Increased Heart Rate Variability following Elective Percutaneous Coronary Intervention in Patients with Stable Coronary Artery Disease and Preprocedural Anxiety

Abstract

Background. There is a strong association between chronic ischemia and autonomic imbalance. Percutaneous coronary intervention (PCI) may restore autonomic balance in patients with stable coronary artery disease (SCAD), which is characterized by increased heart rate variability (HRV). Anxiety is often found in patients who are going to undergo invasive procedures and has been identified to induce autonomic imbalance. The aim of our study is to identify the impact of preprocedural anxiety on increased HRV following an elective PCI. Methods. Our study was a pretest and post-test correlation study involving 44 SCAD patients who underwent elective PCI at Cipto Mangunkusumo National Hospital. The HRV was measured before and after PCI. Anxiety symptoms were evaluated using Hospital Anxiety Depression Score (HADS) questionnaires. Results. We found a higher increase on HRV parameter following the PCI of subjects in the nonanxiety group compared with the anxiety group (median = 9.11 vs. 2.83; U = 154.00; p=0.043). Conclusions. Preprocedural anxiety may inhibit HRV increase following PCI procedure.

Alterations in heart rate variability before and after percutaneous coronary intervention in patients with ischaemic heart disease

“…The increase of SDNN post-PCI was significantly higher in subjects without pre-procedural anxiety compared with those with anxiety. [6] In the present study, during pre-PCI ECG recordings, angina/dyspnoea/anxiety persisted in a few patients. In another study by Delewi et al, [17] anxiety levels were measured using the self-reported visual analogue scale and observed that the pre-procedural anxiety scores obtained were the highest.…”

“…Coronary artery disease patients tend to have increased sympathetic activity as ischemic event induces this enhanced sympathetic function. [5][6][7][8] Elimination of myocardial ischemia could bring back the autonomic balance state to normal. [6][7][8][9] Only a few studies looked at the role of HRV analyses in the restoration of cardiac autonomic balance in patients with ischaemic heart disease (IHD).…”

“…[5][6][7][8] Elimination of myocardial ischemia could bring back the autonomic balance state to normal. [6][7][8][9] Only a few studies looked at the role of HRV analyses in the restoration of cardiac autonomic balance in patients with ischaemic heart disease (IHD). [5,9] Accordingly, in a study by Gomes et al [5] among stable angina patients, by a combination of methods involving muscle sympathetic nerve activity (MSNA), neurochemical (plasma catecholamine levels) and HRV (time-domain and frequency-domain indices), sympathetic nervous system activity was measured before and 1-month post-percutaneous coronary intervention (PCI).…”