Evaluation of Heart Rate Variability in Critically-ill Neonates

Aims: The objective of this work was to evaluate heart rate variability (HRV) in critically-ill neonates admitted to NICU, to detect the effect of different causes of critical illness on cardiac autonomic function and outcome of these neonates.Study Design:Case-control study.Place and Duration of Study:Neonatal Intensive Care Unit (NICU) of Pediatric Department, Tanta University Hospital, in the period from January 2018 to May 2019.Methodology:We included 30 neonates who were critically-ill according to Score for Neonatal Acute Physiology with Perinatal Extension II (SNAPPE-II score) as cases Group. Fifteen healthy full term neonates, matched for age and sex, were enrolled as a control group. 24-hour Holter monitoring was performed with recording and interpretation of ECG data for every neonate in the study, including analysis of HRV.Results:There was significant increase of mean HR in critically-ill neonates as compared to control group. There was significant decrease of all HRV parameters (SDNN, SDANN, SDNNI, RMSSDand PNN50) in critically-ill neonates as compared to control group (P< 0.05). Significant negative correlations between SNAPPE-II score and HRV parameters (SDNN, SDANN, SDNNI, RMSSD, PNN50) in critically-ill neonates were present, whereas there was non-significant positive correlation between SNAPPE-II score and mean heart rate.Conclusion:HRV parameters decreased significantly in critically-ill neonates admitted to NICU, denoting severe cardiac autonomic dysfunction in these sick newborn infants. HRV strongly correlated to severity (SNAPPE-II score) and outcome, with strong relation to mortality of these critically-ill neonates

Utilidad del Monitoreo Holter de 96 horas para la Detección de Fibrilación Auricular en eventos Cerebrovasculares Agudos / Usefulness of 96-hour Holter Monitoring for auricular fibrillation detection in acute cerebrovascular events

Introducción: Cerca del 25% de eventos isquémicos cerebrales son secundarios a fibrilación auricular (FA) paroxística y los pacientes requieren anticoagulación oral permanente. Es necesario identificarlos para prevenir su aparición. El método de rutina utilizado es el Holter de 24 horas. Materiales y Métodos: En un período de 21 meses, 100 pacientes con diagnóstico presuntivo de un evento cerebrovascular isquémico agudo (ECV) o ataque isquémico transitorio (AIT), de origen embólico, fueron sometidos a monitoreo Holter de 96 horas, para detectar fibrilación auricular paroxística. Resultados: En 7% de ellos se encontró alguna forma de esta arritmia, así como en 7,8% de aquellos con diagnóstico de ECV o AIT confirmados y sin evidencia de fuente cardioembólica. Discusión: Concluimos que el método de Holter de 96 horas es mejor que el rutinario de 24 horas, pero para mejorar su sensibilidad, se requiere seleccionar a los pacientes con mayor probabilidad de presentar la arritmia.

Introduction: Close to 25% of cerebrovascular events are related to paroxistic atrial fibrillation (AF), that is why AF patients need to receive permanent oral anticoagulation. We need to identify them to prevent the events. The usual test employed has been the 24 hours Holter. Methods: In a period of 21.5 months, 100 patients with presumptive diagnosis of acute ischemic cerebrovascular event or transient ischemic attack of embolic origin, underwent 96 hours Holter monitoring to detect paroxysmal atrial fibrillation. Results: In nearly 7% of these patients this kind of arrhythmia was found, as well as, in 7.8% of those with confirmed stroke without evidence of cardioembolic source. Discusion: We conclude that the 96 hours Holter is better than the routinary 24-hour Holter, though, in order to incresae the sensitivity of this test, it is worthwhile to choose patientes with higher probability to present this arrhytmia.

Diagnostic values of Holter monitoring in children with unexplained syncope / 中华实用儿科临床杂志

Holter monitoring remains an useful diagnostic tool in the evaluation of syncope in children if synco-pe remains unexplained after the initial examination.But it should not be used as a screening tool.Holter monitoring is recommended in children who were suspected as cardiac syncope or who had an abnormal electrocardiogram.For chil-dren with frequent syncope,Holter monitoring is highly recommended.More information can be provided with extended Holter monitoring to 48 hours if possible.Heart rate variability is probably useful in predicting head -up tilt test diagno-sis of neurally mediated syncope.

Parámetros clínicos y electrocardiográficos por décadas de vida. Análisis por el Holter de 24 horas / Clinical and electrocardiographics parameters, for decades of life. Analysis for the Holter of 24 hours

INTRODUCCIÓN: el electrocardiograma, tiene variaciones normales, de acuerdo con las edades, existiendo alteraciones del ritmo cardiaco, conforme avanza la edad; asi mismo los síntomas y su correlación con las arritmias, varían con la edad y con el sexo de los pacientes. Estas variaciones, pueden registrarse mejor con el Holter de 24 horas. OBJETIVOS: utilizar el Holter de 24 horas, para indagar variaciones, por décadas de vida de: síntomas, arritmias, correlacion síntomas- arritmias y la diferencia de estas variables según el sexo de los pacientes. METODOS: Se efectuaron 1220 estudios a 662 mujeres y a 558 hombres con un rango de edad entre 1 y 93 años. Las variables fueron: edad, sexo, síntomas (disnea, síncope, palpitaciones, lipotimia y dolor precordial); arritmias ventriculares y supraventriculares; correlación positiva, cuándo la arritmia coincidió con el síntoma, correlación negativa, si la arritmia no concidió con el síntoma o el mismo estuvo ausente; si no se registraron arritmias, el estudio fue calificado como normal, Los pacientes fueron clasificados por décadas de vida, correlacionandose las distintas variables con los grupos etareos. RESULTADOS: pacientes sintomáticos 42%. Arritmias 82%. Correlación positiva 23%. Estudios normales 18%. Los hombres predominaron en las edades extremas. Las palpitaciones fueron el síntoma más frecuente, predominando en la década de los 30. Las lipotimias, fueron más frecuentes conforme aumentaba la edad. Las extrasístoles aumentaron en frecuencia conforme la edad avanzaba. La Taquicardia Supraventricular, aumentó progresivamente desde los 30 años. La Fibrilación y Aleteo Auriculares, empezaron a presentarse a los 40 años, haciendose más frecuentes en cada década. Paro Sinusal, se presentó a los 60 años. El Bloqueo A-V Completo, fue mayor al final de las edades. La correlación positiva, fue frecuente en las edades medias. Los estudios normales fueron frecuentes solamente en las primeras edades. Las arritmias, fueron incrementándose, según avanzaba la edad. CONCLUSIÓN: en cada grupo etario, los parámetros clínicos y electrocardiográficos, son diferentes; los pacientes sintomáticos, así como la correlación positiva, son menos frecuentes en las edades extremas; determinadas arritmias se registran cada vez más frecuente, según la edad avanza, debido al progresivo envejecimiento del sistema excitoconductor.

INTRODUCTION: the electrocardiogram , has normal variations in accordance with the ages, existing alterations of the heart rhythm as the age advances , likewise the symptoms and its correlation with the arrhythmias, the vary with the age and the sex of the patients, these variations can register better with the 24 hours Holter monitoring. OBJETIVES: to use the 24 hour Holter monitoring, to investigate variations, for decades oflife of: symptoms, arrhythmias, correlation symptoms-arrhythmias, and the difference of these variables, according to the sex of patients. METHODS: the made studies were 1220, to 662 women and 558 man, with an age range between 1 and 93 years. The variables were: age, sex, symptoms (dyspnea, syncope, presyncope, palpitations and chest pain); ventricular and supraventricular arrhythmias; positive correlation, when the arrhythmia coincide with the symptom; negative correlation, if the arrhythmia didn't coincide with the symptom, or the same on was absent; if they didn't register arrhythmias, the study qualified as normal. The patients were classified by decades of life, being correlated the different variables with the age groups. RESULTS: symptomatic patients 42%, Arrhythmias 81%; positive correlation 23%; normal studies 18%. The men prevailed in the aged extremes. The palpitations, were the most frequent symptom, prevalent in the years 30. The presyncope were most frequent, as the age increased. The premature beats increased in the frequency, as the age advanced. The Supraventricular Tachycardia, increased progressively, from the 30 years. The Atrial Fibrillations and Flutter, the began to be presented, to the 40 years, being made but you frequent in every decade. The Sinus Arrrested, was presented to the 60 years. The Complete Heart Block, were most frequent at the end of the ages. The positive correlation, were frequent in the middle ages. The normal studies, were frequent, only in the first ages. The arrhythmias, were being increased, as the age advanced. CONCLUSION: in each age group, the clinical, and electrocardiográphics parameters, the are different; the symptomatic patients, as well as the positive correlation, the are less frequent in the extreme ages; determined arrhythmias, the register more frequent according to the age it advances, due to progressive aging of the excitoconductor systems.

Association between sense of coherence and heart rate variability in healthy subjects

<p><b>OBJECTIVES</b>This report investigates whether there is any association between sense of coherence (SOC), as a coping measure in confronting stressful conditions, and heart rate variability (HRV), as a measure of the cardiac autonomic nervous system during the daily life pattern.</p><p><b>METHODS</b>Sixteen healthy university students (14 males and 2 females) filled in the validated Japanese version of the SOC-13 questionnaire before being informed about the study protocol. For each participant, we calculated 5-minute HRV indices using logarithmically transformed data on frequency domains for HRV derived by 24-hour Holter monitoring. Frequency domains for HRV recordings were investigated for the 24-hour time periods.</p><p><b>RESULTS</b>The correlation coefficient between the SOC scores and the high frequency power of HRV (0.15-0.40) was positively significant during the resting sitting position (r≥0.60, P<0.05). After grouping SOC scores by the median, the high frequency domain of HRV was higher in high SOC subjects for most of the 24-hour time period.</p><p><b>CONCLUSION</b>A higher SOC could modulate the parasympathetic tone of cardiac autonomic activity, especially during the resting sitting position.</p>

Association between Sense of Coherence and Heart Rate Variability in Healthy Subjects

Objectives: This report investigates whether there is any association between sense of coherence (SOC), as a coping measure in confronting stressful conditions, and heart rate variability (HRV), as a measure of the cardiac autonomic nervous system during the daily life pattern. Methods: Sixteen healthy university students (14 males and 2 females) filled in the validated Japanese version of the SOC-13 questionnaire before being informed about the study protocol. For each participant, we calculated 5-minute HRV indices using logarithmically transformed data on frequency domains for HRV derived by 24-hour Holter monitoring. Frequency domains for HRV recordings were investigated for the 24-hour time periods. Results: The correlation coefficient between the SOC scores and the high frequency power of HRV (0.15-0.40) was positively significant during the resting sitting position (r³0.60, P<0.05). After grouping SOC scores by the median, the high frequency domain of HRV was higher in high SOC subjects for most of the 24-hour time period. Conclusion: A higher SOC could modulate the parasympathetic tone of cardiac autonomic activity, especially during the resting sitting position.

Initial research of ECG holter monitoring filtrating obstructive sleep apnea syndrome / 中国实用内科杂志

5,6 or 7 respectively,the specificity became gradually higher.But the sensitivity and the diagnoses according rate became lower.Conclusion Holter is a simple shortcut useful tool as a non-invasive means of assessing and filtrating OSAS.

Diagnostic Value of Holter Monitoring for Coronary Heart Disease in Diabetics / 中国医师杂志

Objective To explore the diagnostic value of Holter monitoring for coronary heart disease (CHD) in diabetic and non-diabetic patients. Methods 188 patients with coronary heart disease were divided into diabetic group(n=65)and non-diabetic group(n=123). The diagnostic sensitivity, specificity, accuracy and other indices of Holter monitoring for CHD were compared between the two groups according to the results of angiography and Holter monitoring. Logistic regression analysis was applied to analyze the factors affecting holter ST-segment change. Results The sensitivity of Holter monitoring for diagnosing CHD in diabetic group was higher than that in non-diabetic group(P=0.046). There was an association between the positive ST-segment change and number of stenosal arteries, diffuse arterial lesion and complete vessel occlusion respectively (OR=2.36, 4.91, 3.90). Conclusion Although the sensitivity and specificity of Holter monitoring for diagnosing coronary heart disease were low, it remains some diagnostic value for coronary heart disease in diabetic patients.

Detecção de isquemia miocárdica em chagásicos crônicos com precordialgia atípica pelos testes de esforço e Holter / Detection of Myocardial Ischemia in Chagas' Disease Patients with Angina-Like Symptoms by the Effort Test and Holter Monitoring

Objetivo - Investigar a freqüência e as características de alteraçöes isquêmicas miocárdicas detectadas pela eletrocardiografia de esforço e monitorizaçäo eletrocardiográfica contínua (Holter) em pacientes chagásicos com dor precordial. Métodos - Trinta e um pacientes com diagnósticos clínicos e sorológico de doença de Chagas (54,4 ñ 9,6 anos, 51// homens) foram investigados para esclarecimento causal de angina de peito intensa e preocupante a ponto de afetar o padräo de vida e exigir exploraçäo agressiva. A detecçäo de isquemia miocárdica consistiu de 1 teste de esforço máximo e 2) Holter de 24h. Todos os pacientes foram submetidos a cinecoronariografia, ocasiäo em que se executava manobra de hiperventilaçäo controlada para constataçäo de espasmo arterial coronário. Os resultados obtidos com os dois testes (esforço e Holter) foram correlacionados e confrontados com os obtidos durante a cinecoronariografia. Resultados - alteraçöes basais do eletrocardiograma (ECG) impediram a análise do segmento ST em 11 pacientes. Dos restantes, 7(35//) apresentaram angina no teste de esforço. Dois deles (10//) tiveram isquemia miocárdica concomitante, detectando-se coronariopatia orgânica/funcional em ambos (associaçäo positiva, p=0,03): lesöes de 90// na artéria circunflexa e de 50// no trajeto intramiocárdico da descendente anterior esquerda. Nesta última, após hiperventilaçäo, ocorreu espasmo que reduziu em mais de 30// o diâmetro luminal do segmento estenótico, com dor precordial e elevaçäo de ST, que reverteram com nitrato. Durante o Holter (16 pacientes com traçados aproveitáveis), 25// dos indivíduos apresentaram angina do peito, sem qualquer distúrbio arrítmico ou isquêmico concomitante. Isquemia silente ocorreu em 1 paciente (5//) durante o esforço e, em outros (18//), durante o Holter. Sua presença näo foi preditiva de alteraçöes coronárias orgânicas ou funcionais. Näo foram documentadas lesöes significativas nos 11 pacientes cujo ECG näo era passível de análise. Conclusäo - Observou-se importante limitaçäo da aplicabilidade geral dos métodos eletrocardiográficos para detecçäo de isquemia miocárdica nos pacientes chagásicos em decorrência das alteraçöes basais do ECG. Contudo, quando o ECG basal é adequado, o teste de esforço positivo (ST isquêmico, acompanhado de dor precordial) apresentou 100// de valor preditivo para doença arterial coronária orgânica/funcional. Isto ocorreu em pequena, porém näo desprezivel proporçäo desta populaçäo chagásica específica (10//). O teste de Holter näo contribuiu para elucidaçäo da origem da angina do peito em qualquer um dos doentes estudados. Ante a inconsistência dos resultados, o significado o significado clínico e fisiopatológico da isquemia silente na cardiopatia chágasica demanda investigaçäo ulterior

Purpose - To determine the incidence and characteristics of myocardial ischemia, as detected by stress electrocardiography and Holter monitoring in Chagus' patients whose main complaint was precordial pain. Methods - Thirty-one consecutive patients with Chagas' disease diagnosed on the basis of clinical and serological tests, and precordial pain severe enough to warrant cardiac catheterization were studied. Mean age was 54.4 ± 9.6 years, and 51% were males. EKG changes indicative of myocardial ischemia were sought during maximul exercise and also during 24-hour Holter monitoring. The detection of myocardial ischemia by each one of these tests was compared by Fischer exact test, and also correlated to anatomical and functional results of coronary angiography at rest and after standardized hyperventilation for detecting coronary vasospasm. Results - Baseline EKG changes mainly associated with ventricular conduction defects precluded the analysis of the ST segment in 11 patients. Among the other 20 patients, 7(35%) had angina during the exercice test, of whom only 2(10%) showed concomitant ischemic ST changes: one had 90% stenosis in the circumflex branch and the other 50% reduction of luminal diameter in a intramyocardial segment of the leit anterior descending coronary artery, undergoing further 30% constriction after hyperventilation, with pain and ST-elevation that responded to nitrate administration. Thus, a positive correlation between a positive EKG exercise test with accompanying symptoms, and organic/functional coronary artery disease was found (p = 0.03). Holter tracings of good quality were obtained in 16 patients. Angina-like symptoms occurred in 25% of these patients, without concomitant ischemic or dysrhythmic EKG changes. Conversely, silent ischemia was detected in 1 (5%) patient during exercice and in 3 (18%) patients during the Holter monitoring None of these patients had any evidence of organic or functional alterations in the coronary arteries. The absence of significant (> 50%) narrowing of the coronary arteries, t baseline and after hyperventilation, was also documented in the 11 patients in whom no valid EKG tracings were obtained for analysis. Conclusion - EKG-based methods for detecting myocardial eschemia are of limited value in the general population with Chagas' disease presenting with precordial pain, due to the high prevalence of baseline ST changes. The overall incidence of significant coronary artery disease, as detected by angiography, was low but not negligible in this population of Chagas' patients with precordial pain (4%). Nevertheless, a positive EKG test based on ST changes and accompanying pain has a 100% positive predictive accuracy for the presence of organic or functional coronary abnormalities. No additional yield was obtained with Holter monitoring, for the elucidution of the pathophysiology of the precordial pain in Chagas' patients with atypical angina. The significance of episodes of silent ischemia in some of these patients, with angiographically normal coronary arteries, remains to be determined

Relation between Ischemia on Exercise Testing and on Holter Monitoring

BACKGROUND: The relation between treadmill exercise testing and ambulatory ST segment monitoring in detection of ischemia in patients with coronary artery disease has not been well established, with pathophysiologic mechanisms underlying the development of ischemia in the ambulatory setting not being well elucidated. This study was performed to determine the relation between myocardial ischemic indexes on exercise testing and on Holter monitoring. METHODS: We analized 25 patients with stable angina and angiographically documented coronary artery disease, who exhibited ischemia both on a Bruce protocol exercise test and on 24-hr Holter monitoring while receiving routine antianginal medications. RESULTS: Mean heart rate at the onset of 1mm ST segment depression during exercise testing(74.4 VS 114.1 beats/min, p<0.01). Overall the correlations between ischemic indexes on both test were weak. But heart rate at the onset of ischemic episodes during Holter monitoring had a good correlation with heart rate at 1mm ST depression during exercise test. And the number of ischemic episodes on Holter monitoring revealed a weak negative correlation with duration of exercise during treadmill test. CONCLUSION: Ischemic indexes on exercise testing cannot accurately predict ischemic indexes on Holter monitoring in patients with coronary artery disease. In that regard, Holter monitoring may provide other clinical information in addition to that obtained by exercise testing in selected patients.