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Heart rate variability parameters in children with ventricular preexcitation
Serhat Koca1, Feyza Aysenur Pac1, Ajda Mihcioglu2
1Department of Pediatric Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey.
Insights
Autonomic nervous system imbalance, indicated by a higher LF/HF ratio, is linked to adverse conduction and inducible tachycardia in children with ventricular preexcitation. This suggests autonomic status impacts arrhythmia risk.
Area of Science:
- Cardiology
- Autonomic Nervous System Research
- Pediatric Electrophysiology
Background:
- The autonomic nervous system significantly influences cardiac electrophysiology and the development of arrhythmias.
- Understanding autonomic status in pediatric ventricular preexcitation is crucial for assessing arrhythmia risk.
Purpose of the Study:
- To evaluate cardiac autonomic status in children with ventricular preexcitation using heart rate variability (HRV) parameters.
- To correlate HRV parameters with accessory pathway conduction properties, tachycardia inducibility, and symptomology.
Main Methods:
- Retrospective analysis of electrocardiography, Holter monitoring, and electrophysiological study (TEEPS and EPS) data from ventricular preexcitation patients over 7 years.
- Classification of accessory pathway conduction as adverse or nonadverse based on TEEPS results.
- Comparison of HRV parameters (specifically LF/HF ratio) between patient groups (adverse vs. nonadverse conduction, inducible vs. non-inducible tachycardia, symptomatic vs. asymptomatic) and healthy controls.
Main Results:
- The LF/HF ratio, a measure of sympathovagal balance, was significantly higher in patients with adverse accessory pathway conduction compared to those with nonadverse conduction and controls.
- Ventricular preexcitation patients with inducible tachycardia (assessed by EPS) showed a higher LF/HF ratio than those without.
- Symptomatic ventricular preexcitation patients exhibited a higher LF/HF ratio compared to asymptomatic patients.
- No significant difference in HRV parameters was observed between preexcitation patients and healthy controls.
Conclusions:
- Autonomic tonus, reflected by the LF/HF ratio, appears to play a role in the electrophysiological properties of accessory pathways in ventricular preexcitation.
- Elevated sympathovagal imbalance (higher LF/HF ratio) is associated with increased risk of inducible tachycardia and symptomatic presentation in pediatric ventricular preexcitation.
- These findings highlight the potential of HRV analysis in assessing arrhythmia risk in children with ventricular preexcitation.
Introduction:
The autonomic nervous system has a regulatory effect on cardiac electrophysiology and arrhythmogenesis. We aimed to assess cardiac autonomic status using heart rate variability (HRV) parameters in children with ventricular preexcitation.
Methods:
The electrocardiography, Holter monitoring, transesophageal electrophysiological study (TEEPS), and invasive electrophysiological study (EPS) results of ventricular preexcitation patients obtained over a 7-year period in our clinic were evaluated. According to the TEEPS results, patients' accessory pathway conduction was classified as adverse (n = 40) or nonadverse (n = 25). The HRV parameters of patients were compared according to tachycardia inducibility that assessed by TEEPS and EPS. Also, HRV parameters were compared in patients with adverse and nonadverse pathway conduction. Further, the HRV parameters of preexcitation patients were compared with those of healthy controls.
Results:
LF/HF, the best measure of sympathovagal balance, was statistically higher in patients with adverse conduction than in patients without adverse conduction and controls (P = 0.001). The LF/HF ratio was higher in ventricular preexcitation patients with inducible tachycardia than those without in EPS (P = 0.001). In addition, the LF/HF ratio was higher in symptomatic ventricular preexcitation patients than asymptomatic ones (P = 0.001). No difference in HRV parameters was found between preexcitation patients and controls.
Conclusion:
Autonomic tonus in patients with ventricular preexcitation may affect accessory pathway conduction properties, tachycardia inducibility, and symptomology. The indicator of sympathovagal balance, LF/HF ratio, increased in ventricular preexcitation patients with inducible tachycardia and those that were symptomatic.
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