ORIGINAL PAPER
Analysis of heart rate variability in paediatric patients with vasovagal syncope
1
Department of Pediatrics #2, Ivan Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
2
Bogomolets National Medical University, Kyiv, Ukraine
Submission date: 2019-11-21
Acceptance date: 2019-12-11
Publication date: 2019-12-31
Pediatr Pol 2019;94(6):357-367
KEYWORDS
TOPICS
ABSTRACT
Introduction:
The aim of the study was to detect any abnormalities of the autonomic nervous system in children and adolescents with vasovagal syncope.
Material and methods:
We studied 56 children, ages eight to 17 years, with a history of vasovagal syncope and 41 healthy volunteers. Heart rate variability was calculated over a 24-hour period for heart rate, standard deviations of the averages of the R-R intervals in all 5-min segments of R-R intervals (SDANN), the root of the 24-hour square (RMSSD), the proportion of adjacent normal R-R intervals < 50 ms (pNN50), the total power (TP), the low frequency index (LF), the high frequency index (HF), and the LF/HF ratio.
Results:
Patients with vasovagal syncope had significantly reduced values of 24-hour (256.21 ±190.97 ms, 366.51 ±264.7 ms, p = 0.048) and night-time SDANN (168.56 ±140.59 ms, 251.54 ±189.92 ms, p = 0.034); 24-hour (292.96 ±226.25 ms, 390.49 ±254.06 ms, p = 0.046), daytime (349.52 ±298.32 ms, 479.23 ±350.39 ms, p = 0.040), and night-time RMSSD (188.47 ±161.07 ms, 271.05 ±200.70 ms, p = 0.029); daytime pNN50 (25.10 ±13.10%, 32.10 ±14.19%, p = 0.037); and increased value of night-time LF/HF ratio (1.43 ±1.50, 0.86 ±1.00, p = 0.015), in comparison to healthy subjects. In adolescents with vasovagal syncope we found significantly lower values of 24-hour (7578.29 ±5409.74 ms2, 12236.00 ±5651.45 ms2, p = 0.025) and daytime TP (4776.19 ±4146.56 ms2, 10488.70 ±8326.43 ms2, p = 0.039), 24-hour (2120.90 ±2057.00 ms2, 3634.22 ±3026.90 ms2, p = 0.015) and daytime HF (930.10 ±1101.66 ms2, 7832.90 ±18825.10 ms2, p = 0.015), in comparison with children. Males presented lower values of 24-hour (207.4 ±134.63 ms, 324.00 ±236.95 ms, p = 0.042) and daytime SDANN (264.56 ±208.16 ms, 432.65 ±320.52 ms, p = 0.044), and daytime RMSSD (282.54 ±248.94 ms, 446.28 ±342.35 ms, p = 0.041) compared with females.
Conclusions:
Paediatric patients with vasovagal syncope had alterations in basal autonomic balance, which indicated an increased sympathetic modulation. More severe autonomic imbalance occurs in adolescent males.
The aim of the study was to detect any abnormalities of the autonomic nervous system in children and adolescents with vasovagal syncope.
Material and methods:
We studied 56 children, ages eight to 17 years, with a history of vasovagal syncope and 41 healthy volunteers. Heart rate variability was calculated over a 24-hour period for heart rate, standard deviations of the averages of the R-R intervals in all 5-min segments of R-R intervals (SDANN), the root of the 24-hour square (RMSSD), the proportion of adjacent normal R-R intervals < 50 ms (pNN50), the total power (TP), the low frequency index (LF), the high frequency index (HF), and the LF/HF ratio.
Results:
Patients with vasovagal syncope had significantly reduced values of 24-hour (256.21 ±190.97 ms, 366.51 ±264.7 ms, p = 0.048) and night-time SDANN (168.56 ±140.59 ms, 251.54 ±189.92 ms, p = 0.034); 24-hour (292.96 ±226.25 ms, 390.49 ±254.06 ms, p = 0.046), daytime (349.52 ±298.32 ms, 479.23 ±350.39 ms, p = 0.040), and night-time RMSSD (188.47 ±161.07 ms, 271.05 ±200.70 ms, p = 0.029); daytime pNN50 (25.10 ±13.10%, 32.10 ±14.19%, p = 0.037); and increased value of night-time LF/HF ratio (1.43 ±1.50, 0.86 ±1.00, p = 0.015), in comparison to healthy subjects. In adolescents with vasovagal syncope we found significantly lower values of 24-hour (7578.29 ±5409.74 ms2, 12236.00 ±5651.45 ms2, p = 0.025) and daytime TP (4776.19 ±4146.56 ms2, 10488.70 ±8326.43 ms2, p = 0.039), 24-hour (2120.90 ±2057.00 ms2, 3634.22 ±3026.90 ms2, p = 0.015) and daytime HF (930.10 ±1101.66 ms2, 7832.90 ±18825.10 ms2, p = 0.015), in comparison with children. Males presented lower values of 24-hour (207.4 ±134.63 ms, 324.00 ±236.95 ms, p = 0.042) and daytime SDANN (264.56 ±208.16 ms, 432.65 ±320.52 ms, p = 0.044), and daytime RMSSD (282.54 ±248.94 ms, 446.28 ±342.35 ms, p = 0.041) compared with females.
Conclusions:
Paediatric patients with vasovagal syncope had alterations in basal autonomic balance, which indicated an increased sympathetic modulation. More severe autonomic imbalance occurs in adolescent males.
REFERENCES (34)
1.
Bento L, Fonseca-Pinto R, Povoa P. Autonomic nervous system monitoring in intensive care as a prognostic tool. Systematic review. Rev Bras Ter Intensiva 2017; 29: 481-489.
2.
Hilz MJ, Liu M, Roy S, Wang R. Autonomic dysfunction in the neurological intensive care unit. Clin Auton Res 2018; 29: 301-311.
3.
Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation 1996; 93: 1043-1065.
4.
Xhyheri B, Manfrini O, Mazzolini M, et al. Heart rate variability today. Prog Cardiovasc Dis 2012; 55: 321-331.
5.
Gasior JS, Sacha J, Pawłowski M, et al. Normative Values for Heart Rate Variability Parameters in School-Aged Children: Simple Approach Considering Differences in Average Heart Rate. Front Physiol 2018; 9: 1495.
6.
Ernst G. Hidden signals – the history and methods of heart rate variability. Front Public Health 2017; 5: 265.
7.
Bakari S, Koca B, Oztunc F, Abuhandan M. Heart rate variability in patients with atrial septal defect and healthy children. J Cardiol 2013; 61: 436-439.
8.
Marsillio LE, Manghi T, Carroll MS, et al. Heart rate variability as a marker of recovery from critical illness in children. PLoS One 2019; 14: e0215930.
9.
Marquez MF, Gomez-Flores JR, Gonzalez-Hermosillo JA, et al. Role of the sympathetic nervous system in vasovagal syncope and rationale for beta-blockers and norepinephrine transporter inhibitors. Medwave 2016; 16: e6824.
10.
Efremov K, Brisinda D, Venuti A, et al. Heart rate variability analysis during head-up tilt test predicts nitroglycerine-induced syncope. Open Heart 2014; 1: e000063.
11.
Seco MA, Pinto R. Physiological Dynamics of Heart Rate Variability: A Statistical Modeling Approach in Vasovagal Syncope. Millenium 2016; 2: 39-47.
12.
Shim SH, Park SY, Moon SN, et al. Baseline heart rate variability in children and adolescents with vasovagal syncope. Korean J Pediatr 2014; 57: 193-198.
13.
Zygmunt A, Stanczyk J. Heart rate variability in children with neurocardiogenic syncope. Clin Auton Res 2004; 14: 99-106.
14.
Akcaboy M, Atalay S, Ucar T, Tutar E. Heart rate variability during asymptomatic periods in children with recurrent neurocardiogenic syncope. Turk J Pediatr 2011; 3: 59-66.
15.
Brignole M, Moya A, Lange FJ, et al. ESC Guidelines for the diagnosis and management of syncope. Eur Heart J 2018; 39: 1883-1948.
16.
Tanaka H, Fujita Y, Takenaka Y, et al. Japanese clinical guidelines for juvenile orthostatic dysregulation version 1. Pediatr Int 2009; 51: 169-179.
17.
Parati G, Stergiou G, O’Brien E, et al. European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring. J Hypertens 2014; 32: 1359-1366.
18.
Capitello TG, Fiorilli C, Placidi S, et al. What factors influence parents’ perception of the quality of life of children and adolescents with neurocardiogenic syncope? Health Qual Life Outcomes 2016; 14: 79.
19.
Metelka R. Heart rate variability – current diagnosis of the cardiac autonomic neuropathy. A review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2014; 158: 327-338.
20.
Gunjan YT, Banshi S, Ram BS, et al. Can decreased heart rate variability be a marker of autonomic dysfunction, metabolic syndrome and diabetes? J Diabetol 2019; 10: 48-56.
21.
Budrejko S, Kempa M, Chmielecka M, et al. Analysis of heart rate variability during head-up tilt-test in patients with vasovagal syncope. Eur J Transl Clin Med 2018; 1: 24-36.
22.
Kochiadakis G, Marketou M, Koukouraki S, et al. Cardiac autonomic disturbances in patients with vasovagal syndrome: comparison between iodine-123-metaiodobenzylguanidine myocardial scintigraphy and heart rate variability. EP Europace 2012; 14: 1352-1358.
23.
Duplyakov D, Golovina G, Sysuenkova E. Heart rate variability during Westminster protocol of head-up tilt test in patients with neurocardiogenic syncope and healthy volunteers. EP Europace 2017; 19: iii106.
24.
Gürsul E, Bayata S, Duygu H. The Comparison of Heart Rate Variability Parameters between Type 2b Vasovagal Syncope and Other Types of Vasovagal Syncope. J Am Coll Cardiol 2013; 62 (Suppl 2): C151.
25.
Topcu B, Akalın F. The autonomic nervous system dysregulation in response to orthostatic stress in children with neurocardiogenic syncope. Cardiol Young 2010; 20: 165-172.
26.
Vakulenko L. Heart rate variability in children with chronic pyelonephritis and I-III stages of chronic kidney disease. Pocki 2019; 8: 88-93.
27.
Gasior JS, Sacha J, Pawlowski M, et al. Normative Values for Heart Rate Variability Parameters in School-Aged Children: Simple Approach Considering Differences in Average Heart Rate. Front Physiol 2018; 9: 1495.
28.
Silva CC, Bertollo M, Reichert FF, et al. Reliability of Heart Rate Variability in Children: Influence of Sex and Body Position During Data Collection. Pediatr Exerc Sci 2017; 29: 228-236.
29.
Silvetti MS, Drago F, Ragonese P. Heart rate variability in healthy children and adolescents is partially related to age and gender. Int J Cardiol 2001; 81: 169-174.
30.
Subramaniam BS. Influence of Body Mass Index on Heart Rate Variability (HRV) in evaluating cardiac function in adolescents of a selected Indian population. Ital J Public Health 2011; 8: 149-155.
31.
Sato Y, Ichihashi K, Kikuchi Y, et al. Autonomic Function in Adolescents with Orthostatic Dysregulation Measured by Heart Rate Variability. Hypertens Res 2007; 30: 601-605.
32.
Stewart JM. Does heart rate variability explain increased blood pressure in adolescents? J Pediatr 2000; 137: 6-8.
33.
Gui-Ling X, Jing-Hua W, Yan Z, et al. Association of high blood pressure with heart rate variability in children. Iran J Pediatr 2003; 23: 37-44.
34.
Kovalchuk T, Pavlyshyn H, Boyarchuk O. Psychometric properties of the Ukrainian version of the Childhood Health Assessment Questionnaire (CHAQ). Pediatr Pol 2017; 92: 134-142.
Share
RELATED ARTICLE
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
