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Is heart rate variability an objective parameter with which to manage treatment of infants with heart failure due to left-to-right shunting?

Published online by Cambridge University Press:  14 April 2005

Reinald Motz
Department of Paediatric Cardiology, Elisabeth Children's Hospital, Oldenburg, Germany
Peter Harding
Department of Paediatric Cardiology, Elisabeth Children's Hospital, Oldenburg, Germany
Peter Quick
Department of Paediatric Cardiology, Elisabeth Children's Hospital, Oldenburg, Germany
Hans-Heiner Kramer
Department of Paediatric Cardiology, Christian-Albrecht University, Kiel, Germany
Bruno Allgeier
Private practice, Oldenburg, Germany
Reiner Buchhorn
Department of Paediatric Cardiology, Georg-August-University, Göttingen, Germany


Treatment in heart failure could be guided by additional non-clinical measures, such as neurohumoral levels. Variability in heart rate is known to reflect neurohumoral stimulation. With this in mind, we sought to assess retrospectively the variability in heart rate to guide the treatment of infants in heart failure.

We analysed retrospectively the data from 20 infants with a significant left-to-right shunt. All were unsuitable for cardiac surgery or interventional therapy at the time the treatment had commenced. None of the infants improved while receiving diuretics, spironolactone, and digoxin alone, but improved after the addition of propanolol or metoprolol. None of the infants had problems during or after the subsequent operation. Parasympathetic activity reflected by parameters of variability in heart rate, such as the square root of adjacent RR-intervals, and the amount of adjacent RR-intervals greater than 50 milliseconds, improved in nearly all infants during beta blockade. On the other hand, parameters of variability in heart rate reflecting sympathetic activity did not change. Parasympathetic activity reflected the clinical state of nearly all the infants. These parameters, therefore, seem to be a good non-clinical parameter, showing the optimal treatment for heart failure in an ambulatory setting.

Original Article
2005 Cambridge University Press

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Packer M. The neurohormonal hypothesis: a theory to explain the mechanism of disease progression in heart failure. J Am Coll Cardiol 1992; 20: 248254.Google Scholar
Cohn JN, Ferrari R, Sharpe N. Cardiac remodelling – concepts and clinical implication: A consensus paper from an international forum on cardiac remodelling. J Am Coll Cardiol 2000; 35: 569582.Google Scholar
Buchhorn R, Ross RD, Wessel A, Hulpke-Wette M, Bürsch J. Acitivity of the renin-angiotensin-aldosterone and sympathetic nervous system and their relation to hemodynamic and clinical abnormalities in infants with left-to-right shunts. Int J Cardiol 2001; 78: 225230.Google Scholar
Buchhorn R, Wessel A, Bartmus D, Bürsch J. The pathogenesis of heart failure in infants with congenital heart disease. Cardiol Young 2001; 11: 498504.Google Scholar
Giardini A, Formigari R, Bronzetti G, et al. Modulation of neurohumoral activity after treatment of children in heart failure with carvedilol. Cardiol Young 2003; 13: 333336.Google Scholar
Ross RD, Danniels SR, Schwartz DC, Hannon DW, Kaplan S. Return of plasma norepinephrine to normal after resolution of congestive heart failure in congenital heart disease. Am J Cardiol 1987; 60: 14111413.Google Scholar
Buchhorn R, Ross RD, Hulpke-Wette M, et al. Effectiveness of low dose captopril versus propranolol therapy in infants with severe congestive heart failure due to left-to-right shunts. Int J Cardiol 2000; 76: 227233.Google Scholar
Kimball TR, Daniels SR, Meyer RA, et al. Effect of digoxin on contractility and symptoms in infants with a large ventricular septal defect. Am J Cardiol 1991; 68: 13771382.Google Scholar
Leversha ML, Wilson NJ, Clarkson PM, et al. Efficacy and dosage of enalapril in congenital and acquired heart disease. Arch Dis Child 1994; 70: 3539.Google Scholar
Buchhorn R, Hulpke-Wette M, Ruschewski W, et al. Effects of therapeutic beta blockade on myocardial function and cardiac remodelling in congenital cardiac disease. Cardiol Young 2003; 13: 3643.Google Scholar
Cohn JN, Levine TB, Olivari MT, et al. Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med 1984; 311: 819823.Google Scholar
Denver R, Tzandiis A, Martin P, Krum H. Salivary endothelin concentrations in the assessment of chronic heart failure. Lancet 2000; 355: 468.Google Scholar
Troughton RW, Frampton CM, Yandle TG, et al. Treatment of heart failure guided by plasma aminoterminal brain natriuretic peptide (N-BNP) concentrations. Lancet 2000; 355: 11261130.Google Scholar
Woo MA, Stevenson WG, Moser DK, Middlekauf HR. Complex heart rate variability and serum norepinephrine levels in patients with advanced heart failure. J Am Coll Cardiol 1994; 23: 565569.Google Scholar
Massin M, von Bernuth G. Clinical and haemodynamic correlates of heart rate variability in children with congenital heart disease. Eur J Pediatr 1998; 157: 967971.Google Scholar
Task force of The European Society of Cardiology and The North American Society of Pacing and Electrophysiology. Heart rate variability – standards of measurement, physiological interpretation, and clinical use. Eur Heart J 1996; 17: 354381.
Motz R, Luze K, Harding P, Seidenberg J, Buchhorn R. Neue Therapieansätze in der Behandlung der Herzinsuffizienz: Die Bedeutung der Beta-Blocker-Therapie für die kardiale Rekompensation von Kindern mit Links-Rechts-Shuntvitien. Kinder- und Jugendmedizin 2001; 1: 3639.Google Scholar
Ross RD, Bollinger RO, Pinsky WW. Grading the severity of congestive heart failure in infants. Pediatr Cardiol 1992; 13: 7275.Google Scholar
Buchhorn R, Hulpke-Wette M, Hilgers R, et al. Propanolol treatment of congestive heart failure in infants with congenital heart disease: The CHF-PRO-INFANT Trial. Int J Cardiol 2001; 79: 167173.Google Scholar
Nolan J, Batin PD, Andrews R, et al. Prospective study of heart rate variability and mortality in chronic heart failure: results of the United Kingdom heart failure evaluation and assessment of risk trial (UK-heart). Circulation 1998; 98: 15101516.Google Scholar
Ponikowski P, Chua TP, Piepoli M, et al. Ventilatory response to exercise correlates with impaired heart rate variability in patients with chronic congestive heart failure. Am J Cardiol 1998; 82: 338344.Google Scholar
CIBIS-II Investigators. The cardiac insufficiency bisoprolol study II (CIBIS-II): a randomised trial. Lancet 1999; 37: 10221036.
MERIT-HF study group. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL randomised intervention trial in congestive heart failure (MERIT-HF). Lancet 1999; 353: 20012007.
Wessel A, Buchhorn R, Bürsch J. Kreislaufinsuffizienz bei Kindern mit Links-Rechts-Shunt im Rahmen angeborener Herzfehler – Pathophysiologie und therapeutische Konsequenzen. Klin Pädiatr 2000; 212: 5359.Google Scholar
Lin LY, Hwang JJ, Lai LP, et al. Restoration of heart rate turbulence by titrated beta-blocker therapy in patients with congestive heart failure. J Cardiovasc Electrophysiol 2004; 15: 752756.Google Scholar
Després G, Veissier I, Boissy A. Effect of autonomic blockers on heart period variability in calves: Evaluation of the sympatho-vagal balance. Physiol Res 2002; 51: 347353.Google Scholar
Buchhorn R, Hulpke-Wette M, Nothroff J, Paul T. Heart rate variability in infants with heart failure due to congenital heart disease: reversal of depressed heart rate variability by propanolol. Med Sci Monit 2002; 8: CR661CR666.Google Scholar
Malfatto G, Facchini M, Sala L, et al. Effects of cardiac rehabilitation and beta-blocker therapy on heart rate variability after first acute myocardial infarction. Am J Cardiol 1998; 81: 834840.Google Scholar
Lin JL, Chan HL, Du CC, et al. Long-term beta-blocker therapy improves autonomic nervous regulation in advanced congestive heart failure: a longitudinal heart rate variability study. Am Heart J 1999; 137: 658665.Google Scholar