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Evidence for time-dependent autonomic cardiac reinnervation in children subsequent to transplantation of the heart

Published online by Cambridge University Press:  19 August 2008

Joachim Kreuder ,
Heinrich Netz ,
Thomas Paul ,
Andreas Müller ,
Jürgen Bauer  and
Reinald Repp
Joachim Kreuder*
Affiliation:
From the Departments of Pediatric Cardiology, Justus-Liebig University, Giessen, Ludwig-Maximilians University, München and University Medical School, Hannover
Heinrich Netz
Affiliation:
From the Departments of Pediatric Cardiology, Justus-Liebig University, Giessen, Ludwig-Maximilians University, München and University Medical School, Hannover
Thomas Paul
Affiliation:
From the Departments of Pediatric Cardiology, Justus-Liebig University, Giessen, Ludwig-Maximilians University, München and University Medical School, Hannover
Andreas Müller
Affiliation:
From the Departments of Pediatric Cardiology, Justus-Liebig University, Giessen, Ludwig-Maximilians University, München and University Medical School, Hannover
Jürgen Bauer
Affiliation:
From the Departments of Pediatric Cardiology, Justus-Liebig University, Giessen, Ludwig-Maximilians University, München and University Medical School, Hannover
Reinald Repp
Affiliation:
From the Departments of Pediatric Cardiology, Justus-Liebig University, Giessen, Ludwig-Maximilians University, München and University Medical School, Hannover
*
Dr. Joachim Kreuder, Children's Hospital, Justus-Liebig University, Feulgenstraße 12, D-35385 Giessen, Germany. Tel. 49 641 702 4400; Fax. 49 641 702 4489.
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Abstract

Autonomic denervation has been assumed to persist after orthotopic heart transplantation. Analyzing spontaneous and induced variations of heart rate, the status of autonomic cardiac innervation was investigated in six children 19–37 months after cardiac transplantation. The age at the time of transplantation varied from three weeks to 15.4 years. Heart rate variability was assessed on 24-hour Holter recordings by calculating time-domain indices (standard deviation of all RR intervals; standard deviation of the mean RR intervals from successive five-minute periods; mean of the standard deviations of RR intervals from successive five-minute periods; proportion of adjacent RR intervals > 50 msec different; square root of mean square successive differences in RR intervals) and frequency-domain variables (low frequency power, high frequency power and total spectrum power). Sinus node recovery time, sinoatrial conduction time and post-pacing cycle lengths were examined at different rates of endocardial atrial pacing. After the first year subsequent to transplantation, standard deviation of the mean RR intervals reached the normal range in four patients, whereas the other time-domain variables became normal in two patients. Both patients displayed normal or near-normal power spectrums of heart rate with normal day-to-night variations. For the remaining patients, spectrums of heart rate failed to show the main frequency peaks. Only the patient with normal variability in heart rate exhibited a decrease in corrected sinus node recovery time at higher stimulation rates, shortening of the first recovery cycle below the pre-pacing level, and a rapid decline of the accelerated post-pacing heart rate as described in innervated hearts. These results suggest the evolution of time-dependent efferent autonomic reinnervation after cardiac transplantation in children.

Keywords

Heart transplantationheart rate variabilityautonomic nervous system
Type
Original Manuscripts
Information
Cardiology in the Young , Volume 6 , Issue 1 , January 1996 , pp. 12 - 19
Copyright
Copyright © Cambridge University Press 1996

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