Heart Rate Variability and Its Associations with Organ Complications in Adults after Fontan Operation

Okólska, Magdalena; Łach, Jacek; Matusik, Paweł T.; Pająk, Jacek; Mroczek, Tomasz; Podolec, Piotr; Tomkiewicz‐Pająk, Lidia

doi:10.3390/jcm10194492

Cited by 10 publications

(7 citation statements)

References 37 publications

(47 reference statements)

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“…There is increasing interest in the use of markers and risk scores as well as in testing their clinical applicability in cardiovascular medicine [25][26][27][28][29][30][31][32][33]. Several factors have been found to be associated with LVH assessed by different modalities [7,16].…”

Section: Discussionmentioning

confidence: 99%

Clinical Data, Chest Radiograph and Electrocardiography in the Screening for Left Ventricular Hypertrophy: The CAR2E2 Score

Matusik¹,

Bryll

Pac

et al. 2022

JCM

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Left ventricular hypertrophy (LVH) is associated with adverse clinical outcomes and implicates clinical decision-making. The aim of our study was to assess the importance of different approaches in the screening for LVH. We included patients who underwent cardiac magnetic resonance (CMR) imaging and had available chest radiograph in medical documentation. Cardiothoracic ratio (CTR), transverse cardiac diameter (TCD), clinical and selected electrocardiographic (ECG)-LVH data, including the Peguero-Lo Presti criterion, were assessed. CMR–LVH was defined based on indexed left ventricular mass-to-body surface area. Receiver operating characteristics analyses showed that both the CTR and TCD (CTR: area under the curve: [AUC] = 0.857, p < 0.001; TCD: AUC = 0.788, p = 0.001) were predictors for CMR–LVH. However, analyses have shown that diagnoses made with TCD, but not CTR, were consistent with CMR–LVH. From the analyzed ECG–LVH criteria, the Peguero-Lo Presti criterion was the best predictor of LVH. The best sensitivity for screening for LVH was observed when the presence of heart failure, ≥40 years in age (each is assigned 1 point), increased TCD and positive Peguero-Lo Presti criterion (each is assigned 2 points) were combined (CAR2E2 score ≥ 3 points). CAR2E2 score may improve prediction of LVH compared to other approaches. Therefore, it may be useful in the screening for LVH in everyday clinical practice in patients with prevalent cardiovascular diseases.

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Section: Discussionmentioning

confidence: 99%

Clinical Data, Chest Radiograph and Electrocardiography in the Screening for Left Ventricular Hypertrophy: The CAR2E2 Score

Matusik¹,

Bryll

Pac

et al. 2022

JCM

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“…This is in line with the findings by Claessen et al and Hedlund et al, who also demonstrated regular HR response and speculated that reduced HR peak in Fontan patients might be an expression of a physiological reaction to maintain SV and Qc within the context of Frank–Starling mechanism, because of reduced preload ( 35 , 36 ). In addition, due to the numerous operations, many Fontan patients have a lack of responsiveness to modulation by the autonomic nervous system and an impaired sinus node function, both with the consequence of a limited HR variability and HR reserve ( 13 , 37 , 38 ). Here, similar to previous studies, Fontan patients showed significantly lower HR peak compared to controls, but these values were measured at significant lower P peak ( 39 ).…”

Section: Discussionmentioning

confidence: 99%

Adequate exercise response at artificial altitude in Fontan patients

et al. 2022

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PurposeFor Fontan-palliated patients, altitude exposure is still a part of discussion since the extent of hypoxic pulmonary vasoconstriction potentially resulting in decreasing cardiac output (Qc), especially during physical exercise, is still unclear. We investigated the effects of normobaric hypoxia (15.2% O2) simulating 2,500 m above sea level on cardiopulmonary and metabolic parameters and the benefit of daily physical activity (PA) on hypoxic exercise capacity.MethodsA total of 21 Fontan patients (14–31 years) and 20 healthy controls performed cardiopulmonary exercise tests on a bicycle ergometer in normoxia and hypoxia until subjective exhaustion, measuring capillary lactate (cLa) every 2 min. In between, participants underwent an activity tracking over 5 days with a triaxial accelerometer.ResultsHypoxic exercise was well tolerated by Fontan patients, and no adverse clinical events were observed. Fontan patients showed reduced physical capacity under both conditions compared to controls (63% normoxia, 62% hypoxia), but the relative impairment due to hypoxia was similar for both (≈10%). Up to workloads of 2 W/kg oxygen uptake (V.O2) and heart rate (HR) developed similarly in patients and controls. cLa increased faster in relation to workload in Fontan patients, but remained significantly lower at peak workload (normoxia 3.88 ± 1.19 mmol/l vs. 7.05 ± 2.1 mmol/l; hypoxia 4.01 ± 1.12 mmol/l vs. 7.56 ± 1.82 mmol/l). Qc was diminished but could be increased similar to controls. Fontan patients with higher PA levels showed a higher V.O2peak in hypoxia.ConclusionExercise during short-time artificial altitude exposure seems to be safe for young Fontan patients. Further studies are needed to validate longer exposure under real conditions. V.O2, HR, and Qc might not be a limiting factor for exercise until workloads of 2 W/kg. Higher daily PA levels might improve physical capacity under altitude conditions.

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“…In patients after FO, electrodes are located on the epicardium. Thus, every single decision regarding implantation, particularly in the case of young patients, should be made with caution, taking into account the possible complications in follow-up observation [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Arrhythmia in Adults after Fontan Operation

Okólska

Karkowski

Kuniewicz

et al. 2022

JCM

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Structural, hemodynamic, and morphological cardiac changes following Fontan operation (FO) can contribute to the development of arrhythmias and conduction disorders. Sinus node dysfunction, junction rhythms, tachyarrhythmias, and ventricular arrhythmias (VAs) are some of the commonly reported arrhythmias. Only a few studies have analyzed this condition in adults after FO. This study aimed to determine the type and prevalence of arrhythmias and conduction disorders among patients who underwent FO and were under the medical surveillance of the John Paul II Hospital in Krakow. Data for the study were obtained from 50 FO patients (mean age 24 ± 5.7 years; 28 men (56%)). The median follow-up time was 4 (2–9) years. Each patient received a physical examination, an echocardiographic assessment, and a 24 h electrocardiogram assessment. Bradyarrhythmia was diagnosed in 22 patients (44%), supraventricular tachyarrhythmias in 14 patients (28%), and VAs in 6 patients (12%). Six patients required pacemaker implantation, and three required radiofrequency catheter ablation (6%). Arrythmias is a widespread clinical problem in adults after FO. It can lead to serious haemodynamic impairment, and therefore requires early diagnosis and effective treatment with the use of modern approaches, including electrotherapy methods.

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Heart Rate Variability and Its Associations with Organ Complications in Adults after Fontan Operation

Cited by 10 publications

References 37 publications

Clinical Data, Chest Radiograph and Electrocardiography in the Screening for Left Ventricular Hypertrophy: The CAR2E2 Score

Clinical Data, Chest Radiograph and Electrocardiography in the Screening for Left Ventricular Hypertrophy: The CAR2E2 Score

Adequate exercise response at artificial altitude in Fontan patients

Prevalence of Arrhythmia in Adults after Fontan Operation

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