背景:心率变异性(HRV)是心脏自主神经系统的标志。经导管封堵前后对小儿室间隔缺损(VSD)病例的评估有助于了解心脏自主神经控制。
方法:本研究纳入19例经导管封堵治疗的VSD患儿和18例健康儿童。在VSD闭合前对所有患者和对照组患者均进行了24小时Holter节律监测。患者组在三个月时重复动态心律监测。使用CardioScanPremier12®程序测量HRV参数。频域(总功率;非常低的频率,低频(LF),和高频(HF)指数;以及LF/HF比率)和时域(所有RR间隔的标准偏差(SDNN),RR间隔5分钟平均值的标准偏差(SDANN),SDNN索引,相邻RR间期之差的百分比,和相邻过滤RR间期之间的平方差之和的平均值的平方根)参数被评估。
结果:在手术之前,SDNN,SDANN,患者组的总功率值低于对照组;两组的其他参数相似。SDNN没有显著差异,SDANN,或在第三个月在患者组和对照组之间检测到总功率,表明患者心脏的自主神经控制在术后第三个月恢复正常。在封闭前,在任何血液动力学参数与任何时域或频域参数之间未检测到相关性。
结论:本研究显示经导管VSD封堵术改变了儿科患者的HRV参数。
Heart rate variability (HRV) is a sign of the cardiac autonomic nervous system. Its evaluation in pediatric ventricular septal defect (VSD) cases before and after transcatheter closure contributes to an understanding of cardiac autonomic control.
Nineteen children with VSDs treated with transcatheter closure and 18 healthy children were enrolled in this study. A 24-h Holter rhythm monitor was applied to all patients before VSD closure and to those in the control group. Holter rhythm monitoring was repeated at three months in the patient group. HRV parameters were measured using the Cardio Scan Premier 12® program. Frequency-domain (total power; very-low-frequency, low-frequency (LF), and high-frequency (HF) indices; and the LF/HF ratio) and time-domain (standard deviation of all RR intervals (SDNN), standard deviation of 5-min averages of RR intervals (SDANN), the SDNN index, percentage of the difference between adjacent RR intervals, and the square root of the mean of the sum of square differences between adjacent filtered RR intervals) parameters were assessed.
Before the procedure, SDNN, SDANN, and total power values were lower in the patient group than in the control group; other parameters were similar in the two groups. No significant difference in the SDNN, SDANN, or total power was detected between the patient and control groups in the third month, indicating that autonomic control of patients\' hearts became normal during the third postoperative month. No correlation was detected between any hemodynamic parameters and any time-domain or frequency-domain parameters before closure.
This study showed that transcatheter closure of VSDs changed HRV parameters in pediatric patients.