The Relationship Between Heart Rate Variability Parameters and Atrioventricular Nodal Reentrant Tachycardia

Yıl 2018, Cilt: 21 Sayı: 2, 128 - 134, 19.08.2018

Lütfü Aşkın Serdar Türkmen

Öz

Introduction:
Heart
rate variability (HRV) is associated with sympathetic tone. Studies have
disputed the interpretation of the low frequency (LF) and low/high frequency
(LF/HF) ratio for the indication of sympathetic cardiac control and autonomic
balance. This study aims to investigate the association between HRV parameters
and atrioventricular nodal reentrant tachycardia (AVNRT) and observe the effect
of autonomic nervous system on AVNRT.

Patients
and Methods: In total, 354 subjects with palpitations underwent the
electrophysiological study (EPS). Most (71%; 253/354) patients had at least an
ambulatory Holter ECG recording of 24 h. As a consequence of the exclusion
criteria, 160 individuals were classified into two groups: control group (no
arrhythmia induced, n= 90) and AVNRT group (n= 70).

Results: Daytime
and nighttime LF and LF/HF ratio were significantly higher in the AVNRT group
(p< 0.05) than in the control group. Interestingly, daytime ultra-LF, very
LF, and total power were significantly lower in the AVNRT group.

Conclusion: AVNRT is associated with
altered sympathovagal balance. Furthermore, increased LF and LF/HF may be
indicative of enhanced sympathetic activity in patients with AVNRT because of
inhomogeneous ventricular activation via the slow accessory pathway.

Anahtar Kelimeler

Atrioventricular nodal reentrant tachycardia, heart rate variability, low frequency, low/high frequency

Kalp Hızı Değişkenliği Parametreleri ile Atriyoventriküler Nodal Reentrant Taşikardi Arasındaki İlişki

Öz

Giriş: Kalp hızı değişkenliği (HRV) sempatik ton ile ilişkilidir. Çalışmalar
sempatik kardiyak kontrol ve otonom denge endikasyonu için düşük frekans (LF)
ve düşük/yüksek frekans (LF/HF) oranının yorumlamasını tartışmışlardır. Bu
çalışma, HRV parametreleri ile atriyoventriküler nodal reentrant taşikardi
(AVNRT) arasındaki ilişkiyi araştırmayı ve otonomik sinir sisteminin AVNRT
üzerindeki etkisini gözlemeyi amaçlamaktadır.

Hastalar ve
Yöntem: Çarpıntısı olan 354 olguya elektrofizyolojik çalışma
yapıldı (EPS). Hastaların %71 (253/354)'i en az bir 24 saatlik ambulatuvar
Holter elektrokardiyografi (EKG) kaydına sahipti. Dışlama kriterlerinin bir
sonucu olarak, 160 birey iki gruba ayrıldı; kontrol grubu (aritmi indüklenmedi,
n= 90) ve AVNRT grubu (n= 70).

Bulgular: Gündüz ve gece LF ve LF/HF oranı AVNRT'de kontrollerden anlamlı derecede
yüksekti (p< 0.05). İlginç olarak, gündüz ultra düşük frekans, çok düşük
frekans ve toplam güç AVNRT’de anlamlı olarak düşüktü.

Sonuç: AVNRT değişmiş sempatovagal
denge ile ilişkilidir. Dahası, artmış LF ve LF/HF, AVNRT hastalarında yavaş
aksesuar yolla homojen olmayan ventriküler aktivasyonun bir sonucu olarak
artmış sempatik aktivitenin bir göstergesi olabilir.

Anahtar Kelimeler

Atriyoventriküler nodal reentrant taşikardi, kalp hızı değişkenliği, düşük frekans, düşük/yüksek frekans

Kaynakça

• 1. Gölcük E, Yalın K, Bilge AK, Adalet K. Atrioventricular complete block occurring 12 years after successful ablation of slow-slow atrioventricular nodal reentrant tachycardia. Turk Kardiyol Dern Ars 2013;41:233-7.
• 2. Evrengul H, Alihanoglu Y, Kilic ID, Yildiz BS, Kose S. Clinical and electrophysiological characteristics of the patients with relatively slow atrioventricular nodal reentrant tachycardia. J Interv Card Electrophysiol 2014;40:117-23.
• 3. Bohnen M, Stevenson WG, Tedrow UB, Michaud GF, John RM, Epstein LM, et al. Incidence and predictors of major complications from contemporary catheter ablation to treat cardiac arrhythmias. Heart Rhythm 2011;8:1661-6.
• 4. Marzlin KM. Atrioventricular Nodal Reentrant Tachycardia. AACN Adv Crit Care 2017;28:84-8.
• 5. Akhtar M, Jazayeri MR, Sra J, Blanck Z, Deshpande S, Dhala A. Atrioventricular nodal reentry. Clinical, electro- physiological, and therapeutic considerations. Circulation 1993;88:282-95.
• 6. Leong CS, Barret M, Joyce D, Walsh D. P-46 Orthostatic hypotension and heart rate variability in the diagnosis of autonomic dysfunction in advanced cancer. BMJ Publishing Group 2017.
• 7. Miles W, Zipes D. Atrioventricular reentry and variants: Mechanisms, clinical features, and management. Cardiac Electrophysiology: From Cell to Bedside. 3rd ed. Philedelphia, Pa: WB Saunders, 2000;638-55.
• 8. Podrid PJ, Kowey PR. Cardiac arrhythmia: mechanisms, diagnosis, and management. Lippincott Williams & Wilkins 2001.
• 9. Lee MA, Morady F, Kadish A, Schamp DJ, Chin MC, Scheinman MM. Catheter modification of the atrioventricular junction with radiofrequency energy for control of atrioventricular nodal reentry tachycardia. Circulation 1991;83:827-35.
• 10. Jazayeri MR, Hempe SL, Sra JS, Dhala AA, Blanck Z, Deshpande SS. Selective transcatheter ablation of the fast and slow pathways using radiofrequency energy in patients with atrioventricular nodal reentrant tachycardia. Circulation 1992;85:1318-28.
• 11. Haissaguerre M, Gaita F, Fischer B, Commenges D, Montserrat P, d’Ivernois C, et al. Elimination of atrioventricular nodal reentrant tachycardia using discrete slow potentials to guide application of radiofrequency energy. Circulation 1992;85:2162-75.
• 12. Jackman WM. Treatment of supraventricular tachycardia due to atrioventricular nodal reentry by radiofrequency catheter ablation of slow-pathway conduction. N Engl J Med 1992; 327:313-8.
• 13. Brembilla-Perrot B, Sellal JM, Olivier A, Manenti V, Beurrier D, de Chillou C, et al. Recurrences of symptoms after AV node re-entrant tachycardia ablation: a clinical arrhythmia risk score to assess putative underlying cause. Int J Cardiol 2015;179:2926.
• 14. Katritsis DG, Zografos T, Katritsis GD, Giazitzoglou E, Vachliotis V, Paxinos G, et al. Catheter ablation vs. antiarrhythmic drug therapy in patients with symptomatic atrioventricular nodal re-entrant tachycardia: a randomized, controlled trial. Europace 2017;19:602-6.
• 15. He J, Liu Z, Fang PH, Chen XB, Liu J, Tang M, Jia YH, et al. Long-term efficacy of empirical slow pathway ablation in non-inducible and suspected atrioventricular nodal reentry tachycardia. Acta Cardiol 2016;71:457-62.
• 16. Lindsay BD, Chung MK, Gamache MC, Luke RA, Schechtman KB, Osborn JL, et al. Therapeutic end points for the treatment of atrioventricular node reentrant tachycardia by catheter-guided radiofrequency current. J Am Coll Cardiol 1993;22:733-40.
• 17. Sileikiene R, Vaskelyte J, Mizariene V, Nedzelskiene I, Verseckaite R, Jurkevicius R, et al. Heart rate variability and atria function in children at late follow-up evaluation after atrioventricular node slow-pathway radiofrequency ablation. Pediatr Cardiol 2011;32:792-800.
• 18. Stern JD, Rolnitzky L, Goldberg JD, Chinitz LA, Holmes DS, Bernstein NE, et al. Meta-analysis to assess the appropriate endpoint for slow pathway ablation of atrioventricular nodal reentrant tachycardia. Pacing Clin Electrophysiol 2011;34:269-77.
• 19. Nigro G, Russo V, de Chiara A, Rago A, Cioppa ND, Chianese R, et al. Autonomic nervous system modulation before the onset of sustained atrioventricular nodal reentry tachycardia. Ann Noninvasive Electrocardiol 2010;15:49-55.
• 20. Nayyar M, Yusuf J, Khan U, Weber KT. K+ and Mg 2+ dyshomeostasis in acute hyperadrenergic stressor states. Am J Med Sci 2017.
• 21. Cardiology TFotESo. Heart rate variability standards of measurement, physiological interpretation, and clinical use. Eur heart J 1996;17:354-81.
• 22. Malliani A, Pagani M, Lombardi F, Cerutti S. Cardiovascular neural regulation explored in the frequency domain. Circulation 1991;84:482-92.
• 23. Malliani A, Pagani M, Furlan R, Guzzetti S, Lucini D, Montano N. Individual recognition by heart rate variability of two different autonomic profiles related to posture. Circulation 1997;96:4143-5.
• 24. Guzzetti S, Mayet J, Shahi M, Mezzetti S, Foale R, Sever P. Absence of sympathetic overactivity in Afro-Caribbean hypertensive subjects studied by heart rate variability. J Hum Hypertens 2000;14:337.
• 25. Bernardi L, Ricordi L, Lazzari P, Solda P, Calciati A, Ferrari MR. Impaired circadian modulation of sympathovagal activity in diabetes. A possible explanation for altered temporal onset of cardiovascular disease. Circulation 1992;86:1443-52.
• 26. Hsieh M-H, Chiou C-W, Wen Z-C, Wu C-H, Tai C-T, Tsai C-F, et al. Alterations of heart rate variability after radiofrequency catheter ablation of focal atrial fibrillation originating 274 from pulmonary veins. Circulation 1999; 100:2237-43.
• 27. Kiyono K, Hayano J, Watanabe E, Yamamoto Y. Heart rate variability (HRV) and 276 sympathetic nerve activity, in clinical assessment of the autonomic nervous system. Springer 2017;147-61.
• 28. Karadeniz C, Özdemir R, Demirol M, Katipoglu N, Yozgat Y, Mese T, et al. Low iron stores in otherwise healthy children affect electrocardiographic markers of important cardiac events. Pediatr Cardiol 2017;1-6.
• 29. Yo Y, Nagano M, Nagano N, Iiyama K, Higaki J, Mikami H. Effects of age and hypertension on autonomic nervous regulation during passive head-up tilt. Hypertension 1994;23:I82.