Open Access Research Article Evidence Based Medicine and Practice E v i d e n c e B a s e d M e d i c i n e a n d P r a c t i c e ISSN: 2471-9919 Hami and Corcia, Evid Based Med Pract 2017, 3:1 DOI: 10.4172/2471-9919.1000113 Volume 3 • Issue 1 • 1000113 Evid Based Med Pract, an open access journal ISSN: 2471-9919 Keywords: Heart rate variability; Congenital heart disease; Heart surgery Introduction Heart rate variability is a cardiovascular parameter that varies over time, under the inﬂuence of the sympathetic and parasympathetic systems [1]. It is a simple and accessible tool in cardiological practice. Analysis of heart rate variability is a sensitive and non-invasive method that allows the exploration of sympathovagal balance [2,3]. We can predict that autonomic nervous system (ANS) activity will be modiﬁed in patients who have undergone surgery for CHD. Numerous studies have consistently shown that heart surgery, especially aﬅer repair of a tetralogy of Fallot [4-7] and Fontan surgeries [8-10] leads to a signiﬁcant reduction in heart rate variability. A decrease in parasympathetic tone or increase in sympathetic tone predisposes to the development of arrhythmias and leads to a higher risk of sudden death in CHD [11,12]. Moreover, it is well demonstrated that a decrease in HRV eventually may appear not only as a consequence of decreased activities of sympathetic and parasympathetic branches of ANS, but also as independent metabolic phenomen, related to possible impairment of cardiomyocytes, especially cells of sinoatrial node (SAN) that may be less responsive to the neural and humoral impacts [13]. e extents, to which the sympathetic and parasympathetic systems are aﬀected, as well as the possibility for reinnervation, are not known. e aim of our study was to evaluate the impact of heart surgery on sympathetic and parasympathetic activity in children aﬅer surgery for congenital heart disease, and to compare HRV in patients that did and did not had an atriotomy at the time of the surgical repair. Methods In this single centre, retrospective study we report heart rate parameters on 54 patients with CHD who had undergone surgery and a control group of 51 young patients with structural normal hearts (Figure 1). Patients with factors that could inﬂuence the modulation of the HRV were excluded from the study, this included patients with leﬅ ventricular dysfunction and treatment with antiarrhythmic dugs and beta-blockers. Electrocardiography, echocardiography and 24 h Holter monitoring were analysed. In the group of patients with heart disease who underwent surgery, there were 28 males and 26 females. Mean age at surgery was 2.57 +/– 3.3 years (median 0.72, minimum 0.01, maximum 15.34). Twenty patients underwent surgery for a leﬅ-to-right shunt, 11 for a single ventricle, 9 for right ventricular outﬂow tract obstruction, 5 for leﬅ ventricular outﬂow tract obstruction, 6 for transposition of the great vessels, 1 for Ebstein’s anomaly and 2 for double discordance (Figure 2). ese patients were divided into two groups: the ﬁrst had surgery with atriotomy and the second had surgery without atriotomy. All the patients were in sinus rhythm at the initial evaluation. Patients on anti-arrhythmic agents and those with a rhythmic anomaly on Holter monitoring were excluded. Echocardiography showed good *Corresponding author: Karima Hami, Pediatric Cardiology Unit, Cliniques Universitaires Saint-Luc, Brussels, Belgium, Tel: +32 2 764 11 11; E-mail: hami_karima@yahoo.fr Received April 04, 2017; Accepted June 27, 2017; Published July 03, 2017 Citation: Hami K, Corcia MCG (2017) Heart Rate Variability Modiﬁcations after Surgery for Congenital Heart Disease in Young Patients. Evid Based Med Pract 3: 113. doi: 10.4172/2471-9919.1000113 Copyright: © 2017 Hami K, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Objective: The aim of study was to evaluate the heart rate variability ( HRV) changes in children operated on for congenital heart disease (CHD), and speciﬁcally in those who had an atriotomy, comparing them to a control group. Methods and results: HRV was measured in 54 young children (28 male/26 female) who underwent surgery for CHD, as well as in 51 children in a control group. The low-/high-frequency ratio was the only signiﬁcantly increased parameter (1.8 +/– 1.39 versus 1.25 +/– 0.88; p=0.01) in the group of children operated on. We also studied the effect of an atriotomy on HRV. There was no statistically signiﬁcant difference in this group. Conclusion: HRV is decreased in children after surgery for CHD compared to the control group, but atriotomy does not seem to play a direct role in this modiﬁcation. Heart Rate Variability Modifications after Surgery for Congenital Heart Disease in Young Patients Karima Hami* and M Cecilia Gonzalez Corcia Pediatric Cardiology Unit, Cliniques Universitaires Saint-Luc, Brussels, Belgium 51 105 54 11 43 CHD: congenital heart disease Figure 1: Consort ﬂow diagram on enrolment of patients into the study.