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Assessment of heart rate variability in breath holding children by 24 hour Holter monitoring

  • Osman Yilmaz (a1), Murat Ciftel (a1), Kezban Ozturk (a2), Omer Kilic (a3), Hasan Kahveci (a4), Fuat Laloğlu (a5) and Ozben Ceylan (a6)...

Abstract

Purpose: Previous studies have shown that the underlying pathophysiologic mechanism in children with breath holding may be generalised autonomic dysregulation. Thus, we performed cardiac rhythm and heart rate variability analyses using 24-hour Holter monitoring to evaluate the cardiac effects of autonomic dysregulation in children with breath-holding spells. Methods: We performed cardiac rhythm and heart rate analyses using 24-hour Holter monitors to evaluate the cardiac effects of autonomic dysregulation in children during a breath-holding spell. Our study group consisted of 68 children with breath-holding spells – 56 cyanotic type and 12 pallid type – and 39 healthy controls. Results: Clinical and heart rate variability results were compared between each spell type – cyanotic or pallid – and the control group; significant differences (p<0.05) in standard deviation of all NN intervals, mean of the standard deviations of all NN intervals for all 5-minute segments, percentage of differences between adjacent RR intervals >50 ms, and square root of the mean of the sum of squares of the differences between adjacent NN intervals values were found between the pallid and cyanotic groups. Conclusions: Holter monitoring for 24 hours and heart rate variability parameters, particularly in children with pallid spells, are crucial for evaluation of cardiac rhythm changes.

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Corresponding author

Correspondence to: O. Kilic, Department of Pediatric Infectious Diseases, Erzurum District Training and Research Hospital, Erzurum, Turkey. Tel: +90 442 2325364; Fax: +90 442 2325090; E-mail: omerkilic7@yahoo.com

References

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1. DiMario, FJ Jr. Breath-holding spells in childhood. Am J Dis Child 1992; 146: 125131.
2. Kelly, AM, Porter, CJ, McGoon, MD, Espinosa, RE, Osborn, MJ, Hayes, DL. Breath-holding spells associated with significant bradycardia: successful treatment with permanent pacemaker implantation. Pediatrics 2001; 108: 698702.
3. Di Pino, A, Calabrò, MP, Gitto, P, Bianca, I, Oreto, G. Permanent cardiac pacing for severe pallid breath-holding spells. Pacing Clin Electrophysiol 2007; 30: 280282.
4. Ergul, Y, Otar, G, Nisli, K, Dindar, A. Permanent cardiac pacing in a 2.5 month-old infant with severe cyanotic breath-holding spells and prolonged asystole. Cardiol J 2011; 18: 704706.
5. Malik, M. Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J 1996; 17: 354381.
6. Villain, E, Lucet, V, Do Ngoc, D, Bonnet, D, Fraisse, A, Kachaner, J. Cardiac pacing in children with breath-holding spells. Arch Mal Coeur Vaiss 2000; 93: 547552.
7. Vinik, AI, Ziegler, D. Diabetic cardiovascular autonomic neuropathy. Circulation 2007; 115: 387397.
8. Anil, BG, Nedunchezian, K, Jayanthini, V, Pathmanabhan, M. Breath holding spells: evaluation of autonomic nervous system function. Indian Pediatr 2005; 42: 923927.
9. DiMario, FJ Jr, Bauer, L, Baxter, D. Respiratory sinus arrhythmia in children with severe cyanotic and pallid breath-holding spells. J Child Neurol 1998; 13: 440442.
10. DiMario, FJ Jr, Chee, CM, Berman, PH. Pallid breath-holding spells. Evaluation of autonomous nervous system. J Clin Pediatr 1990; 29: 1724.
11. DiMario, FJ Jr, Burleson, JA. Autonomic nervous system function in severe breath-holding spells. Pediatr Neurol 1993; 9: 268274.
12. DiMario, FJ Jr, Bauer, L, Volpe, J, Baxter, D. Respiratory sinus arrhythmia in children with severe cyanotic breath-holding spells. J Child Neurol 1997; 12: 260262.
13. Evans, OB. Breath-holding spells. Pediatr Ann 1997; 26: 410414.
14. Lombroso, CT, Lerman, P. Breathholding spells (cyanotic and pallid infantile syncope). Pediatrics 1967; 39: 563581.
15. Hartikainen, JEK, Tahvannainen, KUO, Kuusela, TA. Short term measurement of heart rate variability. In: Malik M (ed.). Clinical Guide to Cardiac Autonomic Tests. Kluwer Academic Publishers, Norwell, MA, USA, 1998, pp 149176.
16. Rajendra Acharya, U, Paul Joseph, K, Kannathal, N, Lim, CM, Suri, JS. Heart rate variability: a review. Med Biol Eng Comput 2006; 44: 10311051.
17. Sztajzel, J. Heart rate variability: a noninvasive electrocardiographic method to measure the autonomic nervous system. Swiss Med Wkly 2004; 134: 514522.
18. Kayıkçıoğlu, M, Payzın, S. Heart rate variability. Arch Turk Soc Cardiol 2001; 29: 238245.
19. DiMario, FJ Jr. Prospective study of children with cyanotic and pallid breath-holding spells. Pediatrics 2001; 107: 265269.
20. Holmes, GL. Breath-holding attacks in children. Postgrad Med 1988; 84: 196198.
21. Boysen, A, Lewin, MA, Hecker, W, Leichter, HE, Uhlemann, F. Autonomic function testing in children and adolescent with diabetes mellitus. Pediatr Diabetes 2007; 8: 261264.
22. Ewing, DJ, Clarke, BF. Diagnosis and management of diabetic autonomic neuropathy. Br Med J 1982; 285: 916918.
23. Lahiri, MK, Kannankeril, PJ, Goldberger, JJ. Assessment of autonomic function in cardiovascular disease: physiological basis and prognostic implications. J Am Coll Cardiol 2008; 51: 17251733.
24. Kolkiran, A, Tutar, E, Atalay, S, Deda, G, Cin, S. Autonomic nervous system functions in children with breath-holding spells and effects of iron deficiency. Acta Paediatr 2005; 94: 12271231.
25. Noritake, M, Takase, B, Kudoh, K, Kugai, N, Kurita, A, Nagata, N. Diurnal change in heart rate variability in healthy and diabetic subjects. Intern Med 1992; 31: 453456.
26. Massin, MM, Maeyns, K, Withofs, N, Ravet, F, Gérard, P. Circadian rhythm of heart rate and heart rate variability. Arch Dis Child 2000; 83: 179182.
27. Boudreau, P, Yeh, WH, Dumont, GA, Boivin, DB. A circadian rhythm in heart rate variability contributes to the increased cardiac sympathovagal response to awakening in the morning. Chronobiol Int 2012; 29: 757768.
28. Gula, LJ, Krahn, AD, Skanes, A, et al. Heart rate variability in obstructive sleep apnea: a prospective study and frequency domain analysis. Ann Noninvasive Electrocardiol 2003; 8: 144149.
29. Grossman, P, Karemaker, J, Wieling, W. Prediction of tonic parasympathetic cardiac control using respiratory sinus arrhythmia: the need for respiratory control. Psychophysiology 1991; 28: 201216.
30. Katona, PG, Jih, F. Respiratory sinus arrhythmia: noninvasive measure of parasympathetic cardiac control. J Appl Physiol 1975; 39: 801805.
31. Lucet, V, de Bethmann, O, Denjoy, I. Paroxysmal vagal overactivity, apparent life-threatening event and sudden infant death. Biol Neonate 2000; 78: 17.
32. Lucet, V, Le Gall, MA, Shojaeï, T, et al. Vagal hyperreactivity and sudden infant death. Study of 15 families. Arch Mal Coeur Vaiss 2002; 95: 454459.

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