Abnormal Heart Rate Variability Research Articles

Association of small right vagus nerve cross-sectional area with abnormal heart rate variability

Association of small right vagus nerve cross-sectional area with abnormal heart rate variability

Ambulatory electrocardiographic longitudinal monitoring in a canine model for Duchenne muscular dystrophy identifies decreased very low frequency power as a hallmark of impaired heart rate variability.

Duchenne muscular dystrophy (DMD) patients exhibit a late left ventricular systolic dysfunction preceded by an occult phase, during which myocardial fibrosis progresses and some early functional impairments can be detected. These latter include electrocardiographic (ECG) and heart rate variability (HRV) abnormalities. This longitudinal study aimed at describing the sequence of ECG and HRV abnormalities, using Holter ECG in the GRMD (Golden retriever muscular dystrophy) dog model, known to develop a DMD-like disease, including cardiomyopathy. Most of the known ECG abnormalities described in DMD patients were also found in GRMD dogs, including increased heart rate, prolonged QT and shortened PR intervals, ventricular arrhythmias, and several of them could be detected months before the decrease of fractional shortening. The HRV was impaired like in DMD patients, one of the earliest evidenced abnormalities being a decrease in the very low frequency (VLF) component of the power spectrum. This decrease was correlated with the further reduction of fractional shortening. Such decreased VLF probably reflects impaired autonomic function and abnormal vasomotor tone. This study provides new insights into the knowledge of the GRMD dog model and DMD cardiomyopathy and emphasizes the interest to monitor the VLF power in DMD patients, still unexplored in this disease, whilst it is highly predictive of deleterious clinical events in many other pathological conditions.

Acute cardiovascular effects of 4th generation electronic cigarettes and combusted cigarettes: implications for harm reduction.

The health consequences associated with using electronic cigarettes (ECs) are of great public interest because of their potential role in smoking cessation. In 110 participants, including 41 nonusers, 34 people who exclusively use ECs (EC group), and 35 people who smoke tobacco cigarettes (TCs) including 12 dual users (collectively called the TC-D group), the heart rate (HR), blood pressure (BP), and heart rate variability (HRV) were compared at baseline. People in the EC or the TC-D groups were also compared after using a 4th generation EC with or without nicotine, a TC with or without nicotine (TC-D group only), and a straw-control. Baseline HR, BP, and HRV parameters were not different among the EC, the TC-D, and nonuser groups. In people who exclusively use ECs, acute nicotine-EC use increased HR and BP, and produced changes in HRV patterns suggestive of increased cardiac sympathetic influence. In people in the TC-D group, BP increased similarly after acutely smoking a nicotine-TC or a nicotine-EC. However, the increase in HR was significantly greater after smoking a TC compared with the nicotine-EC despite similar acute increases in plasma nicotine. Overall, all exposures containing nicotine significantly increased HR and BP in both cohorts when compared with non-nicotine exposures. Since acute EC use 1) produces an abnormal HRV pattern associated with increased cardiac sympathetic tone in people who chronically use ECs, and 2) similar hemodynamic increases compared with acute TC smoking in people who chronically smoke TCs including dual users, the role of ECs as part of a harm reduction strategy is questioned.NEW & NOTEWORTHY We found that nicotine, not the non-nicotine constituents in tobacco cigarette (TC) or electronic cigarette (EC) emissions, may be the instigator of the acute, potentially adverse, changes in hemodynamics and heart rate variability (HRV) that were recorded several minutes after tobacco product use. Furthermore, acute EC use produced an abnormal HRV pattern associated with increased cardiac risk in people who chronically smoke ECs and produced similar hemodynamic increases compared with acute TC use in people who chronically smoke TCs, including people who are dual users.

Cardiac Autonomic Neuropathy in Newly Diagnosed Patients With Type 2 Diabetes Mellitus.

Cardiac autonomic neuropathy (CAN) is a debilitating complication in diabetes mellitus, leading to life-threatening arrhythmias and various impairments. Its prevalence varies widely, and early detection and management are crucial. This study investigates the prevalence of CAN in newly diagnosed type 2 diabetes mellitus patients in Central India, comparing them to a control group. This case-control study included 35 newly diagnosed type 2 diabetes mellitus patients and 35 age-matched healthy controls from the general population. Cardiac autonomic function testing (AFT) was done by heart rate variability (HRV), the deep breathing test (DBT), the cold pressor test (CPT), and the lying-to-standing test (LST). Parameters were recorded and analyzed usingstatistical tests. Patients with type 2 diabetes mellitus had significantly higher weight, BMI, fasting blood sugar, post-prandial blood sugar, urine albumin-creatinine ratios, and systolic and diastolic blood pressure than controls. Abnormalities in HRV and E: I ratio during the DBT and CPT were more prevalent in these patients. Parasympathetic dysfunction (delta HR) and a lower E: I ratio were also significantly highin this group. Also, LST results suggested a greater likelihood of orthostatic symptoms in the patients' group. This study highlights the importance of AFT in diagnosing early CAN in newly diagnosedpatients. Early diagnosis and management of diabetic CAN are essential to prevent complications.

Abnormal heart rate variability and its application in predicting treatment efficacy in patients with chronic migraine: An exploratory study.

This study aimed to investigate the extent of autonomic nervous system dysfunction in patients with chronic migraine using heart rate variability analysis. In addition, we explored the potential association between heart rate variability and treatment outcomes in patients receiving preventive treatment. In this cross-sectional and prospective study, we compared heart rate variability profiles in 81 preventive-naïve chronic migraine patients and 58 healthy controls. In addition, treatment responses of patients, who received a 12-week treatment with flunarizine, were assessed in relation to baseline heart rate variability. We observed that chronic migraine patients had a reduced heart rate variability, signifying autonomic dysfunction in comparison to healthy controls. Furthermore, patients presenting normal heart rate variability, characterized by a standard deviation exceeding 30 milliseconds in normal-to-normal RR intervals, experienced a superior response to flunarizine treatment. This improvement was exemplified by a significantly larger reduction in monthly headache days for patients with higher heart rate variability compared to those with lower heart rate variability: -9.7 (5.9) vs. -6.2 (6.0) days (p = .026). Autonomic dysfunction occurs in chronic migraine as evaluated by heart rate variability. A preserved function is associated with a better treatment outcome to flunarizine.Trial registration: Neurologic Signatures of Chronic Pain Disorders, NCT02747940. Registered 22 April 2016, https://clinicaltrials.gov/ct2/show/NCT02747940.

Design of intelligent hybrid NAR-GRNN paradigm for fractional order VDP chaotic system in cardiac pacemaker with relaxation oscillator

Managing cardiac disease and abnormal heart rate variability is a challenging problem with its psychological impact on lifesaving intervention. The research presents a novel machine learning approach to paradigm dynamic pacemaker design based on fractional order modified Van der Pol oscillator system implemented to generate rich non-sinusoidal signals for cardiac intervention and treatment. The physical framework of the novel contribution comprises Sino-Atrial (SA) and Atrio-Ventricular (AV) nodes, designed to utilize fractional order excitation signals derived from the VDP dynamic system. Hybrid paradigm is designed by integrating the dynamical nonlinear autoregressive (NAR) neural networks and generalized regression neural networks (GRNNs) to analyze the parametric fractal impulse model for cardiac muscle. The chaotic pattern of the proposed nonlinear system is explored in terms of phase portraits and Lyapunov exponents. The exceptional performance of the cutting-edge fractional order multimodal computing paradigm is validated by achieving an RMSE of 0.1E-14. The dynamic chaotic and fractal trajectory of relaxation oscillator based on its computed control parameters can provide valuable insight to design robust and efficient electronic implantable cardioverter defibrillators (ICDs) as pacemakers to stabilize cardiac impulse variability and alleviate healthcare burden as compared to traditional cardiac rehabilitation procedures.

Etomidate versus Propofol as Induction Agents in Patients Undergoing Decompressive Procedures for Cervical Compressive Myelopathy with and without Impaired Heart Rate Variability

Abstract Background Patients with cervical compressive myelopathy (CCM) are known to have autonomic dysfunction, which can impact surgical outcomes. In such patients, screening patients for heart rate variability (HRV) may enable the anesthesiologist to predict hypotension, thereby attempting to modify the anesthetic technique. This study aimed to compare the hemodynamic changes in CCM patients between propofol and etomidate induction. Methods Sixty CCM patients aged 18 to 70 years underwent an autonomic function test using HRV before decompressive surgery. The selected patients were randomized into two groups of 30 patients each to receive either etomidate or propofol for induction of anesthesia. The groups were compared for hemodynamic changes, the incidence of pain on injection, and the occurrence of myoclonus. While analyzing the hemodynamic changes, the two groups were subdivided into four groups, namely, propofol group with or without autonomic dysfunction (AD) and etomidate group with or without AD. Results In the abnormal HRV group, patients induced with propofol showed a significantly higher incidence of hypotension at 3-minute (p = 0.02) and 5-minute (p = 0.04) time points. On the other hand, in HRV normal patients, induction with propofol showed a significantly higher (p = 0.03) incidence of hypotension at 5 minutes. During induction, higher grades of pain (p = 0.01) were observed in the propofol group, whereas the occurrence of myoclonus was more in the etomidate group (p = 0.07). Conclusion As compared with propofol, the use of etomidate in patients with CCM undergoing decompressive procedures reduces hypotensive episodes, more so in patients with impaired HRV. Thus, HRV-based AD categorization may assist in optimal management of postinduction hypotension in patients with CCM.

Interleukin 6 (IL-6) Regulates GABAA Receptors in the Dorsomedial Hypothalamus Nucleus (DMH) through Activation of the JAK/STAT Pathway to Affect Heart Rate Variability in Stressed Rats.

The dorsomedial hypothalamus nucleus (DMH) is an important component of the autonomic nervous system and plays a critical role in regulating the sympathetic outputs of the heart. Stress alters the neuronal activity of the DMH, affecting sympathetic outputs and triggering heart rate variability. However, the specific molecular mechanisms behind stress leading to abnormal DMH neuronal activity have still not been fully elucidated. Therefore, in the present study, we successfully constructed a stressed rat model and used it to investigate the potential molecular mechanisms by which IL-6 regulates GABAA receptors in the DMH through activation of the JAK/STAT pathway and thus affects heart rate variability in rats. By detecting the c-Fos expression of neurons in the DMH and electrocardiogram (ECG) changes in rats, we clarified the relationship between abnormal DMH neuronal activity and heart rate variability in stressed rats. Then, using ELISA, immunohistochemical staining, Western blotting, RT-qPCR, and RNAscope, we further explored the correlation between the IL-6/JAK/STAT signaling pathway and GABAA receptors. The data showed that an increase in IL-6 induced by stress inhibited GABAA receptors in DMH neurons by activating the JAK/STAT signaling pathway, while specific inhibition of the JAK/STAT signaling pathway using AG490 obviously reduced DMH neuronal activity and improved heart rate variability in rats. These findings suggest that IL-6 regulates the expression of GABAA receptors via the activation of the JAK/STAT pathway in the DMH, which may be an important cause of heart rate variability in stressed rats.

Health warning based on 3R ECG Sample's combined features and LSTM

Most researches use the fixed-length sample to identify ECG abnormalities based on MIT ECG dataset, which leads to information loss. To address this problem, this paper proposes a method for ECG abnormality detection and health warning based on ECG Holter of PHIA and 3R-TSH-L method. The 3R-TSH-L method is implemented by:(1) getting 3R ECG samples using Pan-Tompkins method and using volatility to obtain high-quality raw ECG data; (2) extracting combination features including time-domain features, frequency domain features and time-frequency domain features; (3) using LSTM for classification, training and testing the algorithm based on the MIT-BIH dataset, and obtaining relatively optimal features as spliced normalized fusion features including kurtosis, skewness and RR interval time domain features, STFT-based sub-band spectrum features, and harmonic ratio features. The ECG data were collected using the self-developed ECG Holter (PHIA) on 14 subjects, aged between 24 and 75 including both male and female, to build the ECG dataset (ECG-H). The algorithm was transferred to the ECG-H dataset, and a health warning assessment model based on abnormal ECG rate and heart rate variability weighting was proposed. Experiments show that 3R-TSH-L method proposed in the paper has a high accuracy of 98.28% for the detection of ECG abnormalities of MIT-BIH dataset and a good transfer learning ability of 95.66% accuracy for ECG-H. The health warning model was also testified to be reasonable. The key technique of the ECG Holter of PHIA and the method 3R-TSH-L proposed in this paper is expected to be widely used in family-oriented healthcare.

On the distinct differences in autonomic regulation between pregnant and non-pregnant women - a heart rate variability analysis

Objective. Appropriate adaptation of the maternal autonomic nervous system to progressing gestation is essential to a healthy pregnancy. This is partly evidenced by the association between pregnancy complications and autonomic dysfunction. Therefore, assessing maternal heart rate variability (HRV)—a proxy measure for autonomic activity—may offer insights into maternal health, potentially enabling the early detection of complications. However, identifying abnormal maternal HRV requires a thorough understanding of normal maternal HRV. While HRV in women of childbearing age has been extensively investigated, less is known concerning HRV during pregnancy. Subsequently, we investigate the differences in HRV between healthy pregnant women and their non-pregnant counterparts. Approach. We use a comprehensive suite of HRV features (assessing sympathetic and parasympathetic activity, heart rate (HR) complexity, HR fragmentation, and autonomic responsiveness) to quantify HRV in large groups of healthy pregnant (n = 258) and non-pregnant women (n = 252). We compare the statistical significance and effect size of the potential differences between the groups. Main results. We find significantly increased sympathetic and decreased parasympathetic activity during healthy pregnancy, along with significantly attenuated autonomic responsiveness, which we hypothesize serves as a protective mechanism against sympathetic overactivity. HRV differences between these groups typically had a large effect size (Cohen’s d > 0.8), with the largest effect accompanying the significantly reduced HR complexity and altered sympathovagal balance observed in pregnancy (Cohen’s d > 1.2). Significance. Healthy pregnant women are autonomically distinct from their non-pregnant counterparts. Subsequently, assumptions based on HRV research in non-pregnant women cannot be readily translated to pregnant women.

Evidence of sex differences in cancer-related cardiac complications in mouse models of pancreatic and liver cancer.

Abnormal heart rate variability (HRV) is commonly observed in cancer patients who have undergone targeted therapy and/or surgery, yet the effects of cancer itself on cardiac function remain underexplored. Specifically, there is limited knowledge about sex-specific manifestations of HRV in cancer patients. Transgenic mouse models are widely used to study different types of cancer. Here, we aimed to investigate the sex-specific effects of cancer on cardiac function using transgenic mouse models of pancreatic and liver cancers. This study used male and female transgenic mice with cancer and wild-type controls. Cardiac function was assessed by recording electrocardiograms in conscious mice. RR intervals were detected to determine HRV using time and frequency domain analyses. Histological analysis with Masson's trichrome staining was performed to determine structural changes. In females, increased HRV was observed in both pancreatic and liver cancer-bearing mice. In contrast, in males, increased HRV was observed only in the liver cancer group. Male pancreatic cancer mice demonstrated autonomic balance shift showing an increase in parasympathetic to sympathetic tone. The heart rate (HR) was higher in control and liver cancer male mice groups than in females. Histological analysis did not show significant sex differences but suggested a higher degree of remodeling in liver cancer mice than in control, specifically in the right atrium and left ventricle. This study revealed sex differences in cancer's HR modulation. Specifically, female cancer mice had lower median HR and higher HRV. These findings indicate that sex must be considered when using HRV as a cancer biomarker.

Heart Rate Variability in Patients with Spontaneous Intracerebral Hemorrhage and its Relationship with Clinical Outcomes.

Although abnormal heart rate variability (HRV) is frequently observed in patients with spontaneous intracerebral hemorrhage (ICH), its time course and presentation of different indices remain unclear, and few studies have focused on its association with clinical outcomes. We prospectively recruited consecutive patients with spontaneous ICH between June 2014 and June 2021. HRV was evaluated twice during hospitalization (within 7days and 10-14days after stroke). Time and frequency domain indices were calculated. A modified Rankin Scale score ≥ 3 at 3months was defined as a poor outcome. Finally, 122 patients with ICH and 122 age- and sex-matched volunteers were included. Compared with controls, time domain and absolute frequency domain HRV parameters (total power, low frequency [LF], and high frequency [HF]) in the ICH group were significantly decreased within 7days and 10-14days. For relative values, normalized LF (LF%) and LF/HF were significantly higher, whereas normalized HF (HF%) was significantly lower, in the patient group than in the control group. Furthermore, LF% and HF% measured at 10-14days were independently associated with 3-month outcomes. HRV values were impaired significantly within 14days after ICH. Furthermore, HRV indices measured 10-14days after ICH were independently associated with 3-month outcomes.

Heart Rate Variability Analysis May Identify Individuals With Williams-Beuren Syndrome at Risk of Sudden Death.

Williams-Beuren syndrome (WBS) (Online Mendelian Inheritance in Man #194050) is a rare genetic multisystem disorder resulting from a chromosomal microdeletion at 7q11.23. The condition is characterized by distinct facies, intellectual disability, and supravalvar aortic stenosis. Those with WBS have an increased risk of sudden death, but mechanisms underlying this phenotype are incompletely understood. The aim of this study was to quantify and compare autonomic activity as reflected by heart rate variability (HRV) measures in a cohort of individuals with WBS (n=18) and age- and sex-matched control subjects (n=18). We performed HRV analysis on 24-hour electrocardiography recordings using nonlinear, time and frequency domain analyses on a cohort of subjects with WBS and age- and sex-matched control subjects enrolled in a prospective cross-sectional study designed to characterize WBS disease natural history. WBS subjects demonstrated diminished HRV (reflected by the SD of the NN intervals [P = 0.0001], SD of the average NN interval for 5-minute intervals over 24 hours [P< 0.0001], average of the 5-minute SDs of NN intervals for 24 hours [P = 0.0002], root mean square of successive differences of NN intervals [P = 0.0004], short axis of the Poincaré plot (SD1) [P< 0.0001], and long axis of the Poincaré plot [P< 0.0001]) and indirect markers of parasympathetic activity (reflected by the percent of NN intervals different from previous by 50% or more of local average [P<0.0007], root mean square of successive differences of NN intervals [P = 0.0004], natural log high-frequency power [P = 0.0038], and SD1 [P< 0.0001]). Additional parameters were also significantly different, including natural log very low-frequency power (decreased; P = 0.0002), natural log low-frequency power (decreased; P = 0.0024), and SD1 divided by the long axis of the Poincaré plot (decreased; P< 0.0001). Individuals with WBS demonstrate significant HRV abnormalities consistent with diminished autonomicreserve. Future studies will be needed to determine the relationship between autonomic dysregulation observed and sudden death risk seen in these patients. (Impact of Elastin Mediated Vascular Stiffness on EndOrgans;NCT02840448).

A case report of autoimmune GFAP astrocytopathy presenting with abnormal heart rate variability and blood pressure variability

BackgroundAutonomic dysfunctions including bladder dysfunction, gastrointestinal dysfunction and orthostasis are common symptoms of autoimmune glial fibrillary acidic protein astrocytopathy (A-GFAP-A); however, cardiac autonomic dysfunction and abnormal circadian rhythm of blood pressure, which can lead to poor prognosis and even sudden cardiac death, has never been reported in A-GFAP-A patient.Case presentationA 68-year-old male Chinese patient presented to our hospital with headache, fever, progressive disturbance of consciousness, dysuria, and limb weakness. Abnormal heart rate variability and non-dipper circadian rhythm of blood pressure gradually developed during hospitalization, which is rare in A-GFAP-A. He had positive GFAP IgG in cerebrospinal fluid (CSF). Enhanced brian MRI showed uneven enhancement and T2 hyperintense lesions of medulla oblongata; Cervical spine MRI showed T2 hyperintense lesions in medulla oblongata and upper margin of the T2 vertebral body. A contrast-enhanced thoracic spine MRI showed uneven enhancement and T2 hyperintense lesions of T1 to T6 vertebral segments. After treatment with intravenous immunoglobulin and corticosteroids, the patient’s symptoms, including autonomic dysfunction, alleviated dramatically. Finally, his heart rate variability and blood pressure variability became normal.ConclusionsOur case broadens the spectrum of expected symptoms in A-GFAP- A syndromes as it presented with heart rate variability and blood pressure variability.

EFFECT OF VIDEO GAMING ON HEART RATE VARIABILITY, AUTONOMIC CHANGES, VISUAL EVOKED POTENTIAL AND COGNITION OF MEDICAL STUDENTS IN TERTIARY TEACHING INSTITUTE

Aims To identify the effect of Video Gaming on Heart rate variability, Autonomic Changes, Visual Evoked Potential, Cognition, and the effect of long hours of video game playing This study is an Method observational study conducted among the volunteered medical students studying at Sri Venkateshwaraa Medical College Hospital and Research centre, Ariyur, Puducherry in the year from 2018 to 2021, who are playing video games, and the study was conducted from January 2021-December-2021. The study subjects were interviewed individually, anthropometric parameters, electrocardiogram, Heart Rate (HR), Blood Pressure (BP), Body Mass Index (BMI), Heart rate variability (HRV), Visual Evoked Potential (VEP), Cognition test using Mini-mental status examination (MMSE) 27 were done and data were collected, recorded, and analyzed. Out of 400 study population, males: females (183 (45.8%): Results 270 (54.2%) with a median age of 20.605 ± 0.9702 based on video games played intermittently in 24 hours students were divided into 3 categories, The 1st category played games for ≤ 3 hours (n= 223), 2nd category who played 4-6 hours (n=123), and students played &gt; 6 hours were 54. 311 students played video games using mobile and 89 students used Laptops there was a statistical signicance among the categories. Among 400 students playing games 145 students' BMI was ≥ 25 (0.00007) (Chi-square - 19.0763) , 47 students' heart rate was abnormal among them 33 showed Bradycardia 14 showed Tachycardic and there was statistical signicance among the categories. 193 students' BP was low, 79 students' BP was high (&lt;0.00001) (Chi-square - 48.0334), and there was a statistical signicance among the categories Among the 400 student's Heart R (0.0314) (Chi-square –10.6033). ate Variability results, &lt;50 milliseconds (unhealthy value) of SDNN was found in 44 students and there was a statistical signicance among the categories below and above the normal range of 53.5-82 milliseconds (0.00001)(Chi-square – 206.655), (unhealthy value) of RMSSD for males was found in 59 students and below and above the normal range of 22-79 milliseconds (unhealthy value) of RMSSD for females was found in 53 students there was a statistical signicance among the categories (0.0422)(Chi-square – 13.053), &lt;50 milliseconds (unhealthy value) of PNN-50 was found in 58 students and there was a statistical signicance among the categories . Out of 400 Students &gt;0.4 milliseconds (&lt;0.00001)(Chi-square – 129.0331) (unhealthy value) of Total Power was found in 115 students and there was a statistical signicance among the categories (0.0471) (Chi-square – 6.1101), &gt;0.4 milliseconds (unhealthy value) of Ratio of High and Low-Frequency Powers of heart rate variability was found in 137 students and there was a statistical signicance among the categories (0.0176) (Chi-square – 8.0746). Among the 400 students' Visual Evoke Potential results, &gt;100 milliseconds (unhealthy value) of were found in 118 students &gt;100 milliseconds (unhealthy value) of N145 were found in 124 students, and there was a statistical signicance among the categories , &gt;100 milliseconds (unhealthy value) of P100 were found in 108 (0.00005) (Chi-square- 19.7573) students, and there was a statistical signicance among the categories . Below and above (&lt;0.00001) (Chi-square – 23.6437) the normal range of 3.9-8.3microVolt (unhealthy value) of N75-P100 amplitude for the right eye was found in 48 males, below and above the normal range of 5.9-12.3 microVolt (unhealthy value) of N75-P100 amplitude for the right eye was found in 49 female students there was a statistical signicance among the categories . Below and (&lt;0.00001) (Chi-square – 121.8749) above the normal range of 3.6-8.0microVolt (unhealthy value) of N75-P100 amplitude for the left eye was found in 34 males, below and above the normal range of 5.1-11.5microVolt (unhealthy value) of N75-P100 amplitude for the left eye was found in 44 female students there was a statistical signicance among the categories . Among the 400 (&lt;0.00001) (Chi-square – 93.632) student's Mini-Mental Status Examinations (MMSE) for cognition results, the delayed response was given for all 5 sections of MMSE by the students who played the games for &gt; 6 hours. The results clearly explain that students Conclusions playing games increases body weight, brings abnormality in heart rate, blood pressure, abnormal heart rate variability markers showing decreased Autonomic Nervous System functions, abnormal visual evoke potential markers showing visual impairment, and delayed responses in MMSE showing lesser cognitive capacities leading to poor quality of life, hence this study will enlighten the knowledge of medical students (study population), and other medical students, psychiatrist, counselors counseling kids, and youths who attempted suicide due to failure in video games, and other health care workers.

Prolonged asystole induced by trigeminocardiac reflex accompanied with abnormal heart rate variability during percutaneous balloon compression: a case report.

Trigeminocardiac reflex (TCR) can result in bradycardia and even cardiac arrest, and is reversible with elimination of the stimulus. Here, we report the case of a 68-year-old man who experienced cardiac arrest during percutaneous balloon compression for the treatment of trigeminal neuralgia. In this patient, sinus rhythm did not recover after stimulation removal, causing us to successfully perform cardiopulmonary resuscitation (CPR). The patient regained a sinus rhythm and was pretreated with atropine 0.5 mg, allowing the operation to be started again. The operation was completed successfully and the patient experienced no complications. Subsequent heart rate variability (HRV) analysis showed that parasympathetic activity predominated before anesthesia induction and after tracheal intubation. It further elevated during foramen ovale puncture, leading to prolonged asystole. Fortunately, sympathetic activity predominated after atropine was administered, which manifested as an increase in sympathetic activity and a decrease in parasympathetic activity. This could be beneficial for patients with TCR. This case indicates that TCR-related cardiac arrest might not be reversed with stimulus cessation, and atropine played a key role in preventing TCR. Moreover, HRV analysis might be essential for preoperative screening for high-risk patients. We also reviewed the literature for cases of TCR with prolonged asystole.

Information-Based Similarity of Ordinal Pattern Sequences as a Novel Descriptor in Obstructive Sleep Apnea Screening Based on Wearable Photoplethysmography Bracelets.

Obstructive sleep apnea (OSA) is a common respiratory disorder associated with autonomic nervous system (ANS) dysfunction, resulting in abnormal heart rate variability (HRV). Capable of acquiring heart rate (HR) information with more convenience, wearable photoplethysmography (PPG) bracelets are proven to be a potential surrogate for electrocardiogram (ECG)-based devices. Meanwhile, bracelet-type PPG has been heavily marketed and widely accepted. This study aims to investigate the algorithm that can identify OSA with wearable devices. The information-based similarity of ordinal pattern sequences (OP_IBS), which is a modified version of the information-based similarity (IBS), has been proposed as a novel index to detect OSA based on wearable PPG signals. A total of 92 PPG recordings (29 normal subjects, 39 mild-moderate OSA subjects and 24 severe OSA subjects) were included in this study. OP_IBS along with classical indices were calculated. For severe OSA detection, the accuracy of OP_IBS was 85.9%, much higher than that of the low-frequency power to high-frequency power ratio (70.7%). The combination of OP_IBS, IBS, CV and LF/HF can achieve 91.3% accuracy, 91.0% sensitivity and 91.5% specificity. The performance of OP_IBS is significantly improved compared with our previous study based on the same database with the IBS method. In the Physionet database, OP_IBS also performed exceptionally well with an accuracy of 91.7%. This research shows that the OP_IBS method can access the HR dynamics of OSA subjects and help diagnose OSA in clinical environments.

Cerebellar fastigial nucleus electrostimulation attenuates inflammation in a Post-Infarction rat model by activating cholinergic anti-inflammatory pathway

There are negative correlations between indices of heart rate variability (HRV) and markers of inflammation. The inflammation plays an important role in myocardial damages after myocardial infarction (MI). Our previous study found that fastigial nucleus electrostimulation (FNS) improved abnormal HRV in a rat model of MI. Whether it can reduce inflammation and improve cardiac function after MI and the underlying mechanisms remain unknown. 66 Sprague Dawley rats were randomly divided into 4 groups as follows: i) Sham group (sham operation); ii) MI group (left anterior descending coronary artery ligation); iii) FNS + MI group (left fastigial nucleus electrostimulation plus MI); iv) FNL + FNS + MI group (left fastigial nucleus lesion plus FNS plus MI). The serum expressions of acetylcholine (ACh), pro-inflammatory cytokines tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6), and anti-inflammatory cytokines IL-10 were measured by ELISA. Subsequently, the infarct size, the infiltration of inflammatory cells, the fibrotic area, and cardiac function were also evaluated. Additionally, the expressions of the cholinergic anti-inflammatory pathway (CAP)-related proteins in infarct tissue, such as nuclear factor kappa B (NF-κB) and singal transducers and activators of transcription 3 (STAT3), were determined by Western blot. We found that FNS significantly increased ACh and IL-10 levels in serum, and decreased TNF-α and IL-6 levels. FNS significantly attenuated inflammatory cell infiltration, reduced infarct size, decreased fibrosis, increased left ventricular ejection fraction, and reduced mortality. Besides, the ratios of phosphorylated-STAT3/STAT3 and phosphorylated-NF-κB/NF-κB in infarct tissue significantly elevated after MI. FNS reduced the ratios of p-STAT3/STAT3 and p-NF-κB/NF-κB in infarct tissue. The protective effects of FNS were partially reversed by the fastigial nucleus lesion. Our data suggested that FNS can alleviate the inflammation after MI, and its cardiac neuroprotective mechanism may be achieved by increasing vagal tone, releasing ACh, and further activating the CAP via α7 nicotinic acetylcholine receptor. The precise mechanism remains to be elucidated.

Higher frequency of cardiovascular autonomic neuropathy in youth with type 2 compared to type 1 diabetes: Role of cardiometabolic risk factors.

Cardiovascular autonomic neuropathy (CAN) is an overlooked but common and serious diabetes complication. We examined CAN in youth with diabetes and associations with cardiovascular risk factors. This was a prospective cohort of youth aged <20 years with type 2 or type 1 diabetes (n=66/1153, median age 15.4/16.5 years, duration 1.7/8.0 years), assessed between 2009 and 2020. CAN was defined as ≥2 abnormal heart rate variability measures across time, geometric, and frequency domains. Obesity was defined as BMI ≥ 95th percentile and severe obesity as ≥120% of 95th percentile. Multivariable generalized estimating equations (GEE) were used to examine putative risk factors for CAN, including diabetes type, obesity, and HbA1c . At most recent assessment, youth with type 2 versus type 1 diabetes had median: HbA1 c 7.1% (54 mmol/mol) versus 8.7% (72 mmol/mol) and BMI SDS (2.0 vs. 0.7); frequency of CAN (47% vs. 27%), peripheral nerve abnormality (47% vs. 25%), hypertension (29% vs. 12%), albuminuria (21% vs. 3%), and severe obesity (35% vs. 2%). In multivariable GEE, CAN was associated with type 2 diabetes: Odds Ratio 2.53, 95% CI 1.46, 4.38, p=0.001, higher BMI SDS: 1.49, 95% CI 1.29, 1.73, p < 0.0001, and obesity: 2.09, 95% CI 1.57, 2.78, p < 0.0001. Youth with type 2 diabetes have a higher frequency of CAN, peripheral nerve abnormality, hypertension, albuminuria and severe obesity despite shorter diabetes duration and younger age. Our findings highlight the importance of targeting modifiable risk factors to prevent cardiovascular disease in youth with diabetes.

Pilot Study of Real-World Monitoring of the Heart Rate Variability in Amyotrophic Lateral Sclerosis.

AimsCardiovascular dysautonomia may impact the quality of life and survival in amyotrophic lateral sclerosis (ALS). Such dysfunction is not systematically assessed in these patients. Wearable devices could help. The feasibility of a wearable biosensor to detect heart rate variability (HRV), a physiological marker of sympathovagal balance, was studied for the first time in real-world settings in ALS.MethodsFive ALS patients (two early/three late; one bulbar-onset; mildly-to-moderately disabled) and five age/sex/BMI/comorbidities-matched controls underwent assessment of 3-day HRV via VitalConnect biosensor (worn on the left thorax). De-identified data captured by the biosensor were transferred to a secure cloud server via a relay Bluetooth device. Baseline ALS severity/anxiety and physical activity during testing were documented/quantified. Time-domain HRV measures (i.e., pNN50) were analyzed.ResultsAn overall 3-day abnormal HRV (pNN50 < 3%), was found in three out of five patients (mean ± SD for the group, 2.49 ± 1.51). Similar changes were reported in controls (12.32 ± 21.14%). There were no statistically significant relationships between pNN50 values and baseline anxiety or physical activity during the tested days (p > 0.05 for both groups). A negative correlation was found between pNN50 values and age in patients (p = 0.01) and controls (p = 0.09), which is similar with what is found in the general population. In line with prior studies, pNN50 values were independent of disease stage (p = 0.6) and disability (p = 0.4).ConclusionsThese preliminary results suggest that remote HRV measures using the VitalConnect is feasible and may constitute an improved strategy to provide insights into sympathovagal balance in ALS. Further work with larger sample sizes is warranted.