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Global impairment of cardiac autonomic nervous activity late after the Fontan operation.
Circulation 2003; 108 Suppl 1:II180-5Circ

Abstract

BACKGROUND

Atrial tachyarrhythmia is a common cause of morbidity and mortality in patients with univentricular physiology undergoing the Fontan operation. We examined cardiac autonomic nervous activity, a predictor of arrhythmia and sudden death in other cardiovascular disease, in patients late after the Fontan operation, employing heart rate variability (HRV) and baroreflex sensitivity.

METHODS AND RESULTS

We measured HRV and baroreflex sensitivity in 22 consecutive patients (8 male, age 26+/-9 years) who had undergone the Fontan operation 13+/-6 years previously, and 22 age- and sex-matched healthy controls. Fontan patients had significantly lower HRV (P<0.0001). Baroreflex sensitivity was measured by the alpha-index method (square root of ratio of RR interval spectral power to systolic blood pressure (SBP) spectral power, in the LF and the HF band) and was also significantly depressed in the Fontan group (P<0.0001 for both). Both low frequency (LF) and high frequency (HF) components of HRV were reduced in the Fontan patients (P<0.0001), but there was interindividual variation so that the LF/(LF+HF) ratio may be high, normal, or low, and decreased with increasing right atrial dimensions (r=-0.62, P=0.006). Patients with a history of sustained atrial arrhythmia had a stronger baroreflex than those without (P=0.005).

CONCLUSIONS

Autonomic nervous control of the heart is markedly deranged in patients late after the Fontan operation, with reduced HRV and baroreflex sensitivity. A relative suppression of the sympathetic-compared with the parasympathetic-system was observed in patients with marked right atrial dilation within the Fontan group. Furthermore, stronger baroreflexes were seen in Fontan patients in association with a higher incidence of sustained atrial tachyarrhythmia, implying that sinus node dysfunction is unlikely to be the dominant mechanism. Additional studies are clearly required to examine the prognostic importance of impaired BRS and HRV in these patients.

Authors+Show Affiliations

Royal Brompton Adult Congenital Heart Programme, and Department of Clinical Cardiology, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College School of Medicine, London, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12970229

Citation

Davos, Constantinos H., et al. "Global Impairment of Cardiac Autonomic Nervous Activity Late After the Fontan Operation." Circulation, vol. 108 Suppl 1, 2003, pp. II180-5.
Davos CH, Francis DP, Leenarts MF, et al. Global impairment of cardiac autonomic nervous activity late after the Fontan operation. Circulation. 2003;108 Suppl 1:II180-5.
Davos, C. H., Francis, D. P., Leenarts, M. F., Yap, S. C., Li, W., Davlouros, P. A., ... Gatzoulis, M. A. (2003). Global impairment of cardiac autonomic nervous activity late after the Fontan operation. Circulation, 108 Suppl 1, pp. II180-5.
Davos CH, et al. Global Impairment of Cardiac Autonomic Nervous Activity Late After the Fontan Operation. Circulation. 2003 Sep 9;108 Suppl 1:II180-5. PubMed PMID: 12970229.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Global impairment of cardiac autonomic nervous activity late after the Fontan operation. AU - Davos,Constantinos H, AU - Francis,Darrel P, AU - Leenarts,Marjolein F E, AU - Yap,Sing-Chien, AU - Li,Wei, AU - Davlouros,Periklis A, AU - Wensel,Roland, AU - Coats,Andrew J S, AU - Piepoli,Massimo, AU - Sreeram,Narayanswami, AU - Gatzoulis,Michael A, PY - 2003/9/13/pubmed PY - 2003/10/1/medline PY - 2003/9/13/entrez SP - II180 EP - 5 JF - Circulation JO - Circulation VL - 108 Suppl 1 N2 - BACKGROUND: Atrial tachyarrhythmia is a common cause of morbidity and mortality in patients with univentricular physiology undergoing the Fontan operation. We examined cardiac autonomic nervous activity, a predictor of arrhythmia and sudden death in other cardiovascular disease, in patients late after the Fontan operation, employing heart rate variability (HRV) and baroreflex sensitivity. METHODS AND RESULTS: We measured HRV and baroreflex sensitivity in 22 consecutive patients (8 male, age 26+/-9 years) who had undergone the Fontan operation 13+/-6 years previously, and 22 age- and sex-matched healthy controls. Fontan patients had significantly lower HRV (P<0.0001). Baroreflex sensitivity was measured by the alpha-index method (square root of ratio of RR interval spectral power to systolic blood pressure (SBP) spectral power, in the LF and the HF band) and was also significantly depressed in the Fontan group (P<0.0001 for both). Both low frequency (LF) and high frequency (HF) components of HRV were reduced in the Fontan patients (P<0.0001), but there was interindividual variation so that the LF/(LF+HF) ratio may be high, normal, or low, and decreased with increasing right atrial dimensions (r=-0.62, P=0.006). Patients with a history of sustained atrial arrhythmia had a stronger baroreflex than those without (P=0.005). CONCLUSIONS: Autonomic nervous control of the heart is markedly deranged in patients late after the Fontan operation, with reduced HRV and baroreflex sensitivity. A relative suppression of the sympathetic-compared with the parasympathetic-system was observed in patients with marked right atrial dilation within the Fontan group. Furthermore, stronger baroreflexes were seen in Fontan patients in association with a higher incidence of sustained atrial tachyarrhythmia, implying that sinus node dysfunction is unlikely to be the dominant mechanism. Additional studies are clearly required to examine the prognostic importance of impaired BRS and HRV in these patients. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/12970229/Global_impairment_of_cardiac_autonomic_nervous_activity_late_after_the_Fontan_operation_ L2 - http://www.ahajournals.org/doi/full/10.1161/01.cir.0000087946.47069.cb?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -