Influences of a relaxation intervention on perceived stress and power spectral analysis of heart rate variability.

This study was designed to determine whether power spectral analysis (PSA) of heart rate variability (HRV) can detect change in autonomic tone following a relaxation intervention called therapeutic touch (TT). Thirty healthy subjects underwent TT by one of three TT practitioners using the steps developed by Krieger and Kunz (The Therapeutic Touch, Prentice-Hall, 1979). Both subjects and TT practitioners were monitored by continuous electrocardiographic monitoring (Holter) before (15 minutes), during, and after (15 minutes) TT was administered. Subjects and TT practitioners completed a visual analogue scale (VAS) of perceived stress before and after TT. Change scores for VAS and PSA of high-frequency/low-frequency (HF/LF) ratios were compared for the 2-minute interval before TT began and the end of TT and the end of the recovery period, using t tests. VAS scores decreased (less stress) from before to after TT for both subjects (p < 0.0005) and TT practitioners (p < 0.0005). Mean HF/LF ratios increased significantly to reflect greater parasympathetic dominance from before TT to the end of treatment for subjects (p = 0.006), but not for TT practitioners. However, further analysis revealed that this change was due to an exaggerated HF/LF response from four outliers (p < 0.0005). Data collected in this study did not reveal differences between these four subjects and the rest of the sample. There were no significant changes in HF/LF ratios from the end of TT to end of recovery for either group. Further research is needed to determine why some subjects may have greater change in autonomic tone in response to relaxation in order to be able to predict who will demonstrate physiologic response to relaxation interventions.

Effects of cisapride on QT interval in children.

Recent reports of torsade de pointes and heart block associated with prolonged QT interval in children receiving cisapride raise questions about its safety. We prospectively examined the effects of cisapride on the QT interval in children. Electrocardiography was performed on 30 children before and after cisapride was administered. An additional 71 children underwent electrocardiography only after starting cisapride. The incidence of a corrected QT (QTc) interval > 440 msec or a marked abnormality in T wave morphology was determined in all 101 children. Cisapride significantly lengthened the QTc with a mean increase of 15.5 +/- 4.6 msec (mean +/- SEM, p = 0.002 in the 30 children with baseline electrocardiographs. Twelve of the 101 patients were found to have a QTc > 440 msec, and one had a new prominent notched T wave in all leads. In these 13 (13%) patients with repolarization abnormalities, other factors that might contribute to a long QT were noted in 11 (85%) patients. We conclude that cisapride use in children is associated with a modest increase in QT interval. The incidence of QTc > 440 msec is low. Most children with long QTc have other factors that could compound the effects of cisapride.

Learning curve for radiofrequency catheter ablation in pediatrics at a single institution.

We examined the learning curve for radiofrequency ablation in pediatrics at a single institution. The first 146 cases were retrospectively reviewed, including patients < or = 21 years old with a single tachycardia diagnosis who were undergoing radiofrequency ablation for the first time. Data regarding demographics, electrophysiologic properties of the tachycardia, and procedural characteristics were tabulated. Data were then analyzed for evidence of association between these characteristics, success, and experience. Results revealed that success rates improved significantly with experience, reaching 85% success for all cases after < 100 cases attempted. Success for accessory pathway tachycardias alone reached > 93%. The number of cases of nonpathway tachycardias undertaken significantly increased as experience was gained. Fluoroscopy time improved to 34 +/- 27 minutes after < 100 cases. In conclusion, as experience was gained, (1) success rates showed a steep improvement; (2) the population undergoing radiofrequency ablation clearly shifted to include more difficult diagnoses; and (3) fluoroscopy time significantly decreased.

Electrical stimulation of contractile activity accelerates growth of cultured neonatal cardiocytes.

An electrical stimulation system was designed to regulate synchronized contractile activity of neonatal rat cardiocytes and to examine the effects of mechanical contraction on cardiocyte growth. Continuous electrical stimulation at a pulse duration of 5 milliseconds and frequency of 3 Hz resulted in a time-dependent accumulation of cell protein that reached 34% above initial values, as measured by the protein-to-DNA ratio. The growth response did not occur using voltage amplitudes that were subthreshold for contraction and was independent of contraction frequencies set at > or = 0.5 Hz. The RNA-to-DNA ratio increased in parallel to cell protein, indicating that the capacity for protein synthesis was enhanced by contraction. Rates of 28S rRNA synthesis were accelerated twofold in contracting cardiocytes. By comparison, protein and RNA accumulation did not occur in electrically stimulated cardiocytes in which contraction was blocked by either 10 mumol/L verapamil or by 5 mmol/L 2,3-butanedione monoxime, an inhibitor of actomyosin crossbridge cycling. Electrical stimulation of cardiocyte contraction did not enhance alpha-cardiac actin or myosin heavy chain (alpha+beta) mRNA transcript levels relative to 28S rRNA during the period of rapid growth that occurred over the first 48 hours. It is concluded that (1) electrical stimulation of contraction accelerates cardiocyte growth and RNA accumulation, (2) mechanical contraction is involved in regulating the growth of electrically stimulated cardiocytes, and (3) the levels of alpha-actin and myosin heavy chain mRNA increase in proportion to rRNA during the growth of contracting cardiocytes.