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Evaluation of cardiac autonomic function using heart rate variability in children with acute carbon monoxide poisoning

Published online by Cambridge University Press:  01 August 2017

Cagdas Vural ,
Ener Cagri Dinleyici ,
Pelin Kosger ,
Ozge Bolluk ,
Zubeyir Kilic  and
Birsen Ucar
Cagdas Vural
Affiliation:
Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
Ener Cagri Dinleyici*
Affiliation:
Department of Pediatric Intensive Care, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
Pelin Kosger
Affiliation:
Department of Pediatric Cardiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
Ozge Bolluk
Affiliation:
Department of Biostatistics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
Zubeyir Kilic
Affiliation:
Department of Pediatric Cardiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
Birsen Ucar
Affiliation:
Department of Pediatric Intensive Care, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
*
Correspondence to: E. C. Dinleyici, Professor in Pediatrics, Department of Pediatric Intensive Care, Faculty of Medicine, Eskisehir Osmangazi University, TR-26480 Eskisehir, Turkey. Tel: + 90 222 2392979; Fax: + 90 222 2290064; E-mail: timboothtr@yahoo.com
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Abstract

Introduction

Carbon monoxide poisoning may cause myocardial toxicity and cardiac autonomic dysfunction, which may contribute to the development of life-threatening arrhythmias. We investigated the potential association between acute carbon monoxide exposure and cardiac autonomic function measured by heart rate variability.

Method

The present study included 40 children aged 1–17 years who were admitted to the Pediatric Intensive Care Unit with acute carbon monoxide poisoning and 40 healthy age- and sex-matched controls. Carboxyhaemoglobin and cardiac enzymes were measured at admission. Electrocardiography was performed on admission and discharge, and 24-hour Holter electrocardiography was digitally recorded. Heart rate variability was analysed at both time points – 24-hour recordings – and frequency domains – from the first 5 minutes of intensive care unit admission.

Results

Time domain and frequency indices such as high-frequency spectral power and low-frequency spectral power were similar between patient and control groups (p>0.05). The ratio of low-frequency spectral power to high-frequency spectral power was significantly lower in the carbon monoxide poisoning group (p<0.001) and was negatively correlated with carboxyhaemoglobin levels (r=−0.351, p<0.05). The mean heart rate, QT dispersion, corrected QT dispersion, and P dispersion values were higher in the carbon monoxide poisoning group (p<0.05) on admission. The QT dispersion and corrected QT dispersion remained longer in the carbon monoxide poisoning group compared with controls on discharge (p<0.05).

Conclusion

The frequency domain indices, especially the ratio of low-frequency spectral power to high-frequency spectral power, are useful for the evaluation of the cardiac autonomic function. The decreased low-frequency spectral power-to-high-frequency spectral power ratio reflects a balance of the autonomic nervous system, which shifted to parasympathetic components.

Keywords

Carbon monoxide poisoningchildrenheart rate variability
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 9 , November 2017 , pp. 1662 - 1669
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Copyright
© Cambridge University Press 2017 

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