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Measuring Cardiac Autonomic Nervous System ANS Activity in Children
Published on: April 29, 2013
Evaluation of cardiac autonomic function using heart rate variability in children with acute carbon monoxide
Cagdas Vural1, Ener Cagri Dinleyici2, Pelin Kosger3
11Department of Pediatrics, Faculty of Medicine,Eskisehir Osmangazi University,Eskisehir,Turkey.
Insights
Acute carbon monoxide poisoning in children can affect cardiac autonomic function, indicated by a decreased low-frequency to high-frequency heart rate variability ratio. This suggests a shift towards parasympathetic nervous system dominance following exposure.
Area of Science:
- Pediatric Cardiology
- Autonomic Nervous System Function
- Toxicology
Background:
- Carbon monoxide poisoning can lead to myocardial toxicity and cardiac autonomic dysfunction.
- These cardiac issues may precipitate life-threatening arrhythmias.
Purpose of the Study:
- To investigate the association between acute carbon monoxide exposure and cardiac autonomic function.
- To assess cardiac autonomic function using heart rate variability (HRV) in children.
Main Methods:
- Included 40 children with acute carbon monoxide poisoning and 40 healthy controls.
- Measured carboxyhaemoglobin, cardiac enzymes, and performed ECG and 24-hour Holter monitoring.
- Analyzed HRV in time and frequency domains at admission and discharge.
Main Results:
- The ratio of low-frequency to high-frequency spectral power was significantly lower in the carbon monoxide poisoning group and negatively correlated with carboxyhaemoglobin levels.
- Patients exhibited higher mean heart rate, QT dispersion, and corrected QT dispersion on admission.
- QT dispersion and corrected QT dispersion remained elevated at discharge in the carbon monoxide poisoning group.
Conclusions:
- Frequency domain HRV indices, particularly the low-frequency to high-frequency ratio, are valuable for assessing cardiac autonomic function after carbon monoxide exposure.
- A decreased low-frequency to high-frequency ratio indicates a shift in autonomic balance towards parasympathetic activity.
Abstract:
Introduction Carbon monoxide poisoning may cause myocardial toxicity and cardiac autonomic dysfunction, which may contribute to the development of life-threatening arrhythmias. We investigated the potential association between acute carbon monoxide exposure and cardiac autonomic function measured by heart rate variability.
Method:
The present study included 40 children aged 1-17 years who were admitted to the Pediatric Intensive Care Unit with acute carbon monoxide poisoning and 40 healthy age- and sex-matched controls. Carboxyhaemoglobin and cardiac enzymes were measured at admission. Electrocardiography was performed on admission and discharge, and 24-hour Holter electrocardiography was digitally recorded. Heart rate variability was analysed at both time points - 24-hour recordings - and frequency domains - from the first 5 minutes of intensive care unit admission.
Results:
Time domain and frequency indices such as high-frequency spectral power and low-frequency spectral power were similar between patient and control groups (p>0.05). The ratio of low-frequency spectral power to high-frequency spectral power was significantly lower in the carbon monoxide poisoning group (p<0.001) and was negatively correlated with carboxyhaemoglobin levels (r=-0.351, p<0.05). The mean heart rate, QT dispersion, corrected QT dispersion, and P dispersion values were higher in the carbon monoxide poisoning group (p<0.05) on admission. The QT dispersion and corrected QT dispersion remained longer in the carbon monoxide poisoning group compared with controls on discharge (p<0.05).
Conclusion:
The frequency domain indices, especially the ratio of low-frequency spectral power to high-frequency spectral power, are useful for the evaluation of the cardiac autonomic function. The decreased low-frequency spectral power-to-high-frequency spectral power ratio reflects a balance of the autonomic nervous system, which shifted to parasympathetic components.
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