6 years) with a history of at least one episode of syncope and positive passive HUT and 27 age-matched normal volunteers with negative passive HUT before and during postural tilt and to attempt to relate such changes to specific types of hemodynamic response to tilt. Frequency-domain measurements of the high-(HF) and low-(LF) frequency bands and the ratio LF/HF were derived from Holter recordings and computed by fast Fourier analysis for 5-min intervals. Time-domain measurements of the SDNN, SDNNI, SDANN, RMSSD, and triangular index were derived from 24-h Holter recordings. There were no significant differences between clinical characteristics, time-domain, and basal frequency domain parameters of the groups. Mean values of LF and LF/HF ratio was increased and HF was decreased significantly in response to tilt in both patient and control groups. Mean values of LF and LF/HF ratio were higher and HF was lower compared to controls immediately after tilt. LF and LF/HF ratio showed a statistically significant decrease and a significant increase in HF during syncope in patients. The three subgroups of patients had similar patterns of changes in autonomic activity. The results of this study show that although the basal autonomic function was similar to that of the control group, patients with NS have a different pattern of response to the HUT. In our study, patients with NS demonstrated an exaggerated response to the HUT. This exaggerated response may be the factor that activates the pathological reflexes of NS. The pathological mechanism leading to NS appears to be independent of the specific type of hemodynamic response to HUT.

Keywords

Neurocardiac syncope Tilt test Heart-rate variability 
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References

  1. 1.
    Akselrod S, Gordon D, Ubel FA, et al. (1981) Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control. Science. 213:220–222PubMedCrossRefGoogle Scholar
  2. 2.
    Balaji S, Oslizlok PC, Allen MC, McKay CA, Gillette PC (1994) Neurocardiogenic syncope in children with a normal heart. J Am Coll Cardiol 23:779–785PubMedGoogle Scholar
  3. 3.
    Bekheit S, Tangella M, EI-Sakr A, et al. (1990) Use of heart rate spectral analysis to study effects of calcium channel blockers on sympathetic activity after myocardial infarction. Am Heart J 119:79–84PubMedCrossRefGoogle Scholar
  4. 4.
    Bernardi L, Salvucci F, Leuzzi S, et al. (1996) Cardiovascular reflex changes preceding episodes of vasovagal syncope in pediatric subjects. Clin Sci 9(suppl):25–27Google Scholar
  5. 5.
    Bigger JT, Fleiss JL, Steinman RC, et al. (1992) Correlations among time and frequency domain measures of heart period variability two weeks after acute myocardial infarction. Am J Cardiol 69:891–898PubMedCrossRefGoogle Scholar
  6. 6.
    De Jong-de Vos van Steenwijk CCE, Wieling W, Johannes JM, et al. (1995) Incidence and hemodynamic characteristics of near fainting in healthy 6- to 16-year old subjects. J Am Coll Cardiol 25:1615–1621CrossRefGoogle Scholar
  7. 7.
    Driscoll DJ, Jacobsen SJ, Porter CJ, Wollan PC (1997) Syncope in children and adolescents. J Am Coll Cardiol 29:1031–1045CrossRefGoogle Scholar
  8. 8.
    Grubb BP, Temesy-Armos P, Moore J, Wolfe D, Hahn H, Elliot L (1992) Headupright tilt-table testing in evaluation and management of the malignant vaso-vagalsyndrome. Am J Cardiol 69:904–908PubMedCrossRefGoogle Scholar
  9. 9.
    Heart rate variability: standards of measurement, physiological interpretation, clinical use. The Task Force of the European society of Cardiology and North American Society of Pacing and Electrophysiology (1996). Circulation 93:1043–1065Google Scholar
  10. 10.
    Kochiadakis GE, Kanoupakis EM, Igoumenidis NE, et al. (1998) Spectral analysis of heart rate variability during tilt-table testing in patients with vasovagal syncope. Int J Cardiol 64:185–194PubMedCrossRefGoogle Scholar
  11. 11.
    Kochiadakis GE, Kanoupakis EM, Rombola AT, et al. (1998) Reproducibility of tilt-table testing in patients with vasovagal syncope and its relation to variations in autonomic nervous system activity. PACE 21:1069–1076PubMedGoogle Scholar
  12. 12.
    Lagi A, Cipriani M, Buccheri A, Tamburini C (1999) Heart rate and blood pressure variability in orthostatic syncope. Clin Sci 9(suppl):62–64Google Scholar
  13. 13.
    Lippman N, Stein KM, Lerman B (1995) Failure to decrease parasympathetic tone during upright tin predicts a positive tilt-table test. Am J Cardiol 75:591–595PubMedCrossRefGoogle Scholar
  14. 14.
    Lipsitz LA, Mietus J, Moody GB, et al. (1990) Spectral characteristics of heart rate variability before and during postural tilt. Relations to aging and risk of syncope. Circulation 81:1803–1810PubMedGoogle Scholar
  15. 15.
    Malliani A, Pagani M, Lombardi F, et al. (1991) Cardiovascular neural regulation explored in the frequency domain. Circulation 84:482–492PubMedGoogle Scholar
  16. 16.
    Mizumaki K, Fujiki A, Tani M, et al. (1995) Left ventricular dimensions and autonomic balance during head-up tilt differ between patient with isoproterenol dependent and insoproterenol-independent neurally mediated syncope. J Am Coll Cardiol 26:164–173PubMedCrossRefGoogle Scholar
  17. 17.
    Morillo CA, Klein GJ, Jones DL, Yee R (1994) Time and frequency domain analyses of heart rate variability during orthostatic stress in patients with neurally mediated syncope. Am J Cardiol 74:1258–1262PubMedCrossRefGoogle Scholar
  18. 18.
    Pagani M, Lombardi F, Guzzetti S, et al. (1986) Power spectral analysis of heart rate and arterial pressure variability as a marker of sympato-vagal interaction in man and conscious dog. Circ Res 59:178–193PubMedGoogle Scholar
  19. 19.
    Perry JC, Garson A (1991) The child with recurrent syncope: autonomic function testing and beta-adrenergic hypersensitivity. J Am Coll Cardiol 17:1168–1171PubMedGoogle Scholar
  20. 20.
    Pongiglione G, Fish FA, Strasburger JF, et al. (1990) Heart rate and bloodpressure response to upright tilt in young patients with unexplained syncope. J Am Coll Cardiol 16:165–170PubMedCrossRefGoogle Scholar
  21. 21.
    Raviele A, Gasparini G, Pe Pede F, et al. (1990) Usefulness of head-up tilt test in evaluating patients with syncope of unknown origin and negative electrophysiologic study. Am J Cardiol 65:1322–1327PubMedCrossRefGoogle Scholar
  22. 22.
    Ruckman RK (1987) Cardiac causes of syncope. Pediatr Rev 9:101–108PubMedGoogle Scholar
  23. 23.
    Sehra R, Hubbard JE, Straka SP, et al. (1999) Autonomic changes and heart rate variability in children with neurocardiac syncope. Pediatr Cardiol 20:242–247PubMedCrossRefGoogle Scholar
  24. 24.
    Sheldon R (1994) Effects of aging on responses to isoproteronol tilt-table testing in patients with syncope. Am J Cardiol 74:459–463PubMedCrossRefGoogle Scholar
  25. 25.
    Silvetti MS, Drago F, Ragonese P (2001) Heart rate variability in healthy children and adolescents is partially related to age and gender. Int J Cardiol 81:169–174PubMedCrossRefGoogle Scholar
  26. 26.
    Sneddon JF, Bashir Y, Murgatroyd FD, et al. (1993) Do patients with neurally mediated syncope have augmented vagal tone? Am J Cardiol 72:1314–1315PubMedCrossRefGoogle Scholar
  27. 27.
    Stewart JM, Erb M, Sorbera C (1996) Heart rate variability and the outcome of head-up tilt in syncopal children. Pediatr Res 40:702–709PubMedGoogle Scholar
  28. 28.
    Tanaka H, Thulesius O, Yamaguchi H, Mino M (1994) Circulatory responses in children with unexplained syncope evaluated by continuous non-invasive finger blood pressure monitoring. Acta Paediatr 83:754–761PubMedGoogle Scholar
  29. 29.
    Van Lieshout JJ, Weiling W, Karemaker JM, Eckberg DL (1991) The vasovagal response. Clin Sci 81:575–586PubMedGoogle Scholar
  30. 30.
    Vybiral T, Bryg RJ, Maddens ME, et al. (1989) Effect of passive tilt on sympathetic and parasympathetic components of heart rate variability in normal subjects. Am J Cardiol 63:1117–1120PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Harun Evrengul
    • 1
    • 4
  • Vedide Tavlı
    • 2
  • Havva Evrengul
    • 2
  • Talat Tavlı
    • 3
  • Dursun Dursunoglu
    • 1
  1. 1.Pamukkale University School of MedicineDenizliTurkey
  2. 2.Division of Pediatric CardiologyDr. Behçet Uz Sick Children’s HospitalIzmirTurkey
  3. 3.Celal Bayar University School of MedicineManisaTurkey
  4. 4.DenizliTurkey

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