The loss of circadian heart rate variations in patients undergoing mitral valve replacement and Corridor procedure — comparison to heart transplant patients

Abstract

We have presently demonstrated that when added to mitral valve replacement (MVR) the corridor procedure is 75% efficient in restoring and maintaining sinus rhythm in patients with chronic atrial fibrillation (AF), caused by rheumatic mitral valve disease, (follow up 13.9 months). In the same patient population, we observed that the typical day–night cycle heart rate (HR) variations were lost and our present study concentrates on this subject. Heart rate variability analysis based on 24-h Holter ECG recording (StrataScan 563 DelMar Avionics) or hospital discharge (12th–14th postoperative days) was performed in 3 patient groups: Group I: Patients with a Corridor procedure added to MVR (12 pts, m/f 10/2, mean age 47.3±7.5 yr); Group II (control): with patients MVR performed through the left atrial approach, without additional antiarrhythmic procedures (10 pts, m/f 3/7 mean age 51.5±6.7 yr), and Group III: heart transplant recipients (5 pts, mean age 46.4±11.22 yr). We analyzed the hourly heart rate over 24-h period divided into three 8-h segments (07–14 h; 15–22 h and 23–06 h). Statistical comparison of mean hourly heart rate values was made between the three time periods of Holter monitoring. The Corridor procedure performed with mitral valve replacement resulted in conversion of sinus rhythm in 75% of patients (Group I), but postoperative heart rate variability analyses based on Holter monitoring disclosed that the mean heart rate was not statistically significantly difficult between the three 8-h segments of the day–night ( P>0.05). The same results were found in the group of patients after heart transplant ( P>0.05). The same results were found in the group of patients after heart transplant ( P>0.05). In the second group (classical MVR), statistically significant differences in mean HR variation existed between the three 8-h intervals ( P<0.05), and although atrial fibrillation occurred postoperatively physiologic circadian heart rate variations were preserved. With the Corridor procedure, both atria were surgically and electrically isolated and chronotropic function of the ventricles was restored by creating a small strip of atrial tissue with isolated sinus node and atrio-ventricular node, connected to the ventricles. This technique produced heart denervation nervous system influence, producing the loss of circadian HR variations, similar to the transplanted heart.