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Can Analysis of Heart Rate Variability Predict Arrhythmia in Children with Fontan Circulation?

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The aim of this study was to examine whether changes in heart rate variability (HRV) can predict arrhythmias in children who have undergone the Fontan procedure. The study included 15 children with total cavopulmonary connection. All examinations included echocardiography and 24-h ambulatory electrocardiogram with power spectral analysis of HRV and Poincaré plots (plots of each R-R interval as a function of the previous R-R interval). Six patients developed supraventricular tachycardia (four or more consecutive supraventricular beats). One patient was excluded from the study due to the development of bradycardia, necessitating placement of a pacemaker. Compared to the arrhythmia group, the patients without arrhythmias (n = 8) exhibited a significant difference in the standard deviation of instantaneous beat-to-beat R-R interval variability (= 0.02). Poincaré plots of patients without arrhythmias showed a typical torpedo- or comet-shaped pattern, whereas the arrhythmia group showed a more complex pattern. Although this study examined only a few subjects, needing confirmation by larger studies, it does indicate that patients who develop arrhythmias after receiving the Fontan procedure show a different Poincaré pattern compared to the nonarrhythmic group—even before the arrhythmia can be detected using the conventional Holter procedure. Routine follow-up using the Holter procedure and Poincaré plot analysis could help detect early arrhythmias.

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  1. Anan T, Sunagawa K, Araki H, Nakamura M (1990) Arrhythmia analysis by successive RR plotting. J Electrocardiol 23:243–248

    Article  PubMed  CAS  Google Scholar 

  2. Balaji S, Gewillig M, Bull C, de Leval MR, Deanfield JE (1991) Arrhythmias after the Fontan procedure. Comparison of total cavopulmonary connection and atriopulmonary connection. Circulation 84 (Suppl 5):III162–III167

    PubMed  CAS  Google Scholar 

  3. Butera G, Bonet D, Iserin L, Sidi D, Kachaner J, Villain E (1999) Total cavopulmonary and atriopulmonay connections are associated with reduced heart rate variability. Heart 82:704–707

    PubMed  CAS  Google Scholar 

  4. Butera G, Bonnet D, Kachaner J, Sidi D, Villain E (2003) Heart rate variability in children with hypertrophic cardiomyopathy. Heart 89(2):205–206

    Article  PubMed  CAS  Google Scholar 

  5. Chen S, Nouri S, Pennington DG (1988) Dysrhythmias after modified Fontan procedure. Pediatr Cardiol 9:215–219

    Article  PubMed  CAS  Google Scholar 

  6. Cohen MI, Wernovsky G, Vetter VL, Wieand TS, Gaynor JW, Jacobs ML, Spray TL, Rhodes LA (1998) Sinus node function after a systematically staged Fontan procedure. Circulation 98(19 Suppl II):352–358

    Google Scholar 

  7. Denton T, Diamond G, Helfant R, Khan S, Karaguezian H (1990) Fascinating rhythm: a primer on chaos theory and its application to cardiology. Am Heart J 120:1419–1440

    Article  PubMed  CAS  Google Scholar 

  8. Farrell TG, Bashir Y, Cripps T, Malik M, Poloniecki J, Bennet ED, Ward DE, Camm AJ (1991) Risk stratification for arrhythmic events in post-infarction patients based on heart rate variability, ambulatory electrocardiographic variables and the signal-averaged electrocardiogram. J Am Coll Cardiol 18:687–697

    PubMed  CAS  Google Scholar 

  9. Gelatt M, Hamilton RM, Mc Crindle BW, Gow RM, Williams WG, Trusler GA, Freedom RM (1994) Risk factors for atrial tachyarrhythmias after the Fontan operation. J Am Coll Cardiol 24:1735–1741

    PubMed  CAS  Google Scholar 

  10. Hartikainen JE, Malik M, Staunton A, Poloniecki J, Camm AJ (1996) Distinction between arrhythmic and nonarrhythmic death after acute myocardial infarction based on heart rate variability, signal-averaged electrocardiogram, ventricular arrhythmias and left ventricular ejection fraction. J Am Coll Cardiol 28(2):296–304

    Article  PubMed  CAS  Google Scholar 

  11. Hofbeck M, Koch A, Buheitel G, Gerling S, Rauch R, Weyand M, Singer H (2000) Late postoperative cardiac arrhythmias after total cavopulmonay anastomosis and correlation with age of the patients at operation. Z Kardiol 89(9):788–794

    Article  PubMed  CAS  Google Scholar 

  12. Huikuri HV, Mäkikallio T, Airaksinen J, Mitrani R, Castellanos A, Myerburg RJ (1999) Measurement of heart rate variability: A clinical tool or a research toy? J Am Coll Cardiol 34(7):1878–1883

    Article  PubMed  CAS  Google Scholar 

  13. Kurer CC, Tanner CS, Vetter VL (1991) Electrophysiologic findings after the Fontan repair of functional single ventricle. J Am Coll Cardiol 17(1):174–181

    PubMed  CAS  Google Scholar 

  14. Manning PB, Mayer JE Jr, Wernovsky G, Fishberger SB, Walsh EP (1996) Staged operation to Fontan increases the incidence of sinoatrial node dysfunction. J Thorac Cardiovasc Surg 111(4):833–839

    Article  PubMed  CAS  Google Scholar 

  15. Ohuchi H, Hasegawa S, Yasuda K, Yamada O, Ono Y, Echigo S (2001) Severely impaired cardiac autonomic nervous activity after the Fontan operation. Circulation 104(13):1513–1518

    Article  PubMed  CAS  Google Scholar 

  16. Peters NS, Somerville J (1992) Arrhythmias after the Fontan procedure. Br Heart J 68(2):199–204

    Article  PubMed  CAS  Google Scholar 

  17. Rydberg A, Rask P, Hornsten R, Teien D (2004) Heart rate variability in children with Fontan circulation. Pediatr Cardiol 25(4):365–369

    Article  PubMed  CAS  Google Scholar 

  18. Rydberg A, Wiklund U, Rask P, Hornsten R (2005) Serial assessment of variability in heart rate in children with the Fontan circulation. Cardiol Young 15(5):498–503

    Article  PubMed  Google Scholar 

  19. Stein PH, Domitrovich PP, Hui N, Rautaharju P, Gottdiener J (2005) Sometimes higher heart rate variability is not better heart rate variability: results of graphical and nonlinear analyses. J Cardiovasc Electrophysiol 16:954–959

    Article  PubMed  Google Scholar 

  20. Task force of the European Society of Cardiology, the North American Society of Pacing, Electrophysiology (1996) Heart rate variability. Standards of measurements, physiological interpretation and clinical use. Circulation 93:1043–1065

    Google Scholar 

  21. Woo M, Stevenson W, Moser D, Middlekauff H (1994) Patterns of beat-to-beat heart rate variability in advanced heart failure. J Am Coll Cardiol 23:565–569

    Article  PubMed  CAS  Google Scholar 

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Rydberg, A., Karlsson, M., Hörnsten, R. et al. Can Analysis of Heart Rate Variability Predict Arrhythmia in Children with Fontan Circulation?. Pediatr Cardiol 29, 50–55 (2008).

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